A persistent and essential need subsists for comprehensive cervical cancer screening in North Texas. The targeted region is centered along the I-35 corridor, spanning the majority of Health Service Region (HSR) 3 and portions of HSR 2, 4 and 7, and is predominately rural and/or medically underserved. The population is typically uninsured or underinsured and low-income, and as a result more likely to have infrequent physician visits and reduced access to routine preventative care.

Many communities within this region further lack the financial resources and public health infrastructure required to successfully deliver comprehensive cervical cancer screening and follow-up care for age-eli...

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A persistent and essential need subsists for comprehensive cervical cancer screening in North Texas. The targeted region is centered along the I-35 corridor, spanning the majority of Health Service Region (HSR) 3 and portions of HSR 2, 4 and 7, and is predominately rural and/or medically underserved. The population is typically uninsured or underinsured and low-income, and as a result more likely to have infrequent physician visits and reduced access to routine preventative care.

Many communities within this region further lack the financial resources and public health infrastructure required to successfully deliver comprehensive cervical cancer screening and follow-up care for age-eligible women. Additional barriers, including the defunding of public health clinics historically associated with providing preventative services like cervical cancer screening to low-income women, continues to impact the delivery of care across North Texas. Demand continues to outpace local provider capacity despite changes in healthcare access made available through the Affordable Care Act.

UT Southwestern Moncrief Cancer Institute (MCI) will address these barriers as it links the priority population to community-based service providers within its cancer prevention network through a finely coordinated navigation system, leveraging multiple funding mechanisms to support both clinical services and program infrastructure.

Through the Cervical Cancer Screening & Patient Navigation (X-SPAN) Program, MCI will facilitate a centralized clinical service delivery model tailored to local medical capabilities to ensure the demand for comprehensive cancer screening will be met. This project consists of a) Outreach & Health Promotion to reach the rural and underserved women in the proposed service area by engaging county leadership and screening providers, identifying channels of communication best suited to reach the priority population and collaboration with county-specific interest groups; b) Delivery & Navigation to guide patients through comprehensive screening and follow-up care including a robust navigation process; and c) Centralized Reimbursement to fund clinical services performed either by a local provider or onsite through funding mechanisms like BCCS, Healthy Texas Women Fee-for-Service, grant funding and other local philanthropic support.

The specific goals for the X-SPAN Program are to: 1) Demonstrate effective cervical cancer prevention performance within the 35-county service area by meeting nationally established guidelines and reducing the interval of time between diagnosis and initiation of treatment and 2) Ensure prevention services reach the most vulnerable residents in the rural and medically underserved communities, providing care to those women least likely to take part in cervical cancer screening and follow-up care.

The project will reach more than 500,000 screen-eligible women while targeting those who have not completed a Pap test within the last 3 years. X SPAN will provide at least 2,750 compressive cervical cancer screenings, including Pap and HPV testing, and 230 follow-up procedures, including colposcopy with biopsy and Loop Electrosurgical Excision Procedures (LEEP). 

Delivering quality clinical services to marginalized populations requires infrastructure and funding that is notably missing within the 35-county service area. The X-SPAN program centralizes this capacity at MCI by consolidating key administrative activities, like registration, navigation, screening, follow-up care, and treatment scheduling, from participating providers thereby increasing support for serving the priority population. X-SPAN includes a systematic process for collecting participant data with minimal respondent burden. These data not only allow for centralized financial review and screening reimbursement through the most appropriate funding source, but also support program evaluation to enable continuous process improvement.

With CPRIT support, MCI will continue to partner with county leadership and through its existing infrastructure, leverage local resources to mobilize rural communities across North Texas to increase access to high-quality early detection programming. Through the proposed project, MCI will provide comprehensive cervical cancer screening and patient navigation to those women who would otherwise go without guideline-based care. X-SPAN will continue to advance cancer prevention knowledge, and serve as a proven, replicable model for improving cervical cancer screening for the medically underserved.

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