Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #110863

Kathleen Kehoe, MS, Community Benefit Programs, Partners HealthCare, Renaissance Park, 1135 Tremont Street, Suite 980, Boston, MA 02120, 617 585-2851, kekehoe@partners.org and Christine Pizer, RN, MS, Health Care Strategies, Inc., 287 Harvard Street, #53, Cambridge, MA 02139.

BACKGROUND: While many studies of cancer screening adherence focus on the reasons that patients do not keep screening and abnormal follow-up appointments, fewer focus on care processes and systems at the community practice level. This project was initiated by a major health care system to understand the challenges faced by community health centers (CHCs) in tracking mammography screening and abnormal follow-up.

METHODS: This paper describes a qualitative descriptive study of breast health tracking and follow-up at 3 academic medical centers (AMCs) and 17 CHCs in the Greater Boston area. The participating CHCs serve populations with significant racial, ethnic and socio-economic disparities in breast cancer morbidity and mortality. We conducted 38 in-person, semi-structured interviews with breast health staff. Using Visio flowcharting software, we then mapped each CHC's processes from screening to diagnosis to identify promising practices, barriers and challenges. Each CHC received a detailed process flowchart, narrative summary, and recommendations for operational improvements. We also mapped the processes at the AMCs that are the primary referral sites for the CHCs. Staff from the CHCs attended a roundtable discussion of findings.

FINDINGS: Flowcharts are useful tools for conducting systems-level gap analysis. Promising practices included: patient registries, systems to remind patients to schedule and keep appointments, and protocols to identify and follow-up with no-shows. Results also described four key features of an effective breast health care delivery system.

CONCLUSIONS: This approach has broad applications for providers as well as those interested in designing and evaluating systems-level interventions.

Learning Objectives: At the conclusion of the session, the participant (learner) will be able to

• Articulate the value of flowcharting to map the breast health care delivery process and to identify opportunities for improvement.
• Discuss the pivotal role of coordinated operations in the successful delivery of breast health care services to underserved women.
• List the four components of an effective breast health care delivery system.
• Describe several promising breast health care delivery models at community health centers.

Keywords: Breast Cancer Screening, Community Health Centers

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

Recorded presentation