Alaska Native Breast Cancer Patients: A care coordination quality improvement project

Breast cancer is the leading cancer among Alaska Native women. When an Alaska Native woman living in a village is suspected of having breast cancer, a long journey begins. She must travel by airplane for a diagnostic mammogram, and then again for further tests, diagnosis and/or treatment. 

Travel coordination, tribal payment policies, treatment guidelines, cultural barriers, and provider communication create a potential for delays and gaps throughout the cancer care continuum which impact diagnosis and timely treatment. To address breast cancer disparities within the Alaska Tribal Healthcare System (ATHS) a QI process was developed with assistance from a Susan Komen grant to identify variances and gaps from suspicion of cancer to start of treatment.

We accessed SEER Tumor Registry Data for Alaska Native women at point of diagnosis to treatment for years 1998-2013 by tribal region, age, and stage of cancer diagnosis.  We also identified data gaps within the Electronic Health Record (EHR), clinical protocols and processes throughout the ATHS. Data was compared to regions with CDC funded Breast and Cervical Cancer programs. In depth interviews were conducted regarding clinical processes and cultural considerations.

Graphics regarding first clinician visit, confirmed diagnosis and start of treatment will be presented by stage and region.  Recommendations for system process changes, qualitative results of interviews and process evaluation results will be presented. 

Results of the study provide recommendations for tribal leadership and healthcare providers of Alaska Native people to improve and better integrate cancer care from suspicion of breast cancer through long term survivorship.