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    Awarded Grants
    Improving Mammography Follow-up at an Inner-City Community Health Center

    Scientific Abstract:
    Improving Mammography Follow up at an Inner-City Community Health Center Background: Approximately 11% of screening mammograms detect an abnormality requiring diagnostic follow up. Although delays in the diagnosis of breast cancer affect survival, untimely follow up rates reach 60% in low-income ethnic minorities. Such women often receive care at community health centers where specialty care is particularly difficult to coordinate. We will adapt a successful, culturally competent, case management intervention that we developed for an academic specialty breast practice, and apply it at an inner-city community health center. Hypothesis: Culturally competent case management and robust tracking improves follow up after abnormal mammography at an inner-city community health center. Specific Aims: We will pilot a community-based intervention to: #1 Increase the rate of timely follow up after abnormal mammography by 50%. #2 Identify patient and system factors associated with improved follow up. Study Design: The Health Belief, Transtheoretical and Socio-Cultural Context (ESFT) Models were used to understand barriers to care and adapted to models of coordination of care from the general management literature. The proposed intervention has four components: 1) Work Standardization, 2) Patient Engagement, 3) Information Technology-facilitated Tracking, and 4) Patient Navigation. The study population is patients with an abnormality detected on screening mammogram at a single community health center serving African American and Latina women. The main outcome is receipt of appropriate follow up, dichotomized as to whether the problem was resolved within the recommended time frame. A secondary outcome is time to case resolution. Data will be retrospectively extracted from medical records to determine pre-intervention rates of appropriate follow up. The main analysis for Specific Aim #1 will be a pre- post- comparison, to measure improvements in these rates. We will explore Specific Aim #2 using bivariate and multivariate logistic regression analyses. Potential Outcomes and Benefits of the research: Findings from this pilot study will inform the design of a large-scale intervention trial at multiple community health centers affiliated with several academic medical centers. The larger goal is to disseminate a treatment model that will eliminate racial/ethic disparities in follow up to abnormal mammography at community – academic partnerships nationally.

    Lay Abstract:
    Improving Mammography Follow up at an Inner-City Community Health Center Background: More than one in ten women who undergo screening mammography will experience an abnormal result that requires further testing. Prompt evaluation is essential since delays in the diagnosis of breast cancer contribute to higher death rates. Racial/ethnic minority women and those with low incomes are the least likely to receive timely follow up care. Such delays contribute to higher death rates. Inner-city community health centers serve as a common site of health care for these under-served women. Difficulty coordinating specialty care in such settings contributes to delayed follow up. We have used a culturally appropriate case coordination system to dramatically improve follow up at a large, academic medical center. We want to test whether a similar intervention can succeed at a community health center. Hypothesis: We believe that bringing culturally appropriate case coordination support to African American and Latina women served at an inner-city community health center will help ensure that there is more timely follow up after abnormal screening mammograms. Specific Aims: The purpose of this study is to test the ability of a community-based program to: #1 Increase the number of women who receive timely follow up after abnormal mammography. #2 Identify which patient and system factors are associated with improved follow up. Study Design: Our study intervention will standardize work flow, engage patients, use electronic medical records to track follow up, and help patients navigate the complexities of the medical system with culturally appropriate support. All women who have an abnormality detected on screening mammogram at the community health center will be included. Using standardized tracking and reporting systems, these women will receive individualized assistance in navigating the system by a trained community staff member. Women will be followed to determine whether the problem was resolved within the recommended time frame. This information will be compared to follow up rates prior to starting the program. Potential Outcomes and Benefits of the Research: Findings from this pilot study will be used to develop an effective program for low-income, inner-city minority women who experience abnormal breast cancer screening. Treatment models that work in inner-city community health centers are essential for reducing racial/ethnic disparities in breast cancer outcomes.