||5R03CA256233-02 Interpret this number
||Harvard School Of Public Health
||Improving Mammography Completion and Follow-Up in Community Health Centers
Screening and timely follow-up after an abnormal mammogram are evidence-based methods for
reducing breast cancer morbidity and mortality, but rates remains suboptimal. Community health centers
(CHCs) struggle to address these issues given that their capacity and funding is often out-stripped by the
volume of care they provide. To reduce breast cancer disparities, it is essential that we scale-up
strategies that are both effective and efficient to closing screening gaps in these settings.
Patient Navigation is a well-studied health services strategy that has been shown to increase rates of
breast cancer screening and follow-up after an abnormal mammogram. However, there is very little data
about the prevalence, capacity, funding, and sustainability of navigation in CHCs, or how CHCs that do
not have navigators use other staff resources to manage screening and follow-up. To address this, we
will: (1) determine the extent to which navigators and tracking tools are used in 325 CHCs across the US;
and (2) test whether a low-intensity intervention that provides tracking functionalities and brief practice
facilitation will close screening gaps in CHCs with and without navigators.
We will survey 325 CHCs to collect site characteristics and information about use of navigators and other
staffing models used to address breast cancer screening and follow-up (Aim 1). These CHCs use a
common population management platform, the Data Reporting and Visualization System (DRVS) which
was developed by Azara Healthcare, a provider of healthcare analytics specifically for the CHC setting,
and close partner of the research team. Azara is currently developing new DRVS functionalities to allow
CHCs to track care gaps in breast cancer screening (“BC-SCR tools”), for deployment by late 2020.
We will use a pre-/post-test design to study the use of the BC-SCR tools” in two CHCs, one with
navigation and one without (Aim 2). Outcomes include number of open orders for mammography and
time to follow-up after abnormal screening. We hypothesize that the BC-SCR tools, provided with brief
practice facilitation, will improve these outcomes and diminish any care gaps between sites. While sites
with navigation will likely benefit from these tools, sites who use ancillary, rather than dedicated, staff to
address screening may experience further benefit based on efficiencies provided in tracking of patient
clinical needs. The study design provides an initial test to determine if larger scale study is warranted.
We will use qualitative methods to evaluate CHC staff experience with the intervention (Aim 3).
This project will for the first time establish provide data about the presence, structure, and stability of
navigation programs across the US. We will learn how best to optimize staff resources and provide low-
cost, scalable support for closing screening gaps. This proposal is a timely opportunity in that it takes
advantage of a new technology roll-out and observes its impact in two different care contexts.