Health Disparities and Policy Special Report

Transcription

1 MICHIGAN CANCER CONSORTIUM Health Disparities and Policy Special Report Results from the 2012 MCC Implementation Progress Report Produced by: Michigan Public Health Institute Cancer Control and Prevention Services December 3,

2 Table of Contents Background... 2 Health Disparities... 3 Cancer Prevention: Smoking Cessation... 4 Cancer Prevention: Healthy Lifestyle Early Detection of Cancer Cancer Survivorship Equity in Health Bio-Specimens Policy Cancer Prevention: Smoking Cessation Cancer Prevention: Human Papilloma Virus (HPV) Vaccination Risk Assessment: Cancer Genomics Early Detection of Cancer Cancer Survivorship Equity in Care

3 Background In the past year, reducing health disparities in cancer outcomes and promoting policies to increase access to and utilization of cancer services have been a main focus of the Michigan Cancer Consortium (MCC). In order to evaluate the sum of action member organizations have implemented to accomplish these goals, the MCC membership were invited to report on their activities through the Implementation Progress Report (IPR) survey. The reporting period was from January 1, 2012 to December 31, The IPR survey tool was designed to address the new direction of the MCC strategic plan, which focuses on the continuum of cancer control and prevention. The sources used to create the survey tool were the priorities identified by the MCC health disparities workgroup and the MCC policy committee, as well as the What You Can Do to Fight Cancer in Michigan document in the Comprehensive Cancer Control Plan in Michigan. The online survey was sent to all MCC member representatives in February Of the 109 MCC member organizations, 87 organizations completed the IPR survey resulting in a 80% response rate. This report summarizes the activities implemented by MCC organizations to address the priorities identified by the health disparities workgroup and the policy committee. When priority areas overlap, the implementation activities are presented in both sections. 2

4 Section I. Health Disparities 3

5 Section I: Health Disparities Prevention: Healthy Lifestyle Cancer Prevention: Smoking Cessation A goal of the MCC is to reduce rates of tobacco use among adults and youth. Of organizations that completed the 2012 IPR survey, 85.7% said that their organizations mission was compatible with this goal. Figure 1.1: Implemented Tobacco Cessation Activities Tailored for Minority Populations and/or Populations Disparately Affected by Tobacco Use, 2012 Yes 60.9% n=64 4

6 Section I: Health Disparities Prevention: Tobacco Control Table 1.1: Tobacco Cessation Activities Tailored for Minority Populations and/or Populations Disparately Affected by Tobacco Use, as described by MCC Organizations, 2012 ACCESS Community Health Center Alpena Regional Medical Center - Alpena Cancer Center American Cancer Society, Great Lakes Division, Inc. Barbara Ann Karmanos Cancer Institute/Wayne State University Barry Eaton District Health Botsford Cancer Center Cancer Services Catherine s Health Center Ongoing Tobacco Prevention Education-addressing the harms of tobacco and second hand smoking exposure. -WIC client/mom Education- Educational sessions on the harms of smoking while pregnant and harms of second hand smoke exposure. - Resource table Tobacco cessation classes were provided in Targeted efforts led classes specific to community mental health clients. Provided awareness and educational materials on the risk of tobacco use to agencies serving disparate populations. Promoted the Michigan Tobacco Quit Line. With the Commission on Cancer (CoC) state chair, provided CoC accredited facilities referral forms to the state s quit line. The Institute has developed a policy whereby all patients receive tobacco cessation information (smoke free campus, the benefits of quitting and available resources) on system entry. Electronic medical record and patient assessment documentation further identify tobacco history and use. When appropriate, the benefits of quitting while receiving treatment are discussed by the health care provider and a referral to the Michigan Tobacco Quitline is completed and faxed. The Institute increased calls to the Quitline in Tobacco cessation is highlighted at community education presentations and health fairs that occur throughout the year. Over 30,000 people participated in events in 2012, including minority populations in Detroit area churches and missions. Offered a holistic cessation program that includes auricular acupuncture, hypnosis, Emotional Freedom Techniques, psycho-physiological leaning theory and Sleep Mix Detox Tea. Uninsured are higher users of tobacco. All patients at Barry Community Free Clinic are questioned at each visit about tobacco use by intake nurse and referred to Quitline. Project involving at-risk youth (low-income, disproportionally non-white, disproportionally parenting/pregnant, learning disabilities, etc.) with tobacco cessation and prevention services. Participated in health fairs in multiple community settings where youth, homeless persons, and low-income persons were the focus. A smoking cessation resources guide was developed and distributed widely. Staff were also instrumental in promoting smoke free and tobacco free parks in our counties. Individual education with clients on the harms of smoking and how to get assistance for quitting. Free Quit Smoking Workshops provided by BEDHD, Promotion of Quit Line QUIT-NOW. Community outreach such as press releases, Facebook posts and health fairs Provided free head and neck screening for the uninsured and underinsured. This included smoking cessation literature available at the event. We provide tobacco cessation services for any adult or teen who wants assistance to stop tobacco use. However, we focus on three disparate groups: low income adults, individuals with disabilities (mental health, physical, or prior chemical dependency), and teens in non-traditional school settings. We provide either group or individual nicotine dependency treatment. Last year we provided a cessation class series to two groups: a sheltered workshop-type organization (Arnold Center) and a long term care facility for the disabled (Pinecrest Home) for both employees and workers when they established a smoke-free campus policy. We provided a class series/support group for teens at an alternative high school (Windover) and receive referrals from Probate Court and the Juvenile Care Facility to provide individual tobacco use awareness and cessation assistance for adjudicated teens. Providers and other staff question patients about tobacco use and advise cessation. Provide referral to MI quit line as well as RX support if desired and appropriate. 5

7 Section I: Health Disparities Prevention: Tobacco Control Table 1.1 cont d.: Tobacco Cessation Activities Tailored for Minority Populations and/or Populations Disparately Affected by Tobacco Use as described by MCC Organizations, 2012 Central Michigan District Health District Health #2 District Health #10 District Health #4 Genesee County Health Genesys Hurley Cancer Institute Health of Northwest Michigan Henry Ford Health System Huron County Health Inter-Tribal Council of Michigan, Inc Kent County Health Luce-Mackinac-Alger- Schoolcraft Health Marquette General Cancer Center McLaren Cancer Institute Education for pregnant women who are smoking, one to one basis Promotion with all clients of quit line All of our clients that came in for BCCCP were given information about smoking cessation Tobacco cessation programs are available to all DHD#10 cliental regardless of ability to pay for services. Smoking Cessation for pregnant women enrolled in Maternal Health Program. Offered a free quit smoking class quarterly. Made referrals to the state quit line. Promoted smoke free apartments including public housing. Began a county wide survey of smoke free park policies. Conducted a butt pick up day in a community park. Participated in enforcement of local tobacco control regulation. Participated in FDA tobacco regulation inspection program. Provide monthly Stop Smoking Support Group Distribute Stop Smoking Educational Materials Posting of Stop Smoking Materials. Accessibility to Stop Smoking aids as needed. Promotion of Michigan's Smoke-Free Air law and tobacco cessation to public through small media and website. Assisting schools with tobacco-free campuses and teen smoking reduction by forming focus groups. Promotion of Michigan's Tobacco Quitline for eligible adults, pregnant women and fathers through all our programs. Promoting Quitline telephone number on tear-off posters Promotion of Great American Smoke-out campaign to general public Increasing access to smoke-free environments by working with municipalities to establish smoke-free parks and beaches Formation of county tobacco reduction coalitions Focusing on socio-economic disparities that came out of Community Health Assessment and targeting those areas with substance abuse workgroups which includes tobacco use Promoting education among low income,(all ethnicities), pregnant women in smoking cessation Smoking cessation program. Information in multiple languages. We utilized the Quitline by referring clients to this resource from multiple programs at the health department Community education on the dangers of commercial tobacco use; promotion of the State Quit Line; provider training and education specific to the Native American population Actively referred BCCCP clients as well as general population to tobacco cessation resources, including toll free telephone assistance. Generated mass s to community partners, providers and staff members regarding increase in awareness and education of opportunities. LMAS received a small amount of Tobacco funding during FY12, and conducted site visits at various facilities within our district, and compiled reports. We discuss smoking cessation with each of our clients as indicated. We have not received Tobacco funding for fy13. Participated in the MCC challenge We are actively holding the America Cancer Society Smoking Cessation Classes for adults. Once one session is competed we start another. Have set up tables during the year at the hospital so that people can stop by. Also working with local high school to possibly start a class for teens. 6

8 Section I: Health Disparities Prevention: Tobacco Control Table 1.1 cont d.: Tobacco Cessation Activities Tailored for Minority Populations and/or Populations Disparately Affected by Tobacco Use as described by MCC Organizations, 2012 McLaren Cancer Institute-Clarkston McLaren Home Care Group McLaren-Macomb Mercy Cancer Network Michigan of Community Health Muskegon County Health Providence Cancer Institute Saginaw County of Public Health Spectrum Health Cancer Program Tobacco Free Michigan U of M Comprehensive Cancer Center United Health Care Community Plan Literature about our smoking cessation classes at McLaren Oakland Hospital and at the cancer center, on the scrolling marquee outside of the hospital and quit line literature in the cancer center We are part of a hospital system that provides smoking cessation classes and materials Participated in the Great American Smoke-out with an informational display regarding the risks associated with tobacco use, with an interview by one of our Pulmonary physicians in a local newspaper. Ongoing efforts include being actively engaged with a local high school to develop young adult ""champions"" to help educate adolescents on the dangerous effects of tobacco use and to encourage them not to start smoking. Smoking cessation classes are offered year -long at no charge using the Freedom From Smoking format. the 7 hospitals of the Mercy Cancer Network use direct mail and other advertising to reach populations who need support in tobacco cessation. Special programs, education and tools are provided. Partnered with InterTribal Council (ITC). ITC conducted a survey and focus groups to measure the appeal of the Michigan Tobacco Quitline to Native American Women, specifically those who were pregnant. The survey and focus groups led to new materials designed for this population in order to help them understand what the Quitline does and what kinds of benefits are available. Provided a grant to the Grand Rapids Urban League to encourage the organization to talk to their clients about tobacco use and to encourage them to use the Quitline. Worked with the Asian Center to promote a new national Asian language tobacco Quitline. The national Asian Quitline is funded by the Centers for Disease Control. Worked with Community Mental Health on the issue of tobacco cessation. Started to refer patients to the Michigan Quitline. As a Regional Coordinating Agency, continued to be responsible for Compliance Checks. Additionally, partnered with the Sheriff for Compliance Checks to all tobacco vendors in the County. Partnered with prevention providers on Tobacco awareness in schools and throughout the community Free tobacco cessation classes were offered through the Healthier Communities, which provides education and support to the underserved in the community. These classes were marketed toward clients of the healthier communities programs as well as to others in the community. Additionally, underserved diabetes and heart failure participants in the Core Health Program were provided with cessation home visits by referral from their home visiting nurse or community health worker. Presentations during quarterly membership meetings on issues impacting populations disparately affected by tobacco use. Free smoking cessation sessions were offered to registrant At annual free throat cancer screening for those without insurance. Offered provider education involving smoking cessation with products available for this activity. Provided assistance with smoking cessation for members regarding a hot line during the activity. 7

9 Section I: Health Disparities Prevention: Tobacco Control Table 1.1 cont.: Tobacco Cessation Activities Tailored for Minority Populations and/or Populations Disparately Affected by Tobacco Use as described by MCC Organizations, 2012 University of Detroit Mercy School of Dentistry West Michigan Cancer Center Western Upper Peninsula District Health ZIAD Healthcare for the Underserved, INC Planned awareness Events for patient population and community: June 7, 8, 2012 Michigan Oral Health Conference/Michigan Primary Care Association Exhibit on Providing Tobacco Dependency Treatment for Our Dental Patients June 16, 2012 Oral, Head and Neck Cancer Walk Exhibit/Service as a Resource on Oral Cancer Awareness and Prevention, Tobacco Dependency Treatment September 21, 2012 Ending Your Dental Patient's Dependence on Tobacco Targeted dental professionals, Muskegon County Health November 15, 2012 Great American Smoke out Exhibit/Service as a Resource on Tobacco Dependency Treatment Webinar on April 9, 2013: Tobacco Education for Oral Health Providers Targeted providers of the National Association of Community Health Centers Presentation on May 3, 2013: Tobacco Education for Oral Health Providers Targeted Tobacco Champions of the Mississippi Primary Healthcare Association Made available Healthy Life Style-""Get Your Test"" in English and Spanish, Bill boards--lung screening and smoking cessation (see the that was sent) Quit Smoking Kalamazoo via health department; Michigan Tobacco Quitline CME event with information about lung cancer risk Web site Health fairs Worked closely with the Keweenaw Bay Indian Community to provide cessation promotion, resources and support. Offered Acupuncture for smoking cessation 8

10 Section I: Health Disparities Prevention: Tobacco Control Figure 1.2: Encouraged Health Professionals to Screen Youth about Tobacco Use During Health Care Visits with Referral to Treatment When Appropriate, 2012 Yes 81.6% n=38 Figure 1.3: Participated in Promotion or Distribution of the Michigan Multicultural Networks Education Materials or Partnered with Other Organizations to Reduce Tobacco Use, 2012 Yes 67.2% n=61 9

11 Section I: Health Disparities Prevention: Healthy Lifestyle Cancer Prevention: Healthy Lifestyle A goal of the MCC is to increase the number of Michigan residents who adopt a healthy lifestyle by improving their knowledge, motivation and opportunity to adopt a healthy nutritional regimen and obtain adequate physical activity levels to maintain good health. Of organizations that completed the 2012 IPR survey, 86.6% said that their organizations mission was compatible with this goal. Figure 1.4: Organization Partnered with Michigan Healthier Communities, 2012 Yes 34.4% n=61 Figure 1.5: Organization Partnered with Michigan Healthier Communities by Organization Type, 2012 Community-based health systems (n=17) Organizations representing hard-to-reach or special populations (n=4) Health care insurance plans (n=5) Health education/research & evaluation (n=1) Public health organizations (n=18) Trade/professional/advocacy (n=12) University-based health systems (n=4) 10

12 Section I: Health Disparities Prevention: Healthy Lifestyle Table 1.2: Description of Partnerships with Michigan Healthier Communities as described by MCC Organizations, 2012 American Cancer Society Cancer Action Network American Cancer Society, Great Lakes Division, Inc. Barry Eaton District Health Central Michigan District Health Dickinson Iron District Health District Health #2 District Health #10 Genesee County Health Ingham County Health Inter-Tribal Council of MI, Inc. McLaren Home Care Group Michigan of Community Health Michigan Health & Hospital Association Michigan Primary Care Association Providence Cancer Institute Saginaw County Health Tuscola County Health Western Upper Peninsula District Health Participated in the steering committee. Served on the Steering Committee and the Community Organizations Subcommittee. Served as a contracted entity with the Capital Area Health Alliance to promote and conduct the ACHIEVE program in Eaton County, which includes a short assessment, identification of a policy or environmental change, and reimbursement of the cost to implement it; Worked with Capital Area Health Alliance to promote 4x4 through ACHIEVE in Eaton County. Added a link on website, and utilizing the 4X4 plan in Health Improvement Planning committees as a basis for goal setting in one of served counties (Roscommon). Utilizing flyers and awaiting the final power point from them to do community presentations. Partnering with Federally Qualified Health Center to do this. Website link; news release We referred to the Wellness Plan to apply for grants that promoted healthy lifestyles DHD#10 was one of the six organization funded to work on the 4x4 project in Michigan. Promotion of this plan through existing and new partnerships has been ongoing within the health jurisdiction since 10/1/12. Being a member of the Greater Flint Health Coalition - the local funded agency, the local program advocate presented the program to our primary clinic providers. Partnered with the Capital Area Health Alliance (CAHA) Promoted the 4 x 4 among 12 tribal communities - clinic, worksite and community based activities Provided flu and Pneumonia vaccine to staff Responsible for implementing the 4 x 4 Plan and MI Healthier Tomorrow campaign. We have supported the adoption in our member hospitals MPCA serves on the steering committee. MPCA has shared information on the plan and related activities with FQHCs We provided colorectal cancer screening and physicals for the wellness plan Public Health Week there was a community fair Used the MI Healthy Communities materials and also referred people to the MI Healthier Tomorrow website where they have tools and resources at their fingertips. Disseminated information. 11

13 Section I: Health Disparities Early Detection Early Detection of Cancer A goal of the MCC is to decrease the cancer death rate in Michigan by increasing the proportion of the population receiving appropriate cancer screening and follow-up of abnormal screening results for breast, cervical, and colorectal cancers. Of organizations that completed the 2012 IPR survey, 86.4% said that their organizations mission was compatible with this goal. Figure 1.6: Implemented Educational Activities for Populations Who Never or Rarely Receive Appropriately Timed Breast, Cervical, or Colorectal Cancer Screening, 2012 Yes 82.5% Figure 1.7: Implemented Educational Activities for Populations Who Never or Rarely Receive Appropriately Timed Breast, Cervical, or Colorectal Cancer Screening by Organization Type, 2012 Community-based health systems (n=18) n=63 Organizations representing hard-to-reach or special populations (n=3) Health insurance plans (n=4) Health education/research & evaluation (n=2) Public health organizations (n=19) Trade/professional/advocacy (n=13) University-based health systems (n=4) 12

14 Section I: Health Disparities Early Detection Table 1.3: Educational Activities for Populations Who Never or Rarely Receive Timely Breast, Cervical, or Colorectal Cancer Screening as described by MCC Organizations, 2012 ACCESS Community Health Center Alpena Regional Medical Center - Alpena Cancer Center American Cancer Society, Great Lakes Division, Inc Barbara Ann Karmanos Cancer Institute/Wayne State University Botsford Cancer Center Calhoun County Cancer Control Coalition The Arab American Breast and Colon Cancer Project was designed as a local collaboration between the Arab Community Center for Economic and Social Services (ACCESS) and other clinical cancer screening entities. The goal of this collaboration is to provide in-home community-based, bilingual and culturally sensitive breast cancer education and screening services. Our stated project goal was to provide breast cancer education and screening by conducting 2,000 home visits and recruiting 1,500 women for mammogram screening in the Arab community of Wayne County/Greater Detroit area. At the end of December (final report), our program outcomes reflect our projected goals, for breast and cervical program. In addition to maintaining an active seminar outreach schedule our project team has completed 25,624 educational contacts and 2,297 mammograms through our BCCCP clinic and referred 400 women for follow-ups. Our collaboration with Karmanos Cancer Institute decreased the time between screening and diagnosis and/or diagnosis and treatment. The BCCCP six months report indicated that 98.5% ACCESS cases closed within 60 days. We have had continued success with our in-home model of health education and have adopted a Train the Trainer model for our breast cancer education initiative. Our Tell a Friend and Kin-Keeper programs are utilizing home visits as a venue to educate. During these visits we educate five women, who will then arrange similar educational seminars for another five women. These educational seminars were given in addition to our ongoing individual home visits. The International Conference on Health Issues in Arab communities Award Review Committee was very impressed by our Arab Women s Breast cancer collaborative project and its contribution to cancer control in Michigan and selected us for presenting on their October 16-18, 2012 conference. We were very successful with our colorectal cancer project, educated 500 men and women on colorectal cancer and screened 50. In October of 2012 the 8th Free Women's Cancer Screenings were offered to women in our communities who were uninsured or under insured. Each woman was eligible for a clinical breast exam and pelvic exam with Pap smear and a mammogram as determined to be appropriate by the provider. Colorectal screening kits were also dispensed to the women participating in the clinics. Also, a total of 225 ColoCare kits were distributed among the community in A total of 97 men were screened this year in collaboration with Thunder Bay Urology and grant funding provided by the Region 9 Area Agency on Aging. Promoted screenings through Relay for Life events; Colorectal Action Network (CRAN), radio tours, newspaper articles, and other media outlets; speaking engagements and presentations; distribution of brochures, pamphlets, and other informational packets; sub-contracting to organizations serving disparate populations to raise awareness and increase screenings. The Institute provides community education throughout the tri-county area including missions, and the Wayne County Health on Wheels initiative. Free screening events, free or low cost mammograms and counseling. An on-site oncology social worker in place who assists the uninsured and underinsured with financial issues. We work with the Pink Saturdays program in our area. Patient Navigation for free colonoscopies (scheduled into April/May) Lunch and Learn at Burnham Brook with Dr. Chalasani - March 20th brochures given to the Family Health Center to hand out to patients about getting screened. 13

15 Section I: Health Disparities Early Detection Table 1.3 cont d.: Educational Activities for Populations Who Never or Rarely Receive Timely Breast, Cervical, or Colorectal Cancer Screening as described by MCC Organizations, 2012 Cancer Services Cancer Support Community of Greater Ann Arbor Catherine s Health Center Central Michigan District Health District Health #2 District Health #10 District Health #4 Genesee County Health Genesys Hurley Cancer Institute Gilda s Club Grand Rapids Grand Rapids Clinical Oncology Health of Northwest Michigan Henry Ford Health System Huron County Health Ingham County Health Reached out to targeted underserved men and women (we have a very low rate of minorities in our community) who are unemployed or underemployed by providing information about timely screening at Family Wellness Day at Midland Mall in February and other similar events at community centers around the county. Will ask Smoking Withdrawal Clients if they are taking advantage of the free screenings taking place in our region and encourage them to access these resources. CSC offered a free workshop called The African American Cancer Experience Panel presentation to our community during African American History Month which highlighted breast cancer screening with Dr. Lori Pierce. This also included the importance of psychosocial support and healthy behaviors. BCCCP provider site. Had Press releases promoting BCCCP and Colorectal programs. Agency flyers and information given out for these programs at health fairs. Posted flyers and eligibility information in all kinds of public venues. Had preliminary talks with one of Native American tribes to promote the program with their health care workers and also feature promotion in October through their casino. Attended Health fairs, put out PSA's, newspaper articles, flyers DHD#10 is a provider of both the BCCCP and colorectal cancer early detection programs. Promotion of these services is ongoing within the health jurisdiction as well as with area providers. Outreach education. Provided BCCCP and coordinate with own County health plan to encourage screenings. Breast Cancer Screening event. Literature available and distributed addressing rationale, benefits and process for screening for breast and colorectal. Offered an incentive program, along with nurse navigation for minority women to get mammograms. Partnered with local high-risk clinics and community education/outreach initiatives. Promoted October Breast Health Month and March Colorectal Screening month with media and free screenings. Attended organizational group meetings to educate public on Breast and Cervical Cancer and Colorectal Cancer. Targeted Native American clinic to educate on BCCCP enrollment Partnered with county fund raising organizations to promote public awareness Partnered with grass-roots organization in Antrim County that had the 2nd highest leading breast cancer mortality in the state. They assist in education of that county among the low income and underinsured or uninsured population as well as all women/men in Antrim County urging annual breast screenings Partnered with area hospitals in promotion of cancer screenings Church and community educational programs. Attended health fairs in six county regions which provide Breast and Cervical Cancer Screening and Colorectal Cancer Screening to promote awareness and knowledge of services available. Minority population would be included in Saginaw and St. Clair Counties. ICHD participates in the Breast and Cervical Cancer Control Program. Three of own FQHC clinics are screening sites. Promoted breast and cervical cancer awareness and screening throughout the year. 14

16 Section I: Health Disparities Early Detection Table 1.3 cont d.: Educational Activities for Populations Who Never or Rarely Receive Timely Breast, Cervical, or Colorectal Cancer Screening as described by MCC Organizations, 2012 Inter-Tribal Council of Michigan, Inc. Kalamazoo County Health & Community Services Kalamazoo County Health & Community Services Kent County Health Luce-Mackinac-Alger- Schoolcraft Health Marquette General Cancer Center McLaren Bay Regional McLaren Cancer Institute McLaren Cancer Institute-Clarkston McLaren Greater Lansing McLaren Oakland McLaren-Macomb Promoted the BCCCP among all 12 tribal communities; community health events, provider training; navigation education and community events - all within Native American tribal communities. Participated with Pink Saturdays which is a campaign to increase breast cancer screening. BCCCP Pink Saturdays Free Mammogram Screening Southwest Michigan Cancer Control Coalition. BCCCP, WW, CRC are all in Grand Rapids, and patients exposed to each of these programs get a triple dose of education and awareness regarding the other services, and timely access to this care. Outreach has been quadrupled by careful collaboration with all community partners to ensure adequate coverage of our entire county and to ensure own network reaches into every network. Attended health fairs and other community events; discussing/educating on the BCCCP program. Partnered with the MCHD to enroll patients into BCCP - offer free colorectal cancer FIT tests (partnered with MCI) - free breast cancer risk clinics (2-MQT, 1 Houghton) - 4 free skin screens Free Cancer Screening programs for uninsured or underinsured -- Partnerships with local health departments -- Financial assistance programs for treatment when patients of minority backgrounds are diagnosed with cancer. Free Cancer Screening programs for uninsured or underinsured -- Partnerships with local health departments -- Financial assistance programs for treatment when patients of minority backgrounds are diagnosed with cancer. Sister and Sister Free Mammogram Screening Program Free Prostate Screening Free Skin Screening Free Colorectal kits distributed during the month of March. Free Cancer Screening programs for uninsured or underinsured -- Partnerships with local health departments -- Financial assistance programs for treatment when patients of minority backgrounds are diagnosed with cancer. Free Cancer Screening programs for uninsured or underinsured -- Partnerships with local health departments -- Financial assistance programs for treatment when patients of minority backgrounds are diagnosed with cancer. Free Cancer Screening programs for uninsured or underinsured -- Partnerships with local health departments -- Financial assistance programs for treatment when patients of minority backgrounds are diagnosed with cancer. Have a mobile outreach unit to provide health care and education to underserved men and women in our community. In 2012, implemented BRAvo For Women program, which provides free screening mammography to uninsured, financially qualifying women in our community. Also have partnered with MyCare to stretch our resources to include the diagnostic workup of abnormal mammograms which includes minimally invasive breast biopsy if indicated. Since 2010, held an annual breast cancer awareness event called BRAvo, which focuses on breast health education, breast cancer awareness, and the importance of early detection. Activities occur throughout the year that lead up to the event each October. Free Cancer Screening programs for uninsured or underinsured -- Partnerships with local health departments -- Financial assistance programs for treatment when patients of minority backgrounds are diagnosed with cancer. 15

17 Section I: Health Disparities Early Detection Table 1.3 cont d.: Educational Activities for Populations Who Never or Rarely Receive Timely Breast, Cervical, or Colorectal Cancer Screening as described by MCC Organizations, 2012 Michigan of Community Health Michigan Primary Care Association Michigan State University Breslin Cancer Center MidMichigan Medical Center - Midland Midwest Health Plan Muskegon County Health Providence Cancer Institute Saint Mary s Health Care Sparrow Regional Cancer Center Spectrum Health Cancer Program Provided staff support for the Michigan Colorectal Cancer Early Detection Program (MCRCEDP). The MCRCEDP focuses on Michigan s underserved and minority populations, providing CRC education, screening and patient navigation. The MCRCEDP is located in 39 counties, but may accept clients from other counties. Manage BCCCP program w/ a focus on providing services to minority and low-income women. MDCH provides CRC education for the MCRCEDP Coordinators about evidence based activities found in The Community Guide which increases CRC screening rates and reduces barriers to the underserved population. This includes providing information and in-servicing on the creation of small media which can be created on the Make It Your Own website. All small media may be targeted toward specific populations including minority populations: AA, Native Americans, and Hispanics. Provided CRC education and support to the Coordinators encouraging 1:1 patient navigation and CRC education to increase CRC screening rates. Statewide CRC PSAs on radio and television (Spanish and English). Breast Cancer Awareness Month (October 2012) - PSA's and press releases on the importance of breast cancer screening. Promotion of Breast Cancer Fact Sheet citing statistics on screening, incidence, and mortality related to breast cancer. Twenty two Michigan Health Centers received funding to increase cervical cancer screening using the Patient Centered Medical Home model of care. This process will increase the number of women screened and tracked in health centers that serve the uninsured and under insured. MPCA partners with MDCH to offer two educational webinars on new screening guidelines and resources for treatment and care. Provided educational lectures in partnership with community organizations (e.g. MGL HealthWise University) for targeted minority groups as described above Participated in BCCCP program as well as offered free mammogram screenings for women enrolled in the Midland Health Plan Sent Reminder mailings quarterly to members who are due for screenings. Providers can obtain "opportunity reports" on website for their patients. Opportunity Reports list the patients' recent visits and also any services that are due. Educational articles are published in member and provider newsletter yearly. Educational brochures are available to members who request more information. Distributed information about the BCCCP, Family Planning Project and Colorectal Cancer Screening to churches and doctor offices in areas of minority men or women. Have community programs that partner with the local community in Southfield the Mall walkers, an African American group that walks for fitness at Northland Mall. Provided breakfast and lectures. Lectured this group on colorectal cancer screening. Also have a community lecture series called dinner with a doc. Super Colon exhibit was advertised in Hispanic and African American newspapers. Breast cancer educational sessions targeting Hispanic and African American clinics. Prostate Cancer Education event. Brought our mobile mammography unit to underserved areas and teach early detection education during the mammogram. Participate in many community events / health fairs and include early detection of all cancers education for participants. Mailing campaign for colon cancer screening and a community run supports this too. 16

18 Section I: Health Disparities Early Detection Table 1.3 cont.: Educational Activities for Populations Who Never or Rarely Receive Timely Breast, Cervical, or Colorectal Cancer Screening as described by MCC Organizations, 2012 Susan G Komen Race for the Cure, KCI Susan G Komen for the Cure, MidMichigan Affiliate Susan G Komen for the Cure, West MI Affiliate U of M Comprehensive Cancer Center UnitedHealthcare Community Plan West Michigan Cancer Center Western Upper Peninsula District Health ZIAD Healthcare for the Underserved, INC Komen Detroit recently conducted a community assessment to determine the impact of breast cancer across our service area of Wayne, Oakland and Macomb counties. From demographic information and breast cancer incidence and mortality data along with information on the level of poverty and access to health care services, determined the areas in need of the most outreach. Chose Detroit, Highland Park, Pontiac and Warren as target areas. An example is an outreach initiative in Highland Park, MI with a mini-grant from the American Psychological Association Socioeconomic Status Related Cancer Disparities (SESRCD) program. Hosted breast cancer education workshops throughout the city as community clinics, human service agencies, churches and businesses to provide information on breast cancer and healthy lifestyles to the citizens of Highland Park, along with linking them with free breast cancer screenings. Will continue similar efforts in the remaining target areas. Because focus of the community grants ($1.55M from the 2012 Komen Detroit Race for the cure) is underserved women and men, the grants intensify this focus in a very tangible way. Summary of current grants here: Komen Mid-Michigan, while not a direct service provider, funds several programs that provide education and screening to these target populations. These included education programs through the Allen Neighborhood Center in East Lansing and the EMU Healthy Asian American Project. It also included outreach from screening programs to these populations from our programs run by St Joseph Mercy in Ann Arbor and Allegiance Women's Health Center in Jackson. Komen Mid-Michigan also provides educational materials and presentations at venues who are trying to reach minority and underserved women grantees included Muskegon Family Care, Hackley Community Health, Metropolitan Hospital's "Mammo to go" bus, City on a Hill, Betty Ford Breast Health Center at Spectrum Hospital, The Lack's Cancer Center at St. Mary's Hospital and Genetics Counseling at Spectrum. Each of these organizations used Komen West Michigan funds to deliver educations, screening and diagnostics to under-served men and women in our 5 county areas of Muskegon, Kent, Ottawa, Newaygo and Montcalm. Education events, visiting churches, website information, newsletters, Facebook, materials given at fundraising events Free pap and throat cancer screening days targeted those with no insurance. Provided interpreters for screens as needed in Spanish and Chinese. Identified the population and contact to schedule appointments at events at PCP office and or facility of choice 2,500 Pink Saturday s posters were distributed. More than 75 program volunteers placed the posters at nearly 1,650 locations including stores, beauty shops, restaurants, and churches. Community kick-off press conference was held at a Kalamazoo church. Pink Saturday s billboards were placed throughout Southwest Michigan. Radio ads in English and Spanish were played throughout August, September and October on stations serving Southwest Michigan. CME Event for providers on the importance of screening for minorities Keweenaw Bay Indian Community has sponsored many different health outreach activities in the Community. MTU Spirit of the Harvest Powwow - Pink Shawl Dancers KBIC Women's Dinner Health Heart Fair KBIC Women's Retreat Mother's Day Dinner Breast Cancer Awareness (Afternoon Tea) Primary care. 17

19 Section I: Health Disparities Survivorship Cancer Survivorship A goal of the MCC is to improve the quality of life for cancer survivors in Michigan. Of organizations that completed the 2012 IPR survey, 71.6% said that their organizations mission was compatible with this goal. Figure 1.8: Promoted/Supported Organizational Partnerships to Decrease Barriers to Survivorship Resources for Minorities and Underserved Populations, 2012 Yes 57.1% n=42 Figure 1.9: Promoted/Supported Organizational Partnerships to Decrease Barriers to Survivorship Resources for Minorities and Underserved Populations by Organization Type, 2012 Community-based health systems (n=17) Organizations representing hard-to-reach or special populations (n=2) Health insurance plans (n=1) Public health organizations (n=8) Trade/professional/advocacy (n=11) University-based health systems (n=3) 18

20 Section I: Health Disparities Survivorship Table 1.4: Activities Implemented to Promote or Support Organizational Partnerships to Decrease Barriers to Survivorship Resources for Minorities and Underserved Populations as described by MCC Organizations, 2012 American Cancer Society, Great Lakes Division, Inc Barbara Ann Karmanos Cancer Institute/Wayne State University Botsford Cancer Center Cancer Services Cancer Support Community of Greater Ann Arbor District Health #2 District Health #4 Genesys Hurley Cancer Institute Gilda s Club Grand Rapids Health of Northwest MI Kent County Health Mary Free Bed Rehabilitation Hospital McLaren Bay Regional McLaren Cancer Institute McLaren Cancer Institute-Clarkston ACS works with facilities that serve disparate populations including hospitals, FQHCs, and other health clinics and organizations promoting access to survivor resources by training staff in how to utilize the ACS resource data base and by direct referral to our Patient Resource Center. In 2012 KCI completed a Community Health Needs Assessment and received two Susan G. Komen grants. The CHNA has led to activities that will increase partnerships with the Middle Eastern and Hispanic communities. One grant provided from Komen allows the Institute to provide access to diagnostic and screening breast care for many who would otherwise not be able to afford it and who were not eligible for other programs due to age restrictions. The BCCCP grant allows them to buy additional case load from the state and provide continuing care for those diagnosed with cancer not eligible for Medicaid. We partner with the ACS We offer in collaboration with MidMichigan Medical Center-Midland a wide range of survivorship related services such as support groups, wellness activities including Gentle Yoga and Zumba Gold, financial aid for cancer related rehab costs and transportation at no charge. CSC offers an African American Fellowship monthly that provides support and education to this group of people affected by cancer. CSC also has a Lay Health Advisor Program that is used to reach out to this minority population and educate them about the importance and value of seeking support around cancer. We refer clients to available resources. If clients diagnosed with breast or cervical cancer through our program we can sign them up for Medicaid. Partner with MDCH to offer Breast and Cervical Cancer, Family Planning and Colorectal Cancer Screening. Educational reach out to these groups. Interaction with Social Work identifying barriers and opportunities to decrease, discussed at staff meetings. Employ minority program coordinator Conduct a nurse navigation program for minorities Affiliate with local community churches and leaders Conduct support groups in the minority community Partnerede with American Cancer Society to assist client with health concerns and barriers to health care. Make referrals for Michigan Medicaid eligible clients to receive health insurance during their treatment of breast or cervical cancer. Refer clients to hospital programs that provide cancer treatment and screenings and also refer them to their financial assistance programs Community collaboration with patient navigators and local resources (Hope Lodge, Gilda's Club, Asian American Support Group (1st ever in area) has solidified BCCCP commitment to caring for our diverse communities in a transparent and action oriented vision. Mary Free Bed Rehabilitation Hospital has actively participated with the Kent Co. Health Dept. in its county-wide Community Health Needs Assessment to identify barriers to minorities and underserved populations in regards to access to survivorship care services and for other services. Riley Foundation at McLaren Oakland Riley Foundation at McLaren Oakland Riley Foundation at McLaren Oakland; Patient Navigation system to reduce any and all barriers a patient might have 19

21 Section I: Health Disparities Survivorship Table 1.4 cont d: Activities Implemented to Promote or Support Organizational Partnerships to Decrease Barriers to Survivorship Resources for Minorities and Underserved Populations as described by MCC Organizations, 2012 McLaren Greater Lansing McLaren Oakland McLaren-Macomb Michigan Breast Cancer Coalition Michigan of Community Health Susan G Komen for the Cure, West MI Affiliate The Leukemia & Lymphoma Society- Michigan Chapter Riley Foundation at McLaren Oakland Riley Foundation at McLaren Oakland Riley Foundation at McLaren Oakland Supported survivorship resources for underserved populations with ACCESS an Arab population in Dearborn by taking participating in their health fair and with the Sisters Program and with U of M Outreach Cancer Program. Partnered with McLaren Oakland via funding and support for the implementation of PATH program for cancer survivors transitioning from active treatment. McLaren Oakland is located in Pontiac, Michigan Sister to Sister Program at Gilda's; In 2012 awarded Gilda's Club of Grand Rapids a small grant Collaborated with Henry Ford Health System's Institute on Multicultural Health and the National Arab American Nurses Association to present educational programs including bone marrow registry drives. Figure 1.10: Organization Has a Patient Navigator/Nurse or Staff Providing Navigation Services to Help Reduce Barriers to Care and Coordinate Care Services, 2012 No action taken yet 4.3% We are working toward implementing a system 17.0% Yes, a system is in place and currently being implemented 78.7% n=47 20

22 Section I: Health Disparities Survivorship Figure 1.11: Organization Has a Patient Navigator/Nurse or Staff Providing Navigation Services to Help Reduce Barriers to Care and Coordinate Care Services by Organization Type, 2012 Community-based health care system (n=20) Organizations representing hard-to-reach and/or special populations (n=3) Health care insurance plan (n=2) Public health organizations (n=13) Trade/professional/advocacy (n=6) University-based health systems (n=3) 21

23 Section I: Health Disparities Equity in Care Equity in Health A goal of the MCC is to reduce disparities in cancer outcomes among Michigan populations and to promote equity in cancer prevention, early detection, treatment, and survivorship. Of organizations that completed the 2012 IPR survey, 89.7% said that their organizations mission was compatible with this goal. Figure 1.12: Primary Population Served by Organizations, 2012 American Indian Arab American Black or African American 34.3 Disabled persons 1.4 Hispanic or Latino 15.7 White or Caucasian All % 20.0% 40.0% 60.0% 80.0% 100.0% n=70 Figure 1.13: Geographic Area Served by Organizations, 2012 Rural 47.8% Urban 52.2% 22

24 Section I: Health Disparities Equity in Care Table 1.5: Patient/Client Demographic Data Currently Collected by Organizations, 2012 (n=68) N % Age % Gender % Geographic location % Race % Ethnicity % Income % Education level % Primary language spoken at home % Disability % Health literacy 5 7.4% All of the above % Figure 1.14: Currently Use Office of Management and Budget (OMB) Data Standards to Collect Information for Race and Ethnicity, 2012 No action taken yet 16.7% Don't know 39.6% We are working toward implementin g a system 10.4% n=48 Yes, a system is in place and currently being implemented 33.3% 23

25 Section I: Health Disparities Equity in Care Figure 1.15: Utilize Data on Patients'/Clients' Race, Ethnicity, and Primary Language to Help Guide Cancer Prevention Services, 2012 Yes 51.1% n=45 Community-based health systems (n=17) Organizations representing hard-to-reach or special populations (n=3) Health care insurance plans (n=2) Health education/research & evaluation (n=2) Public health organizations (n=15) Trade/professional/advocacy (n=3) University-based health systems (n=3) 24

26 Section I: Health Disparities Equity in Care Table 1.6: Utilization of Patients /Clients Race, Ethnicity, and Primary Language Spoken to Help Guide Cancer Prevention Services as described by MCC Organizations, 2012 ACCESS Community Health Center American Cancer Society, Great Lakes Division, Inc. Barbara Ann Karmanos Cancer Institute/Wayne State University Botsford Cancer Center Catherine s Health Center District Health #2 Genesee County Health Health of Northwest Michigan Inter-Tribal Council of Michigan, Inc. Kent County Health McLaren Bay Regional McLaren Cancer Institute McLaren Cancer Institute-Clarkston McLaren Greater Lansing McLaren Oakland McLaren-Macomb Michigan of Community Health Coverage and Evaluation Used descriptive data to examine the coverage, breadth and implementation of the campaign. 1.Evaluation tools developed to track and document campaign participants: a.# of participants b. Basic Demographics c. Campaign events (date, type of event, venue location, material presented) d. Evaluation estimated the # of contacts through home visits by individuals looking for access to screening and counted those with insurance coverage we educate and were referred for mammography screening. i. Outreach worker will capture process document 2.Campaign Evaluation Portfolio to collect the products developed. a. PSAs, Arab American Guide to Breast Cancer Screening Awareness; press release, web content, and the event marketing materials. Program Coordinator will analyze all implementation data; report Calculated penetration rates based on the percentage of constituents served with patient information and programs to the expected percentage in a given area. This latter is either information gathered from Census Bureau demographic data and/or cancer incidence of a given demographic group. From there assessment of whether ACS is adequately serving a particular population is done and strategic plan crafted accordingly. Screening rates, cancer incidence and mortality, insurance status, access to health care were used in targeting when and where community based activities should occur. All messages are tailored according to these same criteria. Data is also used to assist decision making for Patient/Community education messaging and educational programs. Completed a community assessment to identify target population and plan services based on community need. Attempted to be sure that information is presented in a culturally sensitive manner and that translators are available if needed. Had educational information available in different languages and utilized a language line service Assessed areas where more outreach may be needed. Primarily if there is a language other than English, interpreters are found or forms are written in other languages, if possible. Compared race and ethnicity of county to patient population seen in our clinics and made adjustments if any is needed. Community Health Assessment done on regular basis which includes race and ethnicity Used Native specific demographics to inform policy, develop programs and apply for funding Used for every plan/objective/goal by health education and health promotion services, as well as motivating guidance for agency overall priorities. Community needs assessments at all COC certified sites include this information. Community needs assessments at all COC certified sites include this information. Community needs assessments at all COC certified sites include this information. Community needs assessments at all COC certified sites include this information. Community needs assessments at all COC certified sites include this information. Community needs assessments at all COC certified sites include this information. Data were used to guide program outreach and to tailor cancer prevention materials and messages. 25