A Rural Emergency Room Intervention for Cancer
Prevention Nancy Schoenberg, PhDNancy Schoenberg, PhD
Carol White, MPHCarol White, MPHMark Dignan, MPH, PhD Mark Dignan, MPH, PhD
ACCN Research Update ACCN Research Update September 28, 2007September 28, 2007
Hershey, PAHershey, PA
Background Emergency Rooms as intervention locationEmergency Rooms as intervention location
• 94.4 million ER visits in 199794.4 million ER visits in 1997• ERs provide extensive services to those ERs provide extensive services to those
without a usual sources of medical care. without a usual sources of medical care. • Many of those attending ERs have high Many of those attending ERs have high
rates of chronic diseaserates of chronic disease• The ED may provide an important The ED may provide an important
opportunity to initiate prevention, opportunity to initiate prevention, screening, and counseling services for screening, and counseling services for millions of Americans who have no other millions of Americans who have no other source for these servicessource for these services
Examples of ER projects
• Most have focused on prevention of suicide, domestic Most have focused on prevention of suicide, domestic violence, substance abuse, falls. violence, substance abuse, falls.
• Harlem Hospital: breast & cervical cancer screenings: Harlem Hospital: breast & cervical cancer screenings: Mandleblatt & colleagues (1997) find ER screening is cost Mandleblatt & colleagues (1997) find ER screening is cost effective for cervical cancer, but expensive for breast cancereffective for cervical cancer, but expensive for breast cancer
• Urban MN: Margolis & colleagues (1998) employ LHAs to Urban MN: Margolis & colleagues (1998) employ LHAs to assist with breast & cervical cancer screening; find modest, assist with breast & cervical cancer screening; find modest, but significant improvement in screenings, particularly among but significant improvement in screenings, particularly among Native American women. Native American women.
ER Pilot Project
• In 2006, Kentucky Team Up, Marcum & Wallace In 2006, Kentucky Team Up, Marcum & Wallace Memorial Hospital, and Kentucky Homeplace staff Memorial Hospital, and Kentucky Homeplace staff developed and implemented an intervention to developed and implemented an intervention to increase cancer screening among men and women increase cancer screening among men and women presenting at Marcum & Wallace ERpresenting at Marcum & Wallace ER
• Marcum & Wallace Memorial Hospital . . . .Marcum & Wallace Memorial Hospital . . . .• Located in Irvine, Kentucky (Estill County)Located in Irvine, Kentucky (Estill County)• Serves three of the counties in Team UpServes three of the counties in Team Up• On average, has ~1000 patient visits per month in On average, has ~1000 patient visits per month in
the emergency roomthe emergency room
Marcum & Wallace Hospital, Irvine KY (Estill County)
• 25 licensed beds 25 licensed beds • Established in 1949 as Established in 1949 as
a result of local a result of local leaders seeing a need leaders seeing a need for a hospital in the for a hospital in the area.area.
• Serves 9 counties in E. Serves 9 counties in E. Kentucky, 46,000 Kentucky, 46,000 people. people.
Part of the community
Essential services to the community
• 24-hour ER24-hour ER
Inpatient ServicesInpatient ServicesOutpatient ServicesOutpatient ServicesSpecialty ClinicsSpecialty ClinicsRadiologyRadiologyLaboratoryLaboratoryPT & RehabPT & Rehab
Project Objectives
• Increase the number of referrals made to the Increase the number of referrals made to the Family Health Care Advisor (FHCA)Family Health Care Advisor (FHCA)
• Increase the number of those who Increase the number of those who subsequently obtain cancer screening, subsequently obtain cancer screening, smoking cessation assistance, and other smoking cessation assistance, and other servicesservices
• Increase the number of men and women who Increase the number of men and women who find a new medical home for primary care find a new medical home for primary care servicesservices
Methods
Phase 1 Phase 1 • The FHCA assesses the medical needs of those18 The FHCA assesses the medical needs of those18
years and older, who present at the ER for non life-years and older, who present at the ER for non life-threatening situations. If medical needs are identified, threatening situations. If medical needs are identified, the FHCA will explain to the patient that he or she can the FHCA will explain to the patient that he or she can help them obtain services.help them obtain services.
• If patient agrees, the FHCA obtains informed consent If patient agrees, the FHCA obtains informed consent from the patient & patient will sign a standardized form from the patient & patient will sign a standardized form authorizing FHCA access to patient’s medical authorizing FHCA access to patient’s medical information.information.
Phase 2Phase 2
• The FHCA will follow-up with the patient, The FHCA will follow-up with the patient, assisting him/her in obtaining cancer assisting him/her in obtaining cancer screening, smoking cessation assistance, or screening, smoking cessation assistance, or other services requested by serving as a other services requested by serving as a liaison between the patient and varied liaison between the patient and varied medical and social resourcesmedical and social resources
Follow-Up Data Collection
• The FHCA will collect follow-up information at The FHCA will collect follow-up information at 3, 6, and 12 months3, 6, and 12 months
• Information includes: Information includes: • The service(s) the patient requestedThe service(s) the patient requested• The type of assistance provided (i.e., The type of assistance provided (i.e.,
screening appointment made, referral to a screening appointment made, referral to a smoking cessation class, etc.)smoking cessation class, etc.)
• The outcome of the service(s) provided The outcome of the service(s) provided
As of December 2006 . . . • 35 out of 120 eligible patients (29%) were referred to 35 out of 120 eligible patients (29%) were referred to
a FHCA for medical assistancea FHCA for medical assistance
• Among the referrals (note: individuals could request Among the referrals (note: individuals could request more than one service), more than one service), • 10 individuals requested breast cancer screening10 individuals requested breast cancer screening• 8 requested cervical cancer screening8 requested cervical cancer screening• 11 requested smoking assistance11 requested smoking assistance• 16 requested medication assistance16 requested medication assistance• 5 requested dental assistance5 requested dental assistance• 1 requested another service 1 requested another service
• Other accomplishments: IRB approval, full time Other accomplishments: IRB approval, full time FHCA hired, process in place. FHCA hired, process in place.
Acknowledgements: Project Team Members
Marcum & Wallace Memorial HospitalMarcum & Wallace Memorial Hospital• John Isfort, Director, Kentucky River Health NetworkJohn Isfort, Director, Kentucky River Health Network• Danny Garret, ER SupervisorDanny Garret, ER SupervisorKentucky HomeplaceKentucky Homeplace• Fran Feltner, DirectorFran Feltner, Director• Courtney Barnes, Family Healthcare Advisor Courtney Barnes, Family Healthcare Advisor UK Prevention Research CenterUK Prevention Research Center• Frank Bills, Research AssistantFrank Bills, Research AssistantCancer Information Service of the Mid-SouthCancer Information Service of the Mid-South• Tami Kelder, Partnership ManagerTami Kelder, Partnership ManagerUK ACCNUK ACCN• Nancy Schoenberg, PINancy Schoenberg, PI• Carol White, Program ManagerCarol White, Program Manager
