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Lessons Learned During COVID-19 Could Bolster Breast Cancer Screening Access in Central Illinois

A doctor reviews mammogram test results with a patient in this stock photo.
Courtesy OSF HealthCare
A doctor reviews mammogram test results with a patient in this stock photo.

OSF HealthCare is adapting lessons learned during the COVID-19 pandemic to expand breast cancer screening to low-income and minority women.

A new digital health worker program funded by a $75,000 grant will facilitate more outreach to underserved women in Peoria, Tazewell, Fulton, Knox, Warren, and Henry counties to connect them with breast cancer screening and treatment services.

Tim Shelley recently talked to Dr. Sarah Stewart de Ramirez, chief medical officer and vice president for OSF Innovation, and Abby Lotz, chief nursing officer and vice president for OSF Gabriel Digital Health about the new program.

Tim Shelley: Okay, so currently OSF has some exciting things going on with trying to increase access to breast cancer treatment and information. And that was facilitated by, I believe, a grant you recently received. You're gonna focus on a few counties here in central Illinois. If you could just give me kind of an overview of what it is and what you hope to accomplish.

Sarah Stewart de Ramirez: Sure, we're really excited to talk to you today about a recent grant that we received. It's a $75,000, one year grant from the Illinois Hospital Association, in conjunction with Blue Cross Blue Shield. And the focus is really on addressing health care disparities. And in our context, it's really looking at the breast cancer screening disparities that occur across our health care system.

And so specifically, if you've looked at breast cancer mortality across the United States, you see a pretty substantial differential in the mortality rates among black versus white women. And that's not unique to our state. In fact, it's across the entire United States that you see a 60% mortality differential. And so when you start to think through why that might be, you really have to take a comprehensive cancer control approach, which means starting out at the beginning, which is prevention and screening.

And so we decided to take on in our health care system, the disparities that surround who is able to access and obtain screening mammography. And when you look at those patients across our system, we see a pretty significant what we call an income-driven disparity, which means that women that make more money, have a higher household income, in general, get their mammograms yearly, more often than women who aren't employed, or have lower incomes in general.

And we really think that that's a that's a disparity that we need to focus on addressing. And this grant gives us the opportunity to use an innovative approach to be able to really make sure that we can reach out to those women and get them access to the screening mammography that they need.

TS: Absolutely. And I don't know if we want to talk a little bit about the the digital component of this and how that plays into trying to reach the women in this area?

SR: Sure, yep.I'll give that to you, Abby.

Abby Lotz: Yeah, thank you. So you know, over the last few months, OSF HealthCare has really taken a different approach on what model of care we're using when we engage with our communities. So COVID-19 prompted us to really take the traditional community health worker model and digitize it so upscaling our community health workers with digital tools and resources so that they can connect with our community members differently.

And what we've really learned is that people want a variety of ways to be able to access--we all utilize our smartphones, for everything in our lives. And so I think that we really need to adapt as health care delivery to make sure that we're meeting people where they are, when it comes to approaching them, whether it's in in health and wellness, preventative care, as Dr. de Ramirez described, or whether it's an illness, which is what we've really done over the last several months in dealing with our pandemic response.

So our plan is really to arm our community health workers with digital tools and resources through a digital health worker program, and utilize different forms of communication messaging, applications, different modes of communicating, whether it's texting in person to really create a hybrid approach to how we encourage people to to be sure that they're getting their preventative breast cancer screening.

TS: And there's several counties covered in this. Obviously, the challenges people in Peoria might face are a little bit different than, say, Canton, or Kewanee, or Galesburg, which I think are some of the other cities included in this area. So if we can just talk a little bit about some of the unique challenges of urban versus rural and how you how you address each one of those.

SR: Sure, you know, I think this is a great opportunity for us as a U.S. health care system, to learn how best we overcome some of those disparities that we see and how we best address them and specific to the question. Here in Peoria, in the Tri-County region, we face one of the largest disparities that we see across our system. And the women that are here are much less likely, the lower income women are much less likely to have access to mammography or obtain their their yearly mammography. And so in that context, what it'll give us the opportunity to do here in the Tri-County is to reach out to them using different modes as Abby spoke to.

So we'll use things like text messaging to be able to communicate with our patients and help the health literacy components and education components around why to get a map mammography, how to get it to schedule them mammography, and the frequency that that entails.

But then, as the grant goes on throughout the year, we'll augment that with additional layers of outreach, things like a digital health worker, where we can have face-to-face digital interactions with patients around again, some of that education and overcoming some of the social and structural barriers to obtaining mammography. And then finally, we can use the data from our health system to be able to really understand the location of a lot of the women who haven't had access to screening mammography in the past, to be able to do targeted face-to-face community outreach.

And so those are really the three kind of large categories of outreach. And we'll be learning along the way, which pieces of those interventions are most effective, and how patients really want to be interacted with as it pertains to their preventive health care. So you can imagine that, as we start to do that, in the Tri-County area, that we'll be doing this across the system.

And as you said, in a county like Knox, Warren, or McLean County, we might see different patterns of response to those different types of interventions. And so what that'll allow us to do, again, is to understand the ways in which people want to interact, as it pertains to preventive health. And that may be different in different places located throughout our system. And we should be able to customize our approach in that way.

AL: I think I would add to that, we've overcome through lessons learned, some of the challenges that those rural communities have with access. And so, you know, I think it will help give us more insight, and inform our health care team to about where we may be needing to provide devices to ensure that we're able to connect confidently with our members in our various communities as well.

SR: I was just gonna say, to build on something, Tim, you and I have spoken about in the past. You know, we know that there are formidable barriers to health care access, that are the social and structural determinants of health. And we know that sometimes that comes in the form of transportation, sometimes that comes in the form of food and security, and that those patterns differ across the state.

And so taking a very specific example, like screening mammography, and making sure that as we move forward to increase access, we're actually having conversations with patients about those social and structural determinants of health. So that we can overcome them is what will allow us to really address the disparities.

And so, you know, Abby can speak to this, but a really crucial part of the Pandemic Health Worker Program was screening, routine screening for the social and structural determinants of health. And so as we carry that forward into the design of a digital health worker and innovative intervention, to be able to address gaps in preventive care, we fully intend that this is not just about increasing education and health literacy. It's also about increasing access through assessing the social and structural determinants of health and addressing them.

TS: Was there anything else about this, this program or just anything in general about your your digital outreach, or efforts that you wanted to add or you wanted our listeners to know?

SR: I think that pretty much sums it up. I think we're living definitely in a new wave, a new age of technology. I think the last couple months has really necessitated our communities to really upscale our digital efforts. And so we don't want to lose the momentum that's been gained in our communities and really keep building upon the education and communication mechanisms that that we've built can continue to improve how we're connecting with all of our patients within OSF HealthCare, as well as potential community members for our health care system.

Copyright 2020 WCBU

Tim Shelley is the Assignment Editor and Digital Director at WCBU Peoria Public Radio.