The present proposal addresses the need for reaching medically underserved Harris County residents with Breast Cancer (BC) screening information, and assisting eligible residents in gaining access to Harris County Hospital District (HCHD) to receive BC screening services, and improving follow-up of high risk residents screened for BC.

We propose to build on an existing CPRIT-funded project, which has developed partnerships with multiple community service agencies in Harris County, Texas including HCHD to create an infrastructure to improve cancer prevention and outreach services for the medically underserved. We will establish additional partnerships with existing community service agencies ...

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The present proposal addresses the need for reaching medically underserved Harris County residents with breast cancer (BC) screening information, and assisting eligible residents in gaining access to Harris County Hospital District (HCHD) to receive BC screening services, and improving follow-up of high risk residents screened for BC.

We propose to build on an existing CPRIT-funded project, which has developed partnerships with multiple community service agencies in Harris County, Texas including HCHD to create an infrastructure to improve cancer prevention and outreach services for the medically underserved. We will establish additional partnerships with existing community service agencies currently at the forefront of the BC fight in the Greater Houston region, with the goal of reaching low-income communities that have not fully benefited from previous breast cancer awareness and screening programs.

The goals of the project are to: 1) provide outreach and education regarding BC prevention and screening guidelines and services to high-risk and/or underserved residents of Harris County (both community residents and HCHD patients); 2) increase access to BC screening services for low-income Harris County residents eligible for service at HCHD and increase the volume of overall screening services provided; and 3) improve the referral and follow-up process for patients with abnormal mammography screening test in the HCHD and collaborating institutions; and 4) conduct ongoing process evaluation of systems performance and efficiency.

Despite availability of effective primary and secondary prevention interventions for BC, a large proportion of individuals eligible for HCHD services are not receiving recommended screening services. In 2011, 28,577 mammograms were completed at HCHD, which represents only 34% of the eligible population (n= 84,000).This is considerably lower than the 81.1% BC screening rate recommended by the Healthy People 2020 objectives. Since only 34% of the eligible population is being screened, there are many more cancers that are not being detected.

Another critical gap affecting BC care at HCHD is that more than 340 patients a day are currently not able to get an appointment with a primary care physician. This has negative consequences on BC screening, in particular for eligible community residents referred to HCHD from outlying community clinics. HCHD requires that all orders be placed through its EMR by providers that are credentialed within the system. Consequently, Harris County community residents who are potentially at high risk for BC are not able to receive diagnostic BC services. This major roadblock greatly hampers early detection of BC. This is especially tragic considering that 89% of women above 40 and older served by HCHD who do not have health insurance are largely from minority groups.

We propose to expand the CNCP membership to include several key BC community service organizations for the purpose of reaching medically underserved Harris County residents with BC screening information, assisting eligible residents in gaining access to HCHD to receive BC screening and diagnostic services, and improving follow-up appointment rates for those already in the system.

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