Targeted Outreach To Provide Breast Cancer Screening In Zipcodes With High Rates Of Late Stage Breast Cancer Diagnosis

State: FL Type: Promising Practice Year: 2016

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The 2010 Sylvester Comprehensive Cancer Center Study (Kobetz, Erin and Parker, Dorothy. Miami: Cancer Data for South Florida: A Tool for Identifying Communities in Need,2010) has identified eight zip codes in Broward County with high rates of late stage breast cancer diagnosis (33004, 33023, 33028, 33068, 33309, 33311, 33317, 33332). The risk of late stage could be attributed to health behaviors, access to health care and/or transportation. The Florida Breast and Cervical Cancer Early Detection Program (FBCCEDP) have created a practice intended to decrease the number of late stage breast cancer diagnosis in these eight zip codes.

FBCCEDP created two goals and objectives to meet each Fiscal Year (FY).

Goal 1: Educate the women residing in the eight target zip codes about the importance of Breast Cancer Screening.

Objective:  Provide 10 educational events on the importance of Early Detection of Breast Cancer in the eight target zip codes and surrounding areas during the FY.

Goal 2: Provide mammography screenings to the women residing in the eight target zip codes.

Objective: Conduct six mammography-screening events in the eight targeted zip codes area via mobile mammography units during the FY.

The DOH-Broward FBCCEDP program partnered with various organizations and individuals in the community to implement the program. This included partnering with health fair event planners located in the target zip codes to provide education and screenings to the targeted communities. At the events, an Educator provided one-on-one direct education and group presentations to participants. The importance of early detection, the different types of breast screenings, the newest technology available to the women, and the importance of the screening equipment’s used to detect abnormalities and breast cancer at early stages were a part of the audience education.  DOH-Broward staff arranged for local tax-assisted hospital partners, Memorial Regional Hospital and Boca Raton Regional Hospital, to attend these community events and to provide on-site screenings.

The intent of the practice was to increase the number of women educated and screened by  FBCCEDP living in the eight zip codes and areas directly adjacent to the target zip codes.

All objectives were met. FBCCEDP outreach was able to conduct 14 education events and 14 screening events in the last FY.

Practice was able to succeed due to the partnering with local community agencys’ to assist in providing education and screening to women living in the targeted zip codes.

The public health impact of practice was 1,094 mammograms were performed via these outreach events. Of this number, 32 women were diagnosed with breast cancer.  Of the 32 women diagnosed, 22 women were from the eight target and surrounding zip codes. A total of 27% of the breast cancers were found at an early stage of diagnosis. FBCCEDP was ensuring all women diagnosed received treatment within 60 days of diagnosis.

 

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Broward County Health Department
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Targeted Outreach To Provide Breast Cancer Screening In Zipcodes With High Rates Of Late Stage Breast Cancer Diagnosis
Broward County is located in the southeastern portion of the State of Florida with Miami-Dade County to the south and Palm Beach County to the north.  Broward County’s 2014 population estimate of 1,869,235, represents 9% of the State’s population, and is the second most populous county of the 67 counties in the State of Florida and eighteenth most populous county in the United States (US Census).  Its diverse population includes residents representing more than 200 different countries and speaking more than 130 different languages.  31.5% of the residents are foreign-born.   Broward County is a minority/majority county demonstrated by its 2014 population by race (Black 28.8%, Asian 3.6%, Hispanic 27.4%, other races .5%, for a total of 60.3% and White 39.7%). The Florida Department of Health in Broward County (DOH-Broward) is the official Public Health Agency in Broward County and has been operational since 1936. It is part of the Integrated Florida Department of Health (DOH) and operates in cooperation with the Broward County Commission under Florida Statute 154. DOH-Broward’s mission is “to protect, promote and improve the health of all people in Florida through integrated state, county and community efforts”.  DOH-Broward is the lead agency providing core public health functions and essential services in the county as part of a complex public health system that includes hospitals, clinics, planning agencies, community-based organizations and others.  DOH-Broward provides population/community-based services to the county’s 1.8 million residents and over 10 million annual visitors, and is responsible for assessing, maintaining and improving health and safety within the county. Public health issue:  The 2010 Sylvester Comprehensive Cancer Center Study (Kobetz, Erin and Parker, Dorothy. Miami: Cancer Data for South Florida: A Tool for Identifying Communities in Need,2010) has identified eight zip codes in Broward County with high rates of late stage breast cancer diagnosis (33004, 33023, 33028, 33068, 33309, 33311, 33317, 33332). The risk of late stage could be attributed to health behaviors, access to health care and/or transportation. The Florida Breast and Cervical Cancer Early Detection Program (FBCCEDP) have created a practice intended to decrease the number of late stage breast cancer diagnosis in these eight zip codes. Goals and objectives of proposed practice:  FBCCEDP created two goals and objectives to meet each Fiscal Year (FY). Goal 1: Educate the women residing in the eight target zip codes about the importance of Breast Cancer Screening. Objective:  Provide 10 educational events on the importance of Early Detection of Breast Cancer in the eight target zip codes and surrounding areas during the FY. Goal 2: Provide mammography screenings to the women residing in the eight target zip codes. Objective: Conduct six mammography-screening events in the eight targeted zip codes area via mobile mammography units during the FY. How was practice implemented:  The DOH-Broward FBCCEDP program partnered with various organizations and individuals in the community to implement the program. This included partnering with health fair event planners located in the target zip codes to provide education and screenings to the targeted communities. At the events, an Educator provided one-on-one direct education and group presentations to participants. The importance of early detection, the different types of breast screenings, the newest technology available to the women, and the importance of the screening equipment’s used to detect abnormalities and breast cancer at early stages were a part of the audience education.  DOH-Broward staff arranged for local tax-assisted hospital partners, Memorial Regional Hospital and Boca Raton Regional Hospital, to attend these community events and to provide on-site screenings. Results:  The intent of the practice was to increase the number of women educated and screened by  FBCCEDP living in the eight zip codes and areas directly adjacent to the target zip codes. Were all of the objectives met?:  All objectives were met. FBCCEDP outreach was able to conduct 14 education events and 14 screening events in the last FY. What specific factors led to the success of this practice?:  Practice was able to succeed due to the partnering with local community agencys’ to assist in providing education and screening to women living in the targeted zip codes. Public Health impact of practice: The public health impact of practice was 1,094 mammograms were performed via these outreach events. Of this number, 32 women were diagnosed with breast cancer.  Of the 32 women diagnosed, 22 women were from the eight target and surrounding zip codes. A total of 27% of the breast cancers were found at an early stage of diagnosis. FBCCEDP was ensuring all women diagnosed received treatment within 60 days of diagnosis. Website: http://broward.floridahealth.gov/    
· Statement of the problem/public health issue In 2008, Broward County had a higher rate of late stage breast cancer diagnosis than the State of Florida (34.8 vs 33.5) (www.floridacharts.com). According to 2010 data there is an increase in the incidence of breast cancer among black women and a decrease among white women in Broward County. The 2014 data also indicated a disparity in the death rate due to breast cancer between white and blacks in Broward County. The age adjusted death rate indicates that black women are dying at a high rate than white women (23.7 vs 18.8). Relative to survivorship in the United States and according to data extracted by the Susan G. Komen Foundation, after a breast cancer diagnosis, the survival rate in white women has increased by 92% between 2004 and 2010, but only by 80% for black women during the same period of time. The attributed reasons for the differences are: • Biologic and genetic differences in tumors • Prevalence of risk factors • Barriers to health care access • Health behaviors • Later stage of breast cancer at diagnosis The 2010 Sylvester Comprehensive Cancer Center study was able to identify areas with higher percentage of late stage diagnosed breast cancer. Late stage diagnosis can cause a decrease in treatment success and increase the risk of cancer morbidity.  One effective way to reduce the cancer death rate is through early detection and access to treatment. FBCCEDP is increasing awareness and the use of available screening technologies available to residents of the eight target zip codes.   · What target population is affected by problem (please include relevant demographics) The target population most affected by this problem is women who reside in the following eight zip codes (33004, 33023, 33028, 33068, 33309, 33311, 33317, 33332). The 2010 Sylvester Comprehensive Cancer Center Study was able to identify which zip codes had the highest number of late stage diagnosis which easily identified which geographic areas to target by this practice. · What has been done in the past to address the problem? Prior to the identification of these zip codes, data was unavailable to target efforts to areas of highest need.  The program sent a request to Health Foundation of South Florida to assist with indicating which areas of Broward County had high risk of late stage diagnosis. With this request HFSF funded the 2010 Sylvester Comprehensive Cancer Center study at University of Miami. · Why is current/proposed practice better? Current practice is better than past practices due to having specific information which allows FBCCEDP outreach activities to target women who are not likely to receive screenings at the recommended intervals due to socio economic barriers they may face. FBCCEDP addresses the problem by providing information on the importance of screenings for early detection as well as provide access to screenings in their community. · Is current practice innovative?  How so/explain? Current practice is innovative due to its ability to target specific geographic areas with high rates of late stage diagnosis so that there can be a reduction in mortality rates with the use of 2010 Sylvester Comprehensive Cancer Center Study.   · Is current practice evidence-based? Yes, American Cancer Society guidelines for the early detection and screening of at-risk women for breast cancer
· Goal(s) and objectives of practice FBCCEDP created two goals and objectives to meet each Fiscal Year (FY). Goal 1: Educate the women residing in the eight target zip codes about the importance of Breast Cancer Screening. Objective:  Provide 10 educational events on the importance of Early Detection of Breast Cancer in the eight target zip codes and surrounding areas during the FY. Goal 2: Provide mammography screenings to the women residing in the eight target zip codes. Objective: Conduct six mammography-screening events in the eight targeted zip codes area via mobile mammography units during the FY. · What did you do to achieve the goals and objectives? FBCCEDP created partnerships with two tax-assisted hospital districts in Broward County; Memorial Health Care Systems and Broward Health to provide breast cancer screening and follow-up care. Additionally, contracts exist with other community partners such as Holy Cross Hospital and Boca Raton Regional Hospital. Mobile Mammography units can be utilized though Memorial Regional Hospital and Boca Raton Regional to provide mammogram screening services to women residing in Broward County. Through these two partnerships, a means exist to provide mammogram screening events to any community with concentration in the target zip codes.  · What was the timeframe for the practice? Due to the success of this practice, it is ongoing.  FBCCEDP will continue to provide education and screenings to women who reside in Broward County meeting the goals set each FY. Until new data is released with updated target zip codes, the program will continue to provide education, information, and screenings to all women residing in Broward County, with concentration in the high rate of late stage diagnosed zip codes.  · Were other stakeholders involved? What was their role in the planning and implementation process? The Health Foundation of South Florida (HFSF) was a major stakeholder in the practice. HFSH funded the 2010 Sylvester Comprehensive Cancer Study which significantly assisted the DOH-Broward FBCCEDP to target services to women in greatest need and to ensure that the number of late stage diagnosis decreases in FBCCEDP. 
This project has been funded for 18 years, and utilizes evaluation methods outlined by the National Breast and Cervical Cancer Early Detection Program through the United States Centers for Disease Control and Prevention (CDC) and American Cancer Society. The program evaluation methods involve setting indicators for quality care coordination of services to women who receive an abnormal screening result, or a resulting cancer diagnosis. These indicators are measured based on the number of days it takes to arrive at a cancer diagnosis as well as the number of days diagnosed women entered into treatment. This project evaluates the effectiveness of care coordination from those set by CDC standards. To determine the effectiveness of Outreach and Education, this program measures the number of women from the target population screened as a result of its Outreach and Education.  · What did you find out?  To what extent were your objectives achieved?  Please re-state your objectives from the methodology section. The practice was a success due to FBCCEDP outreach efforts and the ability to link women with positive findings to care. Through outreach efforts, the program diagnosed 22 of the 32 women from the eight target zip codes, 27% of those diagnosed in the eight target zip codes were found to be at an early stage of breast cancer diagnosis. Each objective was achieved by the efforts of the FBCCEDP outreach. Objective:  Provide 10 educational events on the importance of Early Detection of Breast Cancer in the eight target zip codes and surrounding areas during the FY. Objective: Conduct six mammography-screening events in the eight targeted zip codes area via mobile mammography units during the FY. · Did you evaluate your practice? o   List performance measures used. Include process and outcome measures as appropriate. The performance measured used were:  number of women that attended outreach events; number of women educated; number of women screened; number of positive results; number of women linked to care;  which was tracked by outreach location. o   Describe how results were analyzed FBCCEDP utilized an “Outreach Events” tracking spreadsheet. The program was able to document all attended events, the zip code of the event, number of persons educated and number of persons screened. This allowed the program to determine the number of educational events, the people it reached and number of screenings provided to the target zip codes. o   Were any modifications made to the practice as a result of the data findings? Due to achievement of target goals no modifications were made.
The Florida Department of Health currently funds the FBCCEDP through a grant from the United States Centers for Disease Control and Prevention (CDC) National Breast and Cervical Cancer Early Detection Program. The program has been successful in obtaining funding from other entities, including the Health Foundation of South Florida (awarded $120,000.00 to fund diagnostic procedures), and the Breast Cancer Foundation ($10,000 to assist in funding a Health Educator) and will continue to seek funding. This position is currently being sustained at 66% by Susan G. Komen for the Cure funds.  After speaking with many women in the target communities, it was determined the lack of knowledge, transportation, and lack of health insurance/ funds to pay for screenings was a major barrier. The program was also able to determine the importance of the grantors position to provide funds for diagnostic services to the women in need.  By bringing services to the community, client needs were met in an efficient manner.  As long as grant funding continues, the program is sustainable.  There is minimal administrative costs associated with this practice.  There are sufficient stakeholders who are committed to sustain the practice. The Florida Department of Health in Broward County is committed to sustain the practice which in turn will help the program with providing continued services within the community.
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