Healthy U Express: Expanding access and timeliness of care to reduce breast cancer screening disparities in Bexar County, Texas

Background: While screening is considered the most effective method of reducing breast cancer mortality, only 67% of women ages 40 and older report getting mammograms in Bexar County, Texas in 2010. In September 2011, University Health System (UHS), in partnership with its academic partner UT Medicine, designed and implemented the Healthy U Express, a mobile screening program based on national cancer screening guidelines. The Healthy U Express's primary objective was to expand timely access to screening services among segments of eligible economically underserved, uninsured, and working women through on-site screening events held at community, workplace, and faith-based venues. Methods: A logic model was developed to guide implementation of this project. Patient flow process maps were developed using screening guidelines as outlined by the American Cancer Society to ensure appropriate delivery of screening and diagnostic services. Patient surveys were used to assess patients' experiences associated with appointments, timeliness-of-care, provider interactions, and overall care received. Measures used to evaluate the outcome of reducing geographic barriers to screening services were assessed through geospatial analysis of patients in comparison to locations of mobile screening events, number of women who received their first mammogram, and total number of women who received mammogram services on the Healthy U Express. Results: From September 2011 to December 2012, 2,523 women were screened on the Healthy U Express. Approximately 62% of participants were Hispanic (mean age of 50 years), and 20% reported never having a mammogram. With the addition of the Healthy U Express, UHS expanded its points of entry from 2 static sites to 103 unique locations around the county. The Healthy U Express accounted for 13% of all breast cancer screenings at UHS in 2012, and contributed to a 24% increase in the total number of women screened from 2010. Overall, 485 women required a diagnostic follow-up, 62 required biopsies, and 11 were diagnosed with breast cancer. Geospatial analysis indicates improved reach to high health disparate areas of Bexar County. Further, the use of broadband technology has significantly reduced screening and diagnostic time resulting in reduced levels of anxiety and a high level of satisfaction for patients. Conclusion: The Healthy U Express has improved breast cancer screening rates, timelines-of-care, and access among economically underserved, uninsured, and working women in Bexar County. Together, these results highlight the importance of mobile screening programs in reaching economically diverse populations with limited opportunities to schedule clinical preventive services.