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A Rural Emergency Room Intervention for Cancer Prevention

A Rural Emergency Room Intervention for Cancer Prevention. Nancy Schoenberg, PhD Carol White, MPH Mark Dignan, MPH, PhD ACCN Research Update September 28, 2007 Hershey, PA. Background. Emergency Rooms as intervention location 94.4 million ER visits in 1997

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A Rural Emergency Room Intervention for Cancer Prevention

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  1. A Rural Emergency Room Intervention for Cancer Prevention Nancy Schoenberg, PhD Carol White, MPH Mark Dignan, MPH, PhD ACCN Research Update September 28, 2007 Hershey, PA

  2. Background Emergency Rooms as intervention location • 94.4 million ER visits in 1997 • ERs provide extensive services to those without a usual sources of medical care. • Many of those attending ERs have high rates of chronic disease • The ED may provide an important opportunity to initiate prevention, screening, and counseling services for millions of Americans who have no other source for these services

  3. Examples of ER projects • Most have focused on prevention of suicide, domestic violence, substance abuse, falls. • Harlem Hospital: breast & cervical cancer screenings: Mandleblatt & colleagues (1997) find ER screening is cost effective for cervical cancer, but expensive for breast cancer • Urban MN: Margolis & colleagues (1998) employ LHAs to assist with breast & cervical cancer screening; find modest, but significant improvement in screenings, particularly among Native American women.

  4. ER Pilot Project • In 2006, Kentucky Team Up, Marcum & Wallace Memorial Hospital, and Kentucky Homeplace staff developed and implemented an intervention to increase cancer screening among men and women presenting at Marcum & Wallace ER • Marcum & Wallace Memorial Hospital . . . . • Located in Irvine, Kentucky (Estill County) • Serves three of the counties in Team Up • On average, has ~1000 patient visits per month in the emergency room

  5. Marcum & Wallace Hospital, Irvine KY (Estill County) • 25 licensed beds • Established in 1949 as a result of local leaders seeing a need for a hospital in the area. • Serves 9 counties in E. Kentucky, 46,000 people.

  6. Part of the community

  7. Essential services to the community • 24-hour ER Inpatient ServicesOutpatient ServicesSpecialty ClinicsRadiologyLaboratoryPT & Rehab

  8. Project Objectives • Increase the number of referrals made to the Family Health Care Advisor (FHCA) • Increase the number of those who subsequently obtain cancer screening, smoking cessation assistance, and other services • Increase the number of men and women who find a new medical home for primary care services

  9. Methods Phase 1 • The FHCA assesses the medical needs of those18 years and older, who present at the ER for non life-threatening situations. If medical needs are identified, the FHCA will explain to the patient that he or she can help them obtain services. • If patient agrees, the FHCA obtains informed consent from the patient & patient will sign a standardized form authorizing FHCA access to patient’s medical information.

  10. Phase 2 • The FHCA will follow-up with the patient, assisting him/her in obtaining cancer screening, smoking cessation assistance, or other services requested by serving as a liaison between the patient and varied medical and social resources

  11. Follow-Up Data Collection • The FHCA will collect follow-up information at 3, 6, and 12 months • Information includes: • The service(s) the patient requested • The type of assistance provided (i.e., screening appointment made, referral to a smoking cessation class, etc.) • The outcome of the service(s) provided

  12. As of December 2006 . . . • 35 out of 120 eligible patients (29%) were referred to a FHCA for medical assistance • Among the referrals (note: individuals could request more than one service), • 10 individuals requested breast cancer screening • 8 requested cervical cancer screening • 11 requested smoking assistance • 16 requested medication assistance • 5 requested dental assistance • 1 requested another service • Other accomplishments: IRB approval, full time FHCA hired, process in place.

  13. Acknowledgements: Project Team Members Marcum & Wallace Memorial Hospital • John Isfort, Director, Kentucky River Health Network • Danny Garret, ER Supervisor Kentucky Homeplace • Fran Feltner, Director • Courtney Barnes, Family Healthcare Advisor UK Prevention Research Center • Frank Bills, Research Assistant Cancer Information Service of the Mid-South • Tami Kelder, Partnership Manager UK ACCN • Nancy Schoenberg, PI • Carol White, Program Manager

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