WE BAD:WE BAD:Women’s Equitable Breast Women’s Equitable Breast

Cancer Awareness & Cancer Awareness & DetectionDetection

Eban Experience Session II

June 17, 2011

AimAim

• Goal is to increase screening mammography rates for Hmong and Somali patients.

• Aim is to identify specific community outreach strategies to increase breast cancer awareness and decrease barriers.

Team Members• Becky Anderson, RT, Radiology Tech Consultant

• Judy Cannon, RN, Mgr. Regions Breast Health Center

• Ruth Canon, RT, Radiology Tech Consultant

• Marybeth Causse, RN, Care Delivery Supervisor, Riverside Clinic

• Kalue Her, Community Advisor

• Aida Ibrahim, Community Advisor

• Dave Johnson, Regional Clinic Director

• Ken Nordberg, Manager, Radiology

• Ka Zoua Vang, Community Advisor

• Linda Wiitala, Special Populations Project Coordinator

4

Breast Cancer ScreeningBreast Cancer ScreeningA Brief History of Our PDSAsA Brief History of Our PDSAs

Same-day mammogram

process

Phone call outreach process

Race/payerIntegrated into reports

Scripting for providers Outreach

resumed

Outreach stopped for system upgrade

2010 Results of Breast Cancer 2010 Results of Breast Cancer Screening Improvement Screening Improvement

Strategies Strategies

• Performed 4,918 same-day mammograms and 2,260 of those were for high-risk women targeted by disparities improvement strategies.

• Made over 9,778 phone calls, contacted approximately 8,380 patients, and scheduled 20% of those patients for their mammograms.

What Do We Do Next? – EbanWhat Do We Do Next? – Eban

Community Outreach Workflow Community Outreach Workflow

FrameworkFramework

Start of Community Outreach

Implement and EvaluateOutreach Strategies

Meet with Key CommunityLeaders and Organizations

Assessment of Community Needs and Resources

Determine SpecificCommunities of Focus

Build a List of Your Stakeholders

Identify and Understandthe Issue

Development of OutreachStrategies & Education Materials

Continue & Share Best Practice

PDSA # 1 – Information Exchange with CAs Objective To identify Hmong & Somali cultural attitudes and

beliefs related to preventive services like mammography.

Prediction Our current outreach and mammography processes may not address prevalent attitudes and beliefs. CAs will share insight with us.

Population Hmong and Somali women in the Twin Cities who are eligible for screening mammography.

Plan-Do-Study-Act (PDSA) Cycles:Plan-Do-Study-Act (PDSA) Cycles:

Plan-Do-Study-Act (PDSA) Cycles:Plan-Do-Study-Act (PDSA) Cycles:

PDSA #1 – Information Exchange with CAsTEST CYCLE 1 Start Date: April 22 End Date: April 26

Plan At initial Eban group meeting staff will share mammo screening recommendations and request feedback from CAs on attitudes and beliefs in their communities.

Do CA Feedback – Staff Learnings• Word-of-mouth is powerful means of sharing info;• Somalis tend to believe cancer is an American disease;• Hmong tend to fear being ostracized with cancer dx;• Communities need fact-based info on cancer to get past myths.• A mobile unit would likely be well-received;• Hmong Resource Fair & MDH Sage good links to community;• CAs not very familiar with mammography process.

Study Group discussed and realized CAs need more information on mammography process itself.

Act Next step planned: Provide CAs with tour of primary care referral to on-site mammography and walk-through of process.

PDSA #2 – CAs’ Mammography Walk-Through

Objective To identify potential barriers to completing the screening and to a positive patient experience for target populations.

Prediction Our current referral and screening procedures may present language and cultural barriers to a positive or even acceptable patient experience. CAs will be able to give insight.

Population Hmong and Somali women eligible for screening mammography.

Plan-Do-Study-Act (PDSA) Cycles:Plan-Do-Study-Act (PDSA) Cycles:

Plan-Do-Study-Act (PDSA) Cycles:Plan-Do-Study-Act (PDSA) Cycles:

PDSA #2 – CAs’ Mammography Walk-Through

TEST CYCLE 1 Start Date: April 26 End Date: May 24

Plan Staff will lead CAs on walk-through of primary care referral to and process of screening mammography. CA feedback will be noted for discussion at next team meeting.

Do CA Feedback – Staff Learnings • First question: Does my insurance cover it?• Not enough education about procedure beforehand;• Lack of available female interpreter may lead to refusal or lower satisfaction;• Signage and visual info for non-English or non-literate patients is lacking.• Interpreters can play vital role in education and way-finding.

Study Feedback noted and discussed at subsequent meeting. CA provided Hmong MDH contacts for topic.

Act Plan to contact Hmong MDH-Sage staff to set up meeting regarding their work with Hmong community.

How have you integrated your How have you integrated your community advisor into your community advisor into your

improvement work?improvement work?• Group meets twice monthly, CAs

requested at one, optional at other;

• CAs toured mammography facility;

• CAs provided link to MDH staff working on similar issue & are invited to participate in follow-up meeting with them.

Successes & ChallengesSuccesses & Challenges• Main Successes

– Valuable feedback on internal processes from CA;– Meeting set up with MDH-Sage personnel resulting

from CA referral;– CIM now providing language & country of origin data.

(Thank you!)

• Challenges– Time & availability constraints (staff & volunteers, e.g.

school, travel, etc.);– Communication with CAs & other outside contacts.