The ACA and Breast Cancer: Danger for Disparities Still Exists, Despite Law s Intentions

Transcription

1 The ACA and Breast Cancer: Danger for Disparities Still Exists, Despite Law s Intentions Join the conversation on Twitter: #BreakingDownWalls Thursday, September 25, 2014

2 Presenters September 25, 2014 Program Speaker presentations Short moderated discussion Open Q&A with Women s Health Awareness Council Speakers Juliet Yonek, M.P.H. Research Associate, Center for Healthcare Studies Northwestern University Kathy Tossas-Milligan, M.S. Associate Director, Breast Cancer Quality Consortium Metropolitan Chicago Breast Cancer Task Force Shannon Sikkila, M.S., R.N., A.P.N. Women s Health Navigator Swedish Covenant Hospital Moderator Teena L. Francois, M.P.H. Associate Director, Community Health Initiatives & Research Metropolitan Chicago Breast Cancer Task Force

3 Juliet Yonek Tackling breast cancer disparities locally: Highlights from a profile of health and health resources within Chicago s 77 community areas Thursday, September 25, 2014

4 Northwestern University Feinberg School of Medicine Tackling Breast Cancer Disparities Locally Highlights From A Profile of Health and Health Resources within Chicago s 77 Community Areas September 25, 2014 Juliet Yonek, MPH Research Associate The Center for Healthcare Studies Northwestern University Feinberg School of Medicine

5 Today s Presentation Provide an overview of racial disparities in breast cancer incidence and mortality in the U.S. and Chicago. Present data on the availability of healthcare and other resources for addressing breast cancer disparities in Chicago s communities.

6 National Breast Cancer Incidence (female, age-adjusted, rate per 100,000) All Races: White: White Non-Hispanic: Black: Hispanic: 91.3 Asian/Pacific Islander: 93.6 American Indian/Alaskan Native: 79.3 Source: SEER Stat Fact Sheets: Breast. Available at Data Source: Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, , National Cancer Institute. Bethesda, MD, based on November 2013 SEER data submission, posted to the SEER web site, April

7 National Breast Cancer Mortality (female, age-adjusted, rate per 100,000) All Races: 22.2 White: 21.7 White Non-Hispanic: 15.4 Black: 30.6 Hispanic: 14.5 Asian/Pacific Islander: 11.3 American Indian/Alaskan Native: 12.0 Source: SEER Stat Fact Sheets: Breast. Available at Data Source: Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, , National Cancer Institute. Bethesda, MD, based on November 2013 SEER data submission, posted to the SEER web site, April

8 Breast Cancer Incidence Rates by State, 2011 U.S.: Illinois: Source: U.S. Cancer Statistics Working Group. United States Cancer Statistics: Incidence and Mortality Web-based Report. Atlanta (GA): Department of Health and Human Services, Centers for Disease Control and Prevention, and National Cancer Institute; Available at: 8

9 Breast Cancer Mortality Rates by State, 2011 U.S.: 21.5 Illinois: 23.4 Source: U.S. Cancer Statistics Working Group. United States Cancer Statistics: Incidence and Mortality Web-based Report. Atlanta (GA): Department of Health and Human Services, Centers for Disease Control and Prevention, and National Cancer Institute; Available at: 9

10 10 Chicago Breast Cancer Mortality Rates for Non-Hispanic Black and White Women

11 Black:White Breast Cancer Mortality Disparities U.S. and 4 Cities: Source: Hunt BR, Whitman S, Hurlbert M. Increasing Black:White disparities in breast cancer mortality in the 50 largest cities in the United States. Cancer Epidemiology (2014),

12 Hypotheses Explaining the Black:White Disparity in Breast Cancer Mortality Differential access to screening Differential quality in the screening process Differential access to treatment once breast cancer is diagnosed Differential quality treatment There are data to support all 4 hypotheses 2007 Metropolitan Chicago Breast Cancer Task Force Report 12

13 Minorities in Chicago Face Numerous Barriers to Fully Engaging in Efforts to Improve Their Health 13

14 Purpose To describe the health status and availability of resources that promote healthy living within Chicago s 77 communities. Framework: CDC s Winnable Battles Goals The Project Provide communities with data to leverage additional resources, inform local policies and plan program interventions; Generate baseline data for assessing progress toward improving health overall and eliminating health inequities.

15 Winnable Battles for Chicago 1. Breast Cancer Morality Disparities 2. Childhood Obesity 3. HIV/AIDS 4. Teen Pregnancy 5. Motor vehicle injury

16 Data Elements and Sources Health Status Breast Cancer Mortality Rates (CDPH, Sinai Urban Health Institute) Healthcare Resources Mammography Facilities Hospital Breast Cancer Treatment Centers (American College of Surgeons) Community Assets* Parks and Recreation, Schools, Bike Paths, Public Transit routes, Grocery Stores, Supermarkets, Farmers Markets Community Stakeholder Perceptions* Conducted key informant interviews Stakeholder types included Alderman, school administrators, community health center directors, faith-based leaders and leader of other community based organizations *Albany Park, Chicago Lawn, S. Lawndale, Auburn Gresham

17 17 Mammography Rates in 10 Chicago Community Areas

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19 South Lawndale Healthcare Resources 19

20 Auburn Gresham Healthcare Resources 20

21 Community Stakeholder Perceptions: Barriers to Breast Cancer Screening Cultural views about healthcare: Fear of getting bad news (Auburn Gresham and Chicago Lawn) Cultural beliefs discourage breast cancer as a topic of discussion (Albany Park and S. Lawndale) Other barriers: Women do not know where to go (Albany Park) Few programs targeting breast cancer awareness and screening (S. Lawndale) 21 Cost or a lack of health insurance in S. Lawndale women without medical insurance wait for free mammograms offered during one of the community s health fairs

22 Summary Areas with the highest breast cancer mortality rates (e.g., those located in Chicago s south and southwest regions) clearly lack the resources needed to improve breast cancer outcomes. These areas are among Chicago s most racially and economically segregated at least 50% of the population is either Black or Hispanic/Latino. 22

23 Conclusions Eliminating health disparities and achieving health equity in Chicago requires interventions at the community level. Communities need data to guide interventions that address locally relevant disparities and to make decisions about where to invest resources. Where we live matters access and availability of healthcare resources and community assets can promote health by encouraging healthy behaviors and making it easier for residents to adopt and maintain them. 23

24 Acknowledgements Center for Health Equity Team Romana Hasnain-Wynia, PhD Sarah Rittner, MA Deidre Weber, Senior Research Coordinator Sherin George, Research Intern Collaborators Chicago Department of Public Health (CDPH) Bechara Choucair, MD, Commissioner Jose Munoz, Deputy Commissioner, Community Relations Chicago State University GIS Department Daniel Block, PhD Funding: Aetna Foundation and Aetna Inc.

25 For More Information 25

26 Kathy Tossas-Milligan What gets measured, gets improved: Battling breast cancer disparities through mammography quality improvement Thursday, September 25, 2014

27 Shannon Sikkila Addressing Disparity: The need for women s health patient navigation Thursday, September 25, 2014

28 Swedish Covenant Hospital s Breast Health Program Swedish Covenant Hospital has built a breast health program that centers on the idea that all women should have access to excellent, affordable breast health services. Our Community Breast Health Program provides women with breast health education, screenings, patient navigation and the latest in breast cancer diagnostic services. The Community Breast Health Program is funded with generous support from several organizations including: A Silver Lining Foundation, National Breast Cancer Foundation, Inc., Susan G. Komen Swedish Covenant Hospital Women s Board, Swedish Covenant Hospital Associates Board Swedish Covenant Hospital Foundation. Women s Health Patient Navigation

29 What is Navigation? Patient navigation is a process by which an individual a patient navigator guides patients through the health care continuum to ensure that any barriers to the access of care are removed. Barriers to quality care fall into a number of categories: Financial and economic Language and cultural Communication Health care system Transportation Bias based on culture/race/age Fear 1 Freeman HP. A model patient navigation program. Oncol Issues. September/October 2004: Freeman HP. Voices of a Broken System: Real People, Real Problems. President's Cancer Panel: Report of the Chairman Reuben SH, ed. Bethesda, Md: National Institutes of Health, National Cancer Institute; Women s Health Patient Navigation

30 What is Navigation? Patient navigation helps ensure that patients receive culturally competent care that is also: Confidential Respectful Compassionate Mindful of the patient's safety Women s Health Patient Navigation

31 Impact of Breast Health Navigation Percentage of women lost to follow up after an abnormal mammogram % % Average number of days between breast cancer diagnosis and initiation of treatment Women s Health Patient Navigation

32 Breast Cancer Survivorship A program funded by a grant from the Illinois Department of Public Health/Carolyn Adams Ticket for the Cure Community Grant Program and Susan G. Komen - Chicago to help breast cancer patients and survivors identify and achieve their personal health and well being goals. Services provided include: Support groups Stress reduction seminars Nutrition classes and counseling Membership at Galter Life Center for 90 days Choice of one integrative service Patient navigation throughout the program Women s Health Patient Navigation

33 Women s Health Navigation Community outreach and needs assessment Facilitating women s preventative health services across disciplines Organization and implementation of culturally and linguistically sensitive education Removal of barriers to ensure that all women are able to access the necessary health services for themselves, and their families Women s Health Patient Navigation

34 Mayora Rosenberg Women s Health Center Opening early October 2014 at Swedish Covenant Hospital Designed by and for women o o o o o Mother-friendly hours Child care available Woman-only provider option Translation services 3D mammography Robust community outreach, patient education and navigation services Puts culture and values at the center of a woman s care Built with the needs of our community in mind o Part of a TIF sponsored by Ald. Pat O Connor and with strong support by Ald. Ameya Pawar Women s Health Patient Navigation