Streamlining Navigation for Urban and Rural Communities in Texas

Background: Tarrant, Denton, Wise, Parker, Hood, and Johnson counties have a higher incidence of invasive breast cancer than any other part of Texas. An estimated 55,000 women from these counties have never received breast cancer screening.

Objectives: The Breast Screening and Patient Navigation (BSPAN) program developed in Tarrant County has been effectively duplicated in the surrounding, underserved counties. The program includes: (a) outreach and breast health education; (b) providing screening services within the patient’s home county; (c) oncology RN navigation of abnormal results to increase the speed to diagnosis and treatment, and (d) acquiring and maximizing funding to reduce financial barriers. Our program utilizes funds from Susan G. Komen Foundation, Cancer Prevention and Research Institute of Texas (CPRIT), Breast and Cervical Cancer Services (BCCS) as well as foundation funds.

Methods:

1. Provide nurse-led breast health educational presentations throughout the rural communities;
2. Attain state BCCS Provider status providing funds for services;
3. Employ key personnel to expedite the Medicaid application for the breast and cervical cancer program;
4. Utilize mobile mammography units of UT Southwestern, Texas Health Harris Methodist Hospital Fort Worth, and local county imaging centers to provide local screening opportunities;
5. Centralize nurse navigation for all 6 counties;
6. Evaluate BSPAN’s effectiveness tracking 3 outcomes over 12 months:

• a) Number of mammograms provided
• b) Time to clinical resolution or treatment of abnormal results
• c) Percent of early-stage versus late-stage cancers identified

Results/Conclusion: Seven breast health programs have been presented throughout the targeted counties. A CPRIT grant to expand the program was awarded in June 2010, and BCCS Provider status from the State of Texas was achieved in July 2010. In 12 months, collaborations with mobile units, local clinics, hospitals, and imaging centers have generated 2338 screening mammograms resulting in 663 abnormal screenings. Additionally, 739 symptomatic women required navigation to additional imaging. Alarmingly, for 33% of symptomatic women, this screening was baseline. Average time from abnormal results to clinical resolution was 16 days. Breast cancer has been confirmed in 68 women, and 75% of the breast cancers were found at early stage. BSPAN provided services to underserved and medically disadvantaged counties in North Texas with minimal staff, including an OCN nurse manager, 3 oncology nurses, clinic staff assistant, and billing specialist. The BSPAN program has shown that statewide duplication is feasible with the strategic appropriation of funds and staff. Education for women in rural counties continues to be essential, as reflected in the high percentage waiting until symptoms to initiate mammography