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NCCCP Reducing Disparities at the Community Level

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  1. NCCCPReducing Disparities at the Community Level Kenneth Chu, Ph.D. Center to Reduce Cancer Health Disparities Date: 6/25/2007

  2. Source of disparities • Cancer Health Disparities occur at the community level when beneficial cancer interventions are not accessible and not utilizedby all

  3. 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

  4. 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

  5. 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

  6. Spectrum of Activities in Reducing Disparities in the Community PATIENT NAVIGATION REHABILITATION OUTREACH Smoking cessation Early detection tests: Mammography and clinical breast exam Pap Smear Colorectal cancer screening Prostate Specific Antigen (PSA) test Medical resolution of abnormal findings from early detection tests through to diagnosis and treatment, if necessary Cancer Prevention/ Early Detection Abnormal findings on screening tests Survivorship Diagnosis Treatment

  7. 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

  8. 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 I Infrastructure Development

  9. 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 2 Implementation

  10. 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 Outreach - Phase 3 Evaluation

  11. 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?

  12. 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

  13. 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

  14. 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

  15. 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

  16. Patient Navigation and NCI Patient Navigation

  17. Spectrum of Activities in Reducing Disparities in the Community PATIENT NAVIGATION REHABILITATION OUTREACH Smoking cessation Early detection tests: Mammography and clinical breast exam Pap Smear Colorectal cancer screening Prostate Specific Antigen (PSA) test Medical resolution of abnormal findings from early detection tests through to diagnosis and treatment, if necessary Cancer Prevention/ Early Detection Abnormal findings on screening tests Survivorship Diagnosis Treatment

  18. 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

  19. Patient Navigation • Factors • Primary Care Providers/Clinics – Abnormal finding • Patient • Barriers • Patient Navigator • Solutions to barriers • Health Care System (Hospital)

  20. Cancer Care Barriers Cultural Barriers Cancer is “Punishment” Poor Education Low Income Rely on folk medicine Language Issues Inflexible clinic hours Fear & Stigma of Cancer Trust Lack of cancer info Lack of family support Patient Barriers Transportation Poor image of health care Lack of Insurance Comorbidities Child- & Eldercare Cancer is a “death sentence” Risk promoting behaviors Cancer Care Use Scheduling Appointments Fragmentation of care Insurance Comorbidities Trust Lack of Recommend-ations Health Care System Barriers Staffing Primary Care Provider Social Injustice Patient Compliance Lack of cultural sensitivity to patient Lack of facilities Reimburse-ments Communication issues Radical Profiling

  21. 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?

  22. 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

  23. 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

  24. 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

  25. 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?

  26. 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