ncccp reducing disparities at the community level
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NCCCPReducing Disparities at the
Community Level
Kenneth Chu, Ph.D. Center to Reduce Cancer Health DisparitiesDate: 6/25/2007
Source of disparities
• Cancer Health Disparities occur at the community level when beneficial cancer interventions are not accessible and not utilized by all
NCCCP and DisparitiesUnique Characteristics
NCCCP can address the ACCESSIBILITY issue:
• “Those screened for cancer will receive treatment,” regardless of financial status
• The NCCCP hospitals allocate 40% of the NCI funding to disparities
• NCCCP hospitals provide health care for the uninsured and the underinsured
Beneficial Cancer Interventions
• Beneficial cancer interventions include proven primary prevention, early detection procedures as well as proven cancer treatments that can reduce cancer mortality rates
Key NCCCP Disparities Program Areas
• Outreach – Getting people to primary and secondary cancer prevention– Cancer awareness – Culturally appropriate– Primary prevention - Smoking cessation– Secondary prevention – Early detection
• Patient Navigation – Helping patients navigate the health care system from discovery of abnormal finding through treatment
• Why both? Early Detection procedures may need both programs to
reduce disparities
OUTREACH PATIENT NAVIGATION REHABILITATION
Spectrum of Activities in Reducing Disparities in the Community
Abnormal findings on
screening tests
Diagnosis Treatment Survivorship
Smoking cessation
Early detection tests:
Mammography and clinical breast exam
Pap Smear
Colorectal cancer screening
Prostate Specific Antigen (PSA) test
Cancer Prevention / Early Detection
Medical resolution of abnormal findings from early detection tests through to
diagnosis and treatment, if necessary
Factors affecting Disparities at the Community Level
• Culture– Language, beliefs, perceptions, traditions
• Socio-Economic Status (SES)– Health insurance status, literacy
• Social Determinants (Community Conditions)– Living environment, transportation
• Social Injustice– Discrimination
Outreach - Phase I Infrastructure Development
ACTIVITIES• Establish Baseline data by
population groups • Community needs
assessment• Identify community leaders and
organizations• Identify culturally appropriate
materials & delivery systems
• Identify hospital resources
• Survey recommendations of primary care providers and/or Clinics
METRICS• Identify cancer information and
delivery systems• Screening rates, smoking status• Number and types of partnerships
• Existing of materials (create as needed), delivery systems established
• Programs, staff, screening capacity, smoking cessation
• Screening referrals, treatment referrals
Outreach - Phase 2 Implementation
ACTIVITIES• Form community partnerships
to reach disparate populations with educational activities
• Increase culturally appropriate cancer educational activities
• Increase screening recommended by primary care providers/Clinics
• Increase primary and secondary prevention use
METRICS• Number and types of
partnerships formed and educational activities
• Number of screenings resulting from educational activity
• CME Credits earned• Number of patients referred
• Number of participants in primary & secondary prevention activities
Outreach - Phase 3 Evaluation
ACTIVITIES• Understand effects of
educational activities• Link receipt of educational
materials to screening behaviors
• Assess the role of the community-based organizations
• Examine the impact of primary care provider/Clinic education
METRICS• Patients’ & Provider feedback
on educational activities• Number of screenings resulting
from educational activity
• Number of patients referred from community-based organizations activities
• Compare referrals form PCP receiving CMEs to others
Research Questions
• Can increasing community partnerships and their education increase utilization rates?
• Can increase in primary care provider/ clinic recommendations increase utilization rates?
• Can increase in outreach resources and capacity increase utilization rates?
Resources
• Community Network Program (CNP) – Cancer Education, Research and Training in Diverse Populations
• Goal: Increase access and use to beneficial cancer interventions
• Resources for• Culturally appropriate cancer educational materials• Practices for reducing disparities• Community Partnerships
Resources
• 25 Community Network Program Grantees– 8 African American – GA, NC, SC, AL, MO, MI,
TN, AR – 4 American Indian – MN, WA, OK, AZ– 2 Asian – CA, PA– 4 Hispanic – TX, CO, DC, WA– 3 Pacific Islander – HI, CA, Samoa– 4 Underserved – MD, MA, FL, KY
Resources
• Minority Institution/Cancer Centers Program (MI/CCP)– Increase the number of underrepresented
minority scientists engaged in cancer research– Improve the effectiveness of NCI-designated
Cancer Centers in cancer disparities research– Promote community-based outreach
– Resources for• Community Outreach
Resources
• 6 Minority Institution/Cancer Centers Partnership Program (MI/CCP-U54)– 1- Hispanic - TX-PR– 1 - American Indian - AZ– 3 - African American - GA-AL MD-DC TN– 1 – African Carribean - NY
Patient Navigation
and
NCI Patient Navigation
OUTREACH PATIENT NAVIGATION REHABILITATION
Spectrum of Activities in Reducing Disparities in the Community
Abnormal findings on
screening tests
Diagnosis Treatment Survivorship
Smoking cessation
Early detection tests:
Mammography and clinical breast exam
Pap Smear
Colorectal cancer screening
Prostate Specific Antigen (PSA) test
Cancer Prevention / Early Detection
Medical resolution of abnormal findings from early detection
tests through to diagnosis and treatment, if necessary
NCI Patient Navigation
• Begins at abnormal finding from a screening test
• Resolution of abnormal finding• Diagnosis• Initiation of treatment for cancer• Completion of initial treatment• Stage at Diagnosis
Patient Navigation
• Factors– Primary Care Providers/Clinics – Abnormal finding– Patient
• Barriers– Patient Navigator
• Solutions to barriers– Health Care System (Hospital)
Primary Care Provider
Cancer Care
Use
Cancer Care Barriers
Health Care System Barriers
Reimburse-ments
Lack of facilities
Scheduling Appointme
ntsFragmentation of care
Staffing
Social Injustice
Risk promoting behaviors
Cancer is a
“death sentenc
e”
Poor image of health care
Lack of cancer info Cultural Barriers
Fear & Stigma of Cancer
Cancer is “Punishment”Rely on
folk medicine
Language Issues
Patient Barriers
Comorbidities
Child- &Eldercare
Lack of Insurance
Transportation
Inflexible clinic hours
Low IncomePoor EducationTrust
Lack of family support
Lack of cultural
sensitivity to patient
Radical Profiling
Communication issues
PatientCompliance
Lack of Recommend-ations
InsuranceTrustComorbidit
ies
Research Questions for Patient Navigation
• What are the patient barriers and what are the solutions to those barriers?
• Does navigation affect time to resolution of abnormal finding to diagnosis, to treatment?
• What is the overall impact of patient navigation on reducing health disparities?
Resources
• NCI Patient Navigation Research Program
• Evaluate the efficacy of patient navigation interventions from abnormal finding to reduce or eliminate disparities in clinical outcomes related to lack of timely access to quality care in minority and underserved groups
• Determine the cost-effectiveness of patient navigation interventions
Resources
• Patient Navigation Research Program• 9 PNRP sites
– 3 Hispanic – TX, FL, CO– 1 American Indian – OR– 3 Underserved – OH, NY, MA– 2 African American – IL, DC
Metrics/Quarterly Reports
• Metrics tied to Year 1-3 activities• Quarterly reports should monitor progress
towards achieving year 1-3 activities and should discuss plans for improving performance when achievement is delayed – problems and potential solutions should be highlighted
• Performance will be measured by assessing how activities are achieved per year and in what timeframe
Research Questions on NCCCPPolicies on Disparities
• How do NCCCP hospitals implement the policy “those screened for cancer will receive treatment”?
• How do NCCCP hospitals allocate 40% of the funding to disparities?
• How do NCCCP hospitals provide health care for the uninsured? the underinsured?
Outreach and Patient NavigationTopics for Orientation
• Outreach – CNP perspective – CRCHD staff – Phases– Examples
• Outreach – CIS perspective• Patient Navigation – CRCHD staff
– General introduction• Barriers• Solutions
– Patient Navigation Research Program
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