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 - Funding Information:
The authors thank Sarah Masood and our BSPAN colleagues at Moncrief Cancer Institute for their ongoing collaboration and dedication to patients and our many county partner organizations. • Policy: Preventive services delivery programs seeking to expand should leverage and partner with local organizations to conduct outreach in rural areas. • Research: Local champions bring nuanced knowledge of the target population and tailoring county outreach efforts to local context increases program contact with underserved women. • Practice: Mixed-methods evaluation research is useful to elucidate the influence of local context on program adoption and implementation. This study was funded by the Cancer Prevention Research Institute of Texas (PP120097-Lee), which underwrote the BSPAN clinical screening and navigation program. Additional support was provided by the National Cancer Institute (5P30CA142543) to the Harold C. Simmons Comprehensive Cancer Center and National Institutes of Health (NCATS UL1TR001105) to the UT Southwestern Center for Translational Medicine. Drs. Lee and Tiro are also supported by funding from the Agency for Healthcare Research and Quality (R24 HS022418) to the UT Southwestern Center for Patient-Centered Outcomes Research.
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 -