Community-Based Breast and Colorectal Cancer Prevention

Breast Cancer Prevention

    
 Patient Navigation Program at the Primary Care Level:  The Primary Care Coalition of Montgomery County (PCC), in partnership with the Uniformed Services University of the Health Sciences and the Montgomery County Department of Health and Human Services, has launched an intense three-year program to increase access to breast health care services for low-income, uninsured county women.  Funded by the first-ever Susan G. Komen Foundation Community- Academic Partnership grant award, the program targets low-income, uninsured women over 40 years of age who are enrolled in the CHL safety-net clinics and need access to breast-cancer screening services. 

The project goal is to increase the breast cancer screening and referral rates at participating CHL clinics.  To achieve this goal, the project activities include: 1) Montgomery Cares Breast and Cervical Cancer Needs Assessment, 2) clinic- based culturally competent patient navigation program, 3) online CME clinic provider training: A Review of Breast Cancer Screening: The Role of Culture, 4) Montgomery County Breast and Cervical Cancer Workgroup bi-monthly meetings, and 5) enhancements to the electronic medical record, CHLCare, which is utilized at the clinic sites to ensure the quality, efficiency, and safety of the medical care provided to clinic patients.

• Patient Navigation Guidelines
• Poster Presentation

Patient Naviator Sumaira Zaffer is on site at the Muslim Clinic.

Process Improvement to Increase Breast Cancer Screening Capacity:  The PCC goal is to address the unmet need for breast cancer screening for 100% of the low income and uninsured residents for Montgomery County.  The PCC has taken a lead role in the County as an integrator and convenes monthly process improvement meetings with community partners to leverage resources to ultimately increase capacity for breast cancer screening.

Through the Susan G. Komen Community Based grant, the PCC collaborates with Tom Nolan, PhD, from Associates in Process Improvement and a Senior Fellow at the Institute for Healthcare Improvement (IHI), to apply methods used to build capacity, increase efficiency, and to build a sustainable Quality Improvement (QI) team with the Montgomery County Breast and Cervical Early Detection Program (WCCP) and its partners.

The goal of the program is to improve the capacity, efficiency and access to quality, patient-centered breast health services to 100% of eligible low-income, uninsured women living in Montgomery County. Quality improvement innovations from research conducted on Clinical Microsystems was built upon and applied to the WCCP in three phases to relieve the bottleneck to accessing comprehensive breast cancer screening and treatment services for poor, uninsured Montgomery County women.

• PHASE I: Setting Priorities and Kick-Off – Develop a Quality Improvement (QI) team and set project priorities. 

• PHASE II: Measure Impact of PDSA – The QI team analyzed data before and after the initial Plan, Do, Study, Act (PDSA) cycle and measured the changes that have resulted in improving the WCCP system.  

• PHASE III: Scaling Up and Sustainability – The final phase of the project focuses on developing QI initiatives with other breast cancer prevention providers to impact and sustain long-term QI and growth to meet the breast cancer screening unmet need for low income and uninsured women in Montgomery County. 

Reduce Patient Barriers to Breast Cancer Screening through “Rapid Referral”: The PCC, through process improvement activities, is testing a direct-referral pilot designed to address barriers to access and improve efficiency from referral to completion of mammography screening.  Through the Susan G. Komen and Prevent Cancer Foundation Grants, the PCC and Adventist Healthcare have contracted to pilot a “rapid referral” for mammogram screening.  Patients seen at their CHL clinic schedule their mammogram appointment onsite at the end of their primary care visit.  This has reduced patient cultural and linguistic barriers, increased mammogram completion rate, and reduced the no-show rate for mammography.

 Colorectal Cancer Prevention

Patient Navigation Program: Through the Prevent Cancer Foundation, the PCC builds upon the existing breast health patient navigation program by broadening the scope of cancer screening patient navigation to include colorectal cancer screening. The PCC, in collaboration with the Montgomery County Cancer Crusade, conducts monthly education and schedules appointments for colorectal screening onsite at the participating CHL safety-net clinic.

Montgomery Cares Safety-Net Clinic Needs Assessment

Executive Summary: The purpose of this study was to conduct a comprehensive needs assessment of the breast and cervical cancer screening practices of the safety net clinics providing primary medical care services for residents of Montgomery County residents. The needs assessment (NA) was conducted at eight safety net community clinics that provide health care services to low-income, uninsured, and ethnically diverse residents in Montgomery County, Maryland during the summer of 2007. The eight safety net community health clinics provide primarily comprehensive primary care.  Staff encourages and provides preventive care services, including referrals for cancer screening tests. The central focus of the needs assessment was to examine the breast and cervical cancer referrals and screenings procedures for their eligible patient population and determine the resources and/or gaps for comprehensive breast care services.  The needs assessment (NA) study was conducted at eight safety net community clinics (Montgomery Cares) serving primarily low income, uninsured, ethnically diverse residents in Montgomery County, Maryland.  13,300 residents received their medical care services at these clinics between July 2006 and June 30, 2007 (Montgomery Cares provider services).  Sixty-four percent of these patients were female, and thirty four percent were male.  All of the patients were adults, 31% were between 19-39 years of age, and 59% were between 40 – 64 years of age. Ethnically, half of the patients served were Hispanic/Latino and half were non-Hispanic.  By racial identification 13% were Asian, 21% African American or of African descent, 23% white, 35% were classified as “other” and 8% were listed with race/ethnicity unknown.

The needs assessment document can be accessed through the pdf file below. files/file/Breast and Cervical Cancer Need Assessment.pdf

 Primary Care Coalition (PCC) Breast Health Patient Navigation Guidelines: The Patient Navigation program assists Community HealthLink Clinics in identifying patients in need of clinical breast exam, screening and diagnostic mammography, guide the patients through the health care system and coordinate services.  The patient navigation program guidelines can be accessed through the pdf file below.

 files/file/Breast Cancer Screening Patient Navigation Guidelines.pdf

 Mammogram Referral and Screening Rates in Montgomery County: Through a Susan G. Komen Community-Academic Partnership Grant, the Primary Care Coalition of Montgomery County, in collaboration with the Montgomery County DHHS and Uniformed Services University of Health Services, is striving to ensure that low-income and uninsured women in Montgomery County receive high quality breast health care at the primary care level.  This goal will be met through conducting a clinic wide needs assessment, patient navigation and provider training to increase breast cancer referral and breast cancer screening rates at the participating Montgomery Cares safety-net clinics.  The purpose of the chart abstraction is to provide baseline breast health data for the program.

The poster presentation of the Mammogram Referral and Screening Rates baseline data can be accessed through the pdf file below. 

files/file/Mammogram Referral and Screening Rates in Montgomery County Safety- Net Clinics 2.pdf

 "Microsystems in Health Care: Part 1. Learning from High-Performing Front-Line Clinical Units," from the Journal of the Joint Commission on Accreditation of Healthcare Organizations, can be accessed through the pdf file below.                              

 files/file/Microsystems in Health Care.pdf

 Montgomery County Breast and Cervical Cancer Workgroup                            

Purpose of Workgroup
•    To begin a dialogue on ways to enhance breast health, breast cancer education, screening and follow-up services for minority populations, underserved communities and breast cancer survivors.

•    To address gaps and identify solutions to improve access and utilization of breast health services for minority, medically underserved groups within community and primary care clinic settings

•    To ensure ongoing collaboration and coordination (and not duplicative) of breast health and cancer care services within grant-funded outreach and screening programs and other resources. 

•    To support all community-driven strategies and interventions to eliminate breast health and cervical cancer disparities.

•    To develop a sustainability plan for viability of breast/cervical programs through leveraging of resources, grant opportunities and capacity-building with health care providers and screening/diagnostic facilities.

Mission and Vision Statement (developed by workgroup)

Mission Statement: The workgroup will build systems for effective dialogue, data collection and monitoring among all partners to enhance breast and cervical health and eliminate health disparities in breast cancer through community outreach, education, screening and access to care.

 Vision Statement: There will be a sustainable culturally sensitive coordinated, collaborative infrastructure that will provide comprehensive breast services including: access outreach, education, diagnosis, screening and treatment for breast and cervical services for the uninsured and the medically underserved population.

Montgomery County Council Member Nancy Floreen presented a Breast Cancer Awareness Proclamation to the Montgomery County Breast Cancer Workgroup on October 9th, 2007. Raquel Samson, the Primary Care Coalition Project Manger for the Komen Community-Academic Partnership, accepted the Proclamation on behalf of the Montgomery County Breast Cancer Workgroup.

For further information please contact: raquel_samson@primarycarecoalition.org