County-level outcomes of a rural breast cancer screening outreach strategy: a decentralized hub-and-spoke model (BSPAN2)

Abstract

Rural mammography screening remains suboptimal despite reimbursement programs for uninsured women. Networks linking non-clinical community organizations and clinical providers may overcome limited delivery infrastructure in rural areas. Little is known about how networks expand their service area. To evaluate a hub-andspoke model to expand mammography services to 17 rural counties by assessing county-level delivery and local stakeholder conduct of outreach activities. We conducted a mixed-method evaluation using EMR data, systematic site visits (73 interviews, 51 organizations), 92 patient surveys, and 30 patient interviews. A two-sample t test compared the weighted monthly average of women served between hub-and spoke-led counties; nonparametric trend test evaluated time trend over the study period; Pearson chi-square compared sociodemographic data between hub-and spoke-led counties. From 2013 to 2014, the program screened 4603 underinsured women. Counties where local Bspoke^organizations led outreach activities achieved comparable screening rates to hub-led counties (9.2 and 8.7, respectively, p = 0.984) and did not vary over time (p = 0.866). Qualitative analyses revealed influence of program champions, participant language preference, and stakeholders' concerns about uncompensated care. A program that leverages local organizations' ability to identify and reach rural underserved populations is a feasible approach for expanding preventive services delivery. KeywordsRural, Breast cancer, Healthdisparities, Health services delivery, Mixed methods, Program implementation BACKGROUND Despite the Affordable Care Act's emphasis on preventive services, many rural communities face significant challenges in linking women to the full continuum of breast cancer screening services (e.g., screening and diagnostic mammography, breast biopsy, and referral to cancer treatment) [1]. Rural populations, when adjusted for age, are more likely than their urban counterparts to lack health insurance [2], such that women are significantly less likely to meet

Understanding lung cancer screening behavior: Racial, gender, and geographic differences among Indiana long-term smokers

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An Overview of the National Cancer Institute's Initiatives to Accelerate Rural Cancer Control Research

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The effectiveness of champions in implementing innovations in health care: a systematic review

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