The primary intent of this proposal is to sustain our successful comprehensive breast cancer screening and navigation program, while expanding coverage to an additional 32 counties. We will leverage the operational and collaborative framework of the current program as we continue to engage new providers and community partners across a broader geography. As the only CPRIT-funded project serving this region, our program is the primary resource for breast cancer screening services and follow-up care for low-income, uninsured or underinsured women residing within the existing service area and will also be for the expansion region as well. Need: The proposed project will target more than 540,0...

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The primary intent of this proposal is to sustain our successful comprehensive breast cancer screening and navigation program, while expanding coverage to an additional 32 counties. We will leverage the operational and collaborative framework of the current program as we continue to engage new providers and community partners across a broader geography. As the only CPRIT-funded project serving this region, our program is the primary resource for breast cancer screening services and follow-up care for low-income, uninsured or underinsured women residing within the existing service area and will also be for the expansion region as well. Need: The proposed project will target more than 540,000 screen-eligible women residing in our 67-county service area through coordinated education and outreach efforts, targeting women who are not up to date with screening. Our project aims to reduce disparities in breast cancer screening and detection, particularly those associated with race/ethnicity and socioeconomic status, targeting priority populations as defined by CPRIT, including low-income, uninsured, or underinsured women residing in rural and medically underserved communities. Overall Project Strategy: Fragmented delivery systems, combined with complex reimbursement mechanisms and poor financial integration are systemic issues challenging the successful delivery of breast cancer screening to these women. In response, we designed our breast cancer screening program to include community outreach and health promotion, comprehensive breast cancer screening and follow-up care supported by nurse-driven clinical navigation, along with centralized reimbursement for local providers, leveraging funds aggregated through the UTSW-MCI contract with Texas Breast and Cervical Cancer Service (BCCS), CPRIT, and other local philanthropic support to ensure patients receive high quality care with no financial burden. Within this model, we will also assess social determinants of health (SDoH) associated with breast cancer repeat screening and discordant engagement in different cancer screening modalities to maximize the impact of our robust programming. Specific Goals: We will leverage existing centralized processes as we operate within our virtual integrated system to optimize delivery of breast cancer screening services to rural and medically underserved patients, addressing key stress points across the screening continuum exacerbated by the COVID-19 pandemic. Specifically, we will provide screening and follow-up care supported by oncology-certified nurse-driven clinical navigation to more than 33,328 women over 5 years, where CPRIT will directly fund at least 1,850 screening mammograms and 870 diagnostic procedures, including 745 diagnostic mammograms and 125 biopsies. In doing so, we will also assess social determinants of health (SDoH) associated with breast cancer repeat screening and discordant engagement in different cancer screening modalities. Significance and Impact: Successful delivery of screening services detects cancer at early, more treatable stages, decreasing the mortality rate. While many counties in North Texas lack the public health infrastructure needed to facilitate breast cancer screening and diagnostic programs for their underserved populations, our program continues to encourage community-based care. We support our community partners through our outreach efforts, connecting women to local health providers for screening and follow-up services using telephone-based navigation. Where coverage gaps exist, particularly when physical infrastructure is lacking, patients are scheduled on our mobile health unit. Regardless of where services are received, the centralized reimbursement component ensures timely reimbursement for providers. A financial review is embedded within the navigation process to link patients to the most appropriate funder, maximizing the number of patients served with the resources available. This streamlined process ensures timely payment for the provider, so the patient never receives a bill. As a result, this model not only improves community engagement for both patients and providers, but also ensures the necessary resources are available to support clinical service delivery. As a result, our large-scale, population-based breast cancer screening program creates access points for women's health services while encouraging patient-clinician connectedness for the timely delivery of cancer prevention and follow-up care in rural and medically underserved communities across the service area.

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