TY - JOUR
T1 - County-level outcomes of a rural breast cancer screening outreach strategy
T2 - a decentralized hub-and-spoke model (BSPAN2)
AU - Lee, Simon J.Craddock
AU - Higashi, Robin T.
AU - Inrig, Stephen J.
AU - Sanders, Joanne M.
AU - Zhu, Hong
AU - Argenbright, Keith E.
AU - Tiro, Jasmin A.
N1 - Publisher Copyright:
© 2016, Society of Behavioral Medicine.
PY - 2017/6/1
Y1 - 2017/6/1
N2 - Rural mammography screening remains suboptimal despite reimbursement programs for uninsured women. Networks linking non-clinical community organizations and clinical providers may overcome limited delivery infrastructure in rural areas. Little is known about how networks expand their service area. To evaluate a hub-and-spoke model to expand mammography services to 17 rural counties by assessing county-level delivery and local stakeholder conduct of outreach activities. We conducted a mixed-method evaluation using EMR data, systematic site visits (73 interviews, 51 organizations), 92 patient surveys, and 30 patient interviews. A two-sample t test compared the weighted monthly average of women served between hub- and spoke-led counties; nonparametric trend test evaluated time trend over the study period; Pearson chi-square compared sociodemographic data between hub- and spoke-led counties. From 2013 to 2014, the program screened 4603 underinsured women. Counties where local “spoke” organizations led outreach activities achieved comparable screening rates to hub-led counties (9.2 and 8.7, respectively, p = 0.984) and did not vary over time (p = 0.866). Qualitative analyses revealed influence of program champions, participant language preference, and stakeholders’ concerns about uncompensated care. A program that leverages local organizations’ ability to identify and reach rural underserved populations is a feasible approach for expanding preventive services delivery.
AB - Rural mammography screening remains suboptimal despite reimbursement programs for uninsured women. Networks linking non-clinical community organizations and clinical providers may overcome limited delivery infrastructure in rural areas. Little is known about how networks expand their service area. To evaluate a hub-and-spoke model to expand mammography services to 17 rural counties by assessing county-level delivery and local stakeholder conduct of outreach activities. We conducted a mixed-method evaluation using EMR data, systematic site visits (73 interviews, 51 organizations), 92 patient surveys, and 30 patient interviews. A two-sample t test compared the weighted monthly average of women served between hub- and spoke-led counties; nonparametric trend test evaluated time trend over the study period; Pearson chi-square compared sociodemographic data between hub- and spoke-led counties. From 2013 to 2014, the program screened 4603 underinsured women. Counties where local “spoke” organizations led outreach activities achieved comparable screening rates to hub-led counties (9.2 and 8.7, respectively, p = 0.984) and did not vary over time (p = 0.866). Qualitative analyses revealed influence of program champions, participant language preference, and stakeholders’ concerns about uncompensated care. A program that leverages local organizations’ ability to identify and reach rural underserved populations is a feasible approach for expanding preventive services delivery.
KW - Breast cancer
KW - Health disparities
KW - Health services delivery
KW - Mixed methods
KW - Program implementation
KW - Rural
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U2 - 10.1007/s13142-016-0427-3
DO - 10.1007/s13142-016-0427-3
M3 - Article
C2 - 27402023
AN - SCOPUS:85026632596
SN - 1869-6716
VL - 7
SP - 349
EP - 357
JO - Translational Behavioral Medicine
JF - Translational Behavioral Medicine
IS - 2
ER -