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Abington Memorial Hospital

Closing the Gap

Kathleen Hartman, CRNP Abington, PA

215-481-2640

“Closing the Gap” is an Abington Memorial Hospital initiative developed to address health disparities in underserved communities. As part of this initiative, we offer comprehensive breast screening programs throughout the year for women who are uninsured and/or underinsured. Each of the seven (7) “one stop shopping” events, hosted in collaboration with the hospital’s Mary T. Sachs Breast Center, includes key activities such as a Clinical Breast Examination, Breast Self-Awareness Teaching, and mammography for 400-500 women yearly. In addition, symptomatic patients are able to access care through the hospital’s Ambulatory Services Unit. To address barriers, interpreter services are included at each program and at any necessary follow-up appointments. Comprehensive follow-up is accomplished by a team of staff, led by the hospital’s Outreach Navigator and includes additional testing such as additional mammography views, ultrasound, biopsy and treatment. Patients diagnosed with breast cancer are referred to the hospital’s Nurse Navigator for support services that includes a comprehensive survivorship program. Eligible women are enrolled in the Healthy Woman Program while funding is available. Evaluation methods include adherence to the follow-up recommendations and compliance with yearly screening. These programs save lives by detecting breast cancer early through changing women’s breast health screening behaviors.

Geographic Areas Served PENNSLYVANIA

Bucks

Montgomery Philadelphia

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Christiana Care – Helen F. Graham Cancer Center

Delaware’s Pink Ribbon Breast Program

Nora C. Katurakes Newark, DE 302-623-4628

The purpose of the Pink Ribbon Breast Program is to provide breast health education and screenings to Delaware women. It includes lay navigators, partner agencies, and financial support for screening/diagnostic services. Women from New Castle County, in Wilmington (zip codes 19801, 19802, 19804 and 19805), underserved, uninsured or who are from racial/ethnic minorities will benefit. A PRBP bilingual patient navigator coordinates assists 700 women with mammography completion and funds mammograms for at least 260 women who are ineligible for the Screening for Life program or have limited or no coverage. Funding also supports language services for an interpreter for screening and follow-up appointments. The PRBP navigator collaborates with Henrietta Johnson Medical Center and Westside Family Health care for patient assistance with mammography

scheduling. Two breast health education events are planned for HJMC and 6 sessions in partnership with the Food Bank of Delaware mobile pantry. The Delaware Breast Cancer Coalition and Sisters on a Mission offer support to those diagnosed with breast cancer. Program evaluation will include progress for women educated, screened and funded, review of partner agency participation and program satisfaction. Projected impact is to achieve 10% increase in women screened from racial/ethnic minorities and 10% increase in selected zip codes including women from Kent County.

Geographic Areas Served DELAWARE

New Castle Kent County

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Crozer-Chester Foundation/Crozer-Chester Medical Center

Crozer Cares: A Comprehensive Breast Health Initiative

Maria Malloy Upland, PA 610-447-2645

Located at Crozer-Chester Medical Center, this project’s objective continues to focus on the reduction of barriers typically encountered by medically underserved, uninsured or

underinsured women to ensure continuity of care. The primary goal is to end breast cancer as a terminal disease. This project will provide mammography screenings, clinical breast exams, diagnostic procedures and/or treatment necessary to address abnormalities detected through those exams & screenings. It will provide targeted outreach & education to vulnerable populations of women, especially women of color in Crozer’s service area. Outreach will be implemented by Crozer’s programs & collaborating organizations to reach 1000 women, primarily women of color in Chester & surrounding communities; 300

women will benefit from screening mammograms. The evidence-based “Friend to Friend” model engages & reminds women to have annual screening mammograms with a success rate up to 95%. This program will result in earlier intervention & prevention of breast cancer deaths among disparate populations of women in SE Delaware County. The impact: This County has one of the highest incidences of breast cancer in PA. However, the impact of our extensive outreach, education & early intervention efforts has borne fruit as

Delaware County dropped in breast cancer fatalities. Crozer-Keystone Health System’s data indicates that many more breast cancers are being diagnosed earlier & far fewer in late stages within the targeted population.

Geographic Areas Served PENNSYLVANIA

(4)

Delco Memorial Foundation/Delaware County Memorial Hospital

Delco Cares: A Comprehensive Breast Health Initiative

Barbara Morley Drexel Hill, PA 610-284-8112

Our purpose is the elimination of breast cancer as a life-threatening disease. This program will provide 1000 women with information & education, encourage referrals from multiple local sources, and provide continuity of services to women requiring follow-up diagnostic procedures and treatment. At least 325 women will receive breast screening services. Multiple resources are utilized within the health system & the community to reach women in Upper Darby & West Philadelphia’s medically underserved areas. Diverse immigrant populations with multiple cultural, language & socio-economic barriers are engaged and offered evening or weekend group education & screenings. The use of NCI and SAMHSA’s evidence-based “Maximizing Mammography Participation” program for screenings have had up to a 95% success rate. Community impact is measured by attendance, participation and follow-up in addition to PHMC and the PA Dept. of Health statistics. These efforts, resulting in earlier intervention appear to be having an effect. The PA Dept. of Health’s 2010 statistics indicate incidence at 27.5 per 100,000, reduced from 28.2 in 2002-2006 and consistent reductions since 1992-96 in breast cancer fatalities. DCMH was the first in PA and 5th in the USA to receive disease-specific certification for breast cancer care by the Joint Commission. The program meets the highest national standards and guidelines known to significantly improve outcomes and satisfaction for patients undergoing treatment.

Geographic Areas Served PENNSYLVANIA

Philadelphia Delaware County

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Drexel University College of Medicine/

Hahnemann University Hospital

The Drexel University College of Medicine Women's Health Project

Samira Islam Philadelphia, PA 215-762-1033

The expected or resulting change(s) your program will likely bring in your community. Annual mammography screening among women 40-64 years old allows early detection and the reduction of breast cancer mortality rates. Overall, there has been a national decline in breast cancer mortality rates, but there exists a population of uninsured and underinsured women who face injustices in prevention and treatment of breast cancer. Despite, major public health advances, socioeconomic challenges, such as lack of health insurance, failure to expand Medicaid in PA, linguistic and cultural barriers are ever-present. The DUCoM Women’s Health Project provides culturally specific outreach and education, screening, diagnostic testing, and treatment to medically underserved women in Philadelphia. Using the framework of the Research Tested Intervention Program (RTIP) entitled, “Maximizing Mammography Participation”, the Project Manager will employ two main strategies to encourage women to keep their mammogram appointments. This will be done by 1) sending reminder letters at least two weeks prior to the appointment, and 2) a reminder telephone calls placed the day prior to the appointment. Active outreach and recruitment, coupled with efforts to maximize participation, will allow the DUCoM

Women’s Health Project to ensure timely and quality breast health services for medically underserved women in Philadelphia.

Geographic Areas Served PENNSYLVANIA

Philadelphia Delaware County

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Einstein Healthcare Network

Women in Need

Rochelle Millhouse Philadelphia, PA 215-456-6573

The expected or resulting change(s) your program will likely bring in your community. Designed to bridge a gap in care within the community, WIN offers free diagnostic services related to breast health and screening mammograms to uninsured women in the

community regardless of race, religion, national origin or ability to pay. Although many free breast cancer screening programs are provided at local institutions, once an abnormality is found, uninsured women cannot get appropriate diagnostic care, due often to limited financial resources. The WIN program provides care for uninsured women seeking evaluations of their breast, starting with comprehensive physical examinations, mammography, and additional diagnostic testing such as ultrasounds, biopsies and ultimately cancer treatment, if diagnosed. With the assistance of our Project Coordinator and in-house interpretation services, women who have no health insurance are able to receive timely and complete care. We continually monitor our results, and our goal is to identify cancers at earlier stages and provide care for women with breast cancer who historically have delayed seeking attention. We continue to track our progress through the national data available through the American College of Surgeons. We hope that this program continues to help reduce the disparities that currently exist in our home cluster population, specifically related to breast healthcare. We will continue to participate in community health fairs and programs and have partnered with community groups that serve our target population.

Geographic Areas Served PENNSLYVANIA

(7)

Fox Chase Cancer Center, Temple Health

Mammograms Made Easy

Evelyn Gonzalez Philadelphia, PA 215-728-3689

The expected or resulting change(s) your program will likely bring in your community. The purpose of the proposed project is to provide screening mammograms to uninsured and medically underserved African American and Hispanic women aged 40-64 years in

Philadelphia County through the FCCC Mobile Mammography Van. Further, the project will support women through the continuum of cancer care by navigating those who have inconclusive mammogram results to diagnostic services and, if needed, treatment and survivorship services at FCCC or Temple, our parent institution. Lastly, the project aims to educate women about breast health through our community partners using evidence-based approaches tailored to the target population. Each of these aims will be

accomplished in partnership with 4 CORE partners approved by Komen. A comprehensive evaluation plan will measure the success of the project in meeting these objectives. FCCC is a regional leader in cancer care and holds the NCI’s highest designation as a comprehensive cancer center. OHCHD, who would oversee the grant, is a core component to FCCC’s

mission to prevail over cancer by serving as the institution’s community outreach arm. The OHCHD’s Mobile Mammography Van has been serving women in the community for 27 years, making mammograms accessible to all.

Geographic Areas Served PENNSYLVANIA

(8)

Kimmel Cancer Center at Thomas Jefferson University

Jefferson's Breast Cancer Screening and Treatment Program

Celeste Vaughan-Briggs L.C.S.W. Philadelphia, PA

215-955-5495

The expected or resulting change(s) your program will likely bring in your community. The Jefferson Breast Cancer Screening and Treatment Program will continue providing breast care to all eligible women, from initial screening to final diagnosis and into survivorship. Using patient navigation, an evidence-based approach, Jefferson will link uninsured and/or underinsured women with screening, diagnostic and/or treatment services at Jefferson's Breast Care Center. The Patient Navigator guides women through the continuum of breast cancer and also provides counseling, support and help locating resources as needed. As stated in the Komen Philadelphia Quantitative Data report, the incidence rate for breast cancer in the Affiliate service area was significantly higher than observed for the State of Pa. Additionally, the report states the breast cancer death rate in the Affiliate area was slightly higher than observed in US. (Komen Report, 2014)

Geographic Areas Served PENNSLYVANIA

(9)

Lancaster General Hospital

Breast Health Awareness Outreach, Education, Screening and Support Project

Mary LeVasseur Lancaster, PA 717-544-3269

In partnership with agencies and the community, Lancaster General Health (LG) works to provide a comprehensive, culturally competent continuum of breast health care to women in Lancaster County including education, screening, diagnosis, treatment, support and survivorship services. Through the Barshinger Cancer Institute, LG offers multi-disciplinary cancer care that centers breast health services and related survivorship and other support programs ‘under one roof’ in a facility designed to support physical , emotional and family health. We are requesting support from Komen Philadelphia for key elements of LG’s Breast Health Program with a specific emphasis on ensuring that screening and other patient care services are available to almost 700 underserved, uninsured and underinsured women. We have identified two CORE Partners and one agency partner to provide

culturally appropriate outreach to 200 targeted women including Hispanic, Amish, and/or resettled refugees. These partners and others also will collaborate on further outreach efforts to reach 500 women and meet our screening objectives. Finally, we request gap funding assistance for up to 20 women supplementing locally funded patient support. Funding of this project will strengthen the capacity of LG and our partners to educate, support, serve and assist uninsured and underserved women through our existing Breast Health Program.

Geographic Areas Served PENNSYLVANIA

(10)

MD Anderson Cancer Center at Cooper

Camden Country Cancer Screening Project

Evelyn Robles-Rodriguez Camden, NJ

856-968-7315

The Camden County Cancer Screening Project is a New Jersey Cancer Education & Early Detection (CEED) program based out of Cooper University Hospital. Through this grant, we will provide breast cancer education and outreach in Camden County to at least 3,500 women, screen 1,525 underserved, uninsured women (300 through Komen Philadelphia, 300 through Komen Central and South Jersey and 925 through NJCEED), and provide diagnostic follow-up services as well as case management and patient navigation services for those with abnormal findings. We will also provide lymphedema treatment for breast cancer survivors who cannot afford it. Women will be recruited for screening through educational and outreach venues. We will partner with 3 CORE partners: Puerto Rican Unity for Progress to target Latinas; Clark Family Breast Cancer Services, Inc. to target African-Americans; and Mazzoni Center to target lesbian and bi-sexual Latinas. We will hold 2 collaborative educational programs with each CORE partner. The program will be evaluated through weekly data management reports to ensure timely and appropriate case management and reduce reporting errors. We will meet monthly to strategize and evaluate outreach tools. We will continue to provide quality education, screening, and diagnostic and treatment services to uninsured and underserved women in Camden County. This will result in the early diagnosis and treatment of breast cancer in this target community. Geographic Areas Served

NEW JERSEY Camden

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Philadelphia Department of Public Health, Ambulatory Health Services

Breast Cancer Screening & Treatment Project

Yvonne Claudio Philadelphia, PA 215-685-6769

The expected or resulting change(s) your program will likely bring in your community. The Philadelphia Department of Public Health’s Ambulatory Health Services (AHS)

continues the Komen Philadelphia Affiliate-funded program that supports a portion of the breast screenings and diagnostic procedures provided to our medically

uninsured/underinsured patients. Funding requested will support approximately 479 breast screenings, 264 diagnostic services, and 230 specialized exams for women from across our 8 sites. The program incorporates a research-tested intervention (RTI), “Using Direct Mail to Increase Screening Mammography.” This component is aimed at 300

randomly selected women patients, age 40-69, from AHS’ Health Center #4, a site whose service area and patient population are predominantly African American, 77% and 88% respectively. In our RTI, participants are closely tracked to assure they are current with a mammogram, and non-adherent patients are sent a reminder letter. The project also includes education sessions on key breast health topics. The key evaluation indicators measure participants with a date of last mammogram recorded and compliant with a timely mammogram. The RTI component indicators include the number of mailings and response rate. Indicators for the health education sessions are participants

reached/information learned. The expected impact is that our screening rates align with industry standards for adherence, and that we improve our patients’ awareness and understanding of key breast health topics.

Geographic Areas Served PENNSYLVANIA

(12)

Tunnell Cancer Center at Beebe Medical Center

Sharing our Story, Saving our Sisters

Judith Ramirez, EdD Rehoboth, DE 302-645-3769

The Sharing Our Stories, Saving Our Sisters Project (SOS2), aims to save women’s lives by providing eligible Sussex County women access to a seamless breast health system. Women are navigated through CBE’s, mammograms, diagnostic breast health services and

treatment at no cost to eligible participants. Through CORE partnerships with our affiliate Nanticoke Cancer Care Services, churches and community organizations the project uses community ties to create familiarity to the breast cancer survivor’s story and to address barriers so that women may effortlessly go from education to screening to treatment and support knowing that whatever barriers exist for them will be addressed. Lay navigators, who are breast cancer survivors’, co-host culturally appropriate breast health education programs with CORE partners; enable us to address cultural barriers which often prevent minority women from participating in screening; and increase women’s likelihood of participating. Cancer survivors are trustworthy messengers of cancer information. Their stories increase public awareness of cancer and utilization of cancer screenings because they demonstrate success living with cancer. Project evaluation includes quantitative analysis of surveys and participant demographics and qualitative analysis of participant feedback. Expected changes include providing participants the ability to be proactive about their breast health and the sharing their screening story.

Geographic Areas Served DELAWARE Sussex County PENNSYLVANIA Delaware County NEW JERSEY Camden County

(13)

Sacred Heart Hospital

Allentown’s Beating Breast Cancer

Deborah Gilbert Allentown, PA (610) 871-5888

Allentown's Beating Breast Cancer is an outreach and screening program of the Community Outreach/Parish Nursing Department of Sacred Heart Hospital in Allentown, PA. This comprehensive program is a collaboration with the Allentown Health Bureau & the

Neighborhood Health Centers to provide a full continuum of care to medically underserved women. The first component is an outreach program. Outreach workers meet women in neighborhood locations, including places of worship, soup kitchens, food pantries, bodegas and salons, and health centers to educate them about the importance of breast health and annual mammograms. Follow-up, scripted phone calls are then made to the women ages 40-69 to discuss any cultural and/or economic barriers and schedule a CBE and screening mammogram. A reminder letter and phone call are made before the appointment. The education materials are available in English, Spanish and Arabic and the phone callers are fluent in Spanish and Arabic to meet the language needs of the women we serve. Clinical Breast Exams, (CBEs) will be provided by the staff of the Sacred Heart Hospital

Obstetrics/Gynecology Clinic and the Lanshe Breast Center will provide 284 screening mammograms and 120 diagnostic mammograms and/or ultrasounds. The location of Sacred Heart Hospital in the urban core of Allentown will make it convenient to access these services and scheduling the CBE and mammogram at the same time makes it much more likely the women will keep their appointment.

Geographic Areas Served: PENNSYLVANIA

Reading Area, Berks County Lehigh County

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St. Joseph Medical Center Foundation

Promoviendo el Poder del Rosado (Promoting the Power of Pink)

Lisa Spenser, M.Ed., BSRT (T), CN-BP Reading, PA

610-378-2969

The expected or resulting change(s) your program will likely bring in your community. St. Joseph Medical Center (SJMC), the oldest and largest provider of specialized public health programming and charity medical care in Reading and Berks County, is committed to expanding access to breast health screening and treatment for the many uninsured urban and Latina women in our community. Reading is a majority Latino city and was recently designated as the poorest per capita in the nation behind Detroit. Through the proposed project, and in close collaboration with several local organizations, SJMC seeks to reduce cultural, linguistic and socioeconomic barriers and to improve breast health care access and screening rates in the target population. Through targeted outreach, education, and patient navigation with a "promatora" community health worker approach to care coordination, we seek to serve at least 250 women who have no other way to pay with clinical breast exams and screening mammograms annually. Based upon the statistical probability of abnormal findings, SJMC will also be prepared to offer additional diagnostic and treatment procedures as needed to patients where no other financial options are available. Client and systems impact will be tracked by SJMC with assistance from our multi-disciplinary breast health team and designated CORE Partners and key collaborators. Geographic Areas Served

PENNYSLVANIA Berks County

(15)

University of Pennsylvania, Department of Surgery

The Penn Breast Health Initiative

Andrea Nicholson Philadelphia, PA 215-454-3217

The overall purpose of The Penn Breast Health Initiative is to expand the public health and clinical medicine commitments of the University of Pennsylvania, by providing timely and quality breast health services to low-income, uninsured, and medically underserved women. Our goals include: 1.) Offer culturally-tailored educational outreach to medically underserved women in Philadelphia and its surrounding counties, and 2.) Provide

medically underserved women with access to quality breast cancer care inclusive of screening, diagnostic, and treatment services. Our primary evaluation criteria will be confirmation of the actual screening, diagnostic, and treatment services which are

provided. Our impact to the community will be a reduction in breast cancer morbidity and mortality among medically underserved women in Philadelphia through the provision of quality.

Geographic Areas Served PENNSYLVANIA Bucks County Chester County Delaware County Lehigh County Montgomery County Philadelphia County

References

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