Background: Many underserved women in Philadelphia receive healthcare at 1 of 11 FQHC Community Health Centers (CHCs). The Fox Chase Cancer Center (FCCC) mobile screening program sought partnerships with CHCs to address mutual goals of mammography and follow-up services for underserved and high-risk women.
Objective: Provide regular mammography screening and coordinated community navigation to improve access to follow-up care for eligible women from CHCs.
Methods: The Community Navigator (CN) set up regular, recurring screening dates at 3 CHCs. CHC staff selected and scheduled women for each date and ensured that required paperwork and prior films were available. Following protocol, results were provided by FCCC Diagnostic Imaging to women and their CHC doctors within 10 days. The staff also called women with abnormal results (BI-RADS 0) to make a follow-up appointment. Confirmed appointments were communicated to the CN, who then contacted each woman to assist with overcoming barriers to follow-up. Barriers such as language, transportation, and/or insurance were addressed. For patients with language barriers, the CN arranged with the CHC for translators. Funds were made available to assist with transportation issues, and the CN assessed insurance eligibility and advised Patient Financial Services to code women as uninsured as needed so they could receive services (and no bills). The CN also served as liaison between the CHC and the FCCC mammography department to ensure that women returning for follow-up had prescriptions and that communication between FCCC and the CHC regarding results was smooth.
Results: In 2011, there were 11 screenings held at 3 CHCs. Of 277 women screened, 209 (75%) were uninsured; 36 had abnormal results; and 27 returned to FCCC for follow-up services, including 27 diagnostic mammograms, 21 ultrasounds, 3 needle aspirations, 5 core biopsies, and 1 excisional biopsy. Most of the 27 women who received mammograms were contacted by the CN; 15 uninsured women utilized navigation services. The CN facilitated translation by an FCCC translator for 1 woman and translation and transportation assistance by the CHC for 3 others. Two women with behavioral health concerns were escorted while they were at FCCC.
Conclusions: The partnerships between FCCC and the CHCs have proved mutually beneficial. In addition to meeting a shared commitment to provide underserved and high-risk women with breast cancer screening and follow-up, the partnerships provide FCCC’s mobile screening program with stable and efficient screening dates and the CHC with an effective way to meet and track its screening goals for women aged 40 years and older. In addition to facilitating regular screenings, the CN has been critical to ensuring that women needing follow-up services can get them at FCCC, if desired, by helping them overcome barriers such as language and transportation. It is likely some of the women who came back would not have done so without help. Together FCCC and the CHCs are ensuring breast health continuity of care.
