Screening and timely follow-up after an abnormal mammogram are evidence-based methods for reducing breast cancer morbidity and mortality, but rates remains suboptimal. Community health centers (CHCs) struggle to address these issues given that their capacity and funding is often out-stripped by the volume of care they provide. To reduce breast cancer disparities, it is essential that we scale-up strategies that are both effective and efficient to closing screening gaps in these settings. Patient Navigation is a well-studied health services strategy that has been shown to increase rates of breast cancer screening and follow-up after an abnormal mammogram. However, there is very little data about the prevalence, capacity, funding, and sustainability of navigation in CHCs, or how CHCs that do not have navigators use other staff resources to manage screening and follow-up. To address this, we will: (1) determine the extent to which navigators and tracking tools are used in 325 CHCs across the US; and (2) test whether a low-intensity intervention that provides tracking functionalities and brief practice facilitation will close screening gaps in CHCs with and without navigators. We will survey 325 CHCs to collect site characteristics and information about use of navigators and other staffing models used to address breast cancer screening and follow-up (Aim 1). These CHCs use a common population management platform, the Data Reporting and Visualization System (DRVS) which was developed by Azara Healthcare, a provider of healthcare analytics specifically for the CHC setting, and close partner of the research team. Azara is currently developing new DRVS functionalities to allow CHCs to track care gaps in breast cancer screening (?BC-SCR tools?), for deployment by late 2020. We will use a pre-/post-test design to study the use of the BC-SCR tools? in two CHCs, one with navigation and one without (Aim 2). Outcomes include number of open orders for mammography and time to follow-up after abnormal screening. We hypothesize that the BC-SCR tools, provided with brief practice facilitation, will improve these outcomes and diminish any care gaps between sites. While sites with navigation will likely benefit from these tools, sites who use ancillary, rather than dedicated, staff to address screening may experience further benefit based on efficiencies provided in tracking of patient clinical needs. The study design provides an initial test to determine if larger scale study is warranted. We will use qualitative methods to evaluate CHC staff experience with the intervention (Aim 3). This project will for the first time establish provide data about the presence, structure, and stability of navigation programs across the US. We will learn how best to optimize staff resources and provide low- cost, scalable support for closing screening gaps. This proposal is a timely opportunity in that it takes advantage of a new technology roll-out and observes its impact in two different care contexts.

Public Health Relevance

Community health centers (CHC), which take care of mostly uninsured and socioeconomically disadvantaged patients, have a critical opportunity to address persistent disparities in breast cancer morbidity and mortality. We propose to take advantage of the development of population management data tracking and visualization tools and test if these tools, coupled with brief practice facilitation, improve breast cancer screening and follow-up rates in CHCs. The results of this study will inform the final development of the tools and their implementation in CHCs across the country.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Small Research Grants (R03)
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Special Emphasis Panel (ZCA1)
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D'Angelo, Heather
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Harvard University
Social Sciences
Schools of Public Health
United States
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