Innovative Steps for Identifying Disparities in Fighting Breast Cancer

Spotlight Feature

deepa sheth

Deepa Sheth, M.D.

Assistant Professor of Radiology, Breast Imaging Oncologist

University of Chicago Medicine, Chicago

Background: Why do African American women have higher breast cancer mortality rates than white women, even though more African American women go for screenings? To gain a greater understanding of that disparity and uncover efforts to create positive change in its South Side community, the University of Chicago Medicine (UChicago) health system embarked on an innovative approach. With help from a collaboration between the American Hospital Association’s Institute for Diversity and Health Equity (IFDHE) and Blue Cross Blue Shield of Illinois (BCBSIL), UChicago launched the SCreening OutReach and Engagement (SCORE) initiative. Its goal is to increase mammographic screening, particularly among women living in underserved communities, using a novel three-tiered approach that includes navigation, transportation and community outreach. In this Spotlight Feature interview, Deepa Sheth, M.D. and assistant professor of radiology at UChicago Medicine describes the strategy behind the SCORE initiative and how it’s designed to help reduce the health disparities in the fight against breast cancer.

Why did your hospital decide to move forward with this new initiative?

For African American women in Chicago, a breast cancer diagnosis in 2003 meant a 68% greater chance of mortality compared to white females. Now through our strategic partnership between academic institutions, community leaders and breast cancer survivors, this inequality in long-term breast cancer mortality rates has dropped to 39%.

“Health equity must be a strategic goal in every hospital and incorporated into all improvement plans, including quality, patient safety and population health, to improve health outcomes and the patient experience.”

To that end, UChicago Medicine acknowledges that many of the health disparities facing its neighboring communities in Chicago’s South Side are rooted in a nexus of socio-economic, historical and environmental circumstances that go beyond simply providing medical care. A first step in better understanding health disparities and mortality rates involves the collection of patient race, ethnicity and language preference (REaL) data to identify disparities within our communities. Health equity must be a strategic goal in every hospital and incorporated into all improvement plans — including quality, patient safety and population health — to improve health outcomes and the patient experience.

What is the goal of your program and how do you anticipate your efforts will impact patients?

The goal is to match resources at the medical center with the needs of our neighboring communities to achieve a lasting, positive impact on disparate mortality rates.

Racial disparity in health outcomes has been described as a significant quality of care problem that can be addressed by tracking race-specific outcomes. A number of studies have demonstrated that for diseases other than breast cancer, when the quality of care is measured, made transparent, and improved, the Black/white disparity in various health care processes can be reduced or even eliminated.

In this University of Chicago SCORE initiative, the opportunity to increase mammographic screening in our community of underserved women will be evaluated in an evidence-based manner using a novel three-tiered approach that includes navigation, transportation and community outreach. The SCORE initiative will be the launch of the first breast cancer-screening program led by a radiologist at UChicago Medicine that truly aims to serve underserved minority women, provide quality mammographic imaging services, and document concrete metrics of success all with a collaborative, community-based approach.

How are you leveraging your community partnerships to support this new program?

“The success of any patient-centered initiative at a large academic institution is dependent on the relationships that are developed and fostered with community partners.”

The success of any patient-centered initiative at a large academic institution is dependent on the relationships that are developed and fostered with community partners. In the SCORE initiative, the key goals are to determine the neighboring community needs, expand scope of outreach within our patient networks, and have a successful impact on community utilization of mammographic screening.

To ensure success and longevity of this project, UChicago Medicine is partnering with three community partners in order to achieve several concrete objectives:

  • Creating a five-step framework for stratifying REaL data that includes:
    1. Assembling a working group that is focused on health care disparities data
    2. Validating the REaL data
    3. Identifying the highest priority metrics for stratification
    4. Determining if stratification is possible on the selected metrics and
    5. Stratifying the data
  • A detailed and comprehensive analysis into specific community needs, particularly as it pertains to barriers in access, screening mammography utilization and breast cancer awareness
  • Expansion of UChicago Medicine’s patient outreach and engagement network through our community partners
  • Increase UChicago Medicine’s community impact through the development of breast cancer support group events and mammography parties
  • Development of meaningful relationships with our neighboring communities with the aid of a patient navigator and comprehensive patient care at UChicago Medicine.

Does a clearer understanding of socioeconomic conditions impacting patients and other barriers to health equity help you build a better program? How?

A chief priority of UChicago Medicine was to have organization-wide prioritization of community benefit with efforts that specifically emphasize the value and impact on our neighboring community. As a result, a community benefit strategic framework was adopted in 2016 that served to guide future programming and grant-participation.

Although UChicago Medicine has increased education and screening in various community and clinical settings, there is much work to be done. Detailed analysis of each program seeks to determine:

  • Overall impact of the program
  • Community access to the program benefits
  • Individual health behaviors adopted after the program initiation
  • Long-term effect on health outcomes from the program

UChicago Medicine aims to further these efforts and continue to work on the persistent disparity in health outcomes as it relates to breast cancer screening and detection in our communities. By breaking down the specific metrics of our prior work, this grant will work to bolster and fine tune prior successful initiatives while addressing some of the disparities that were exposed.

What information would you share with others about advancing health care equity within their organization?

At UChicago Medicine, we are constantly trying to strengthen and adjust our programs to ensure the highest quality service and care to our neighboring communities. A few key lessons that have been learned from existing programs that address health disparities include:

  • Integrating faculty into programs that align with their interests: This is key! Incorporating faculty to assist in strengthening programs is mutually beneficial. Prior studies have shown that integration of faculty in specific roles resulted in reliable outcomes, stronger program designs and greater accountability.
  • Making your program flexible: Ensure that programs are reaching the targeted community population by providing multiple portals that are easily accessible and encourage interaction. Not only can providing different spaces and formats extend reach into communities, it can also be extended to pilot other opportunities and remain viable - even during a pandemic!
  • Ensuring your program has meaning to your communities: Align your programs’ goals to those in the communities being served.

Significant effort and investment goes into executing programs. Once the priorities align for the hospital and local communities, more meaningful impacts can be made in addressing specific health issues.