Outside Our Walls: the Case for City-Wide Collaboration to Reduce Disparities

Haas, Jennifer S.; Lemon, Stephenie C.; Freund, Karen M.; Battaglia, Tracy A.

doi:10.1007/s11606-020-06006-7

Cited by 2 publications

(5 citation statements)

References 3 publications

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“…Although process mapping has proven useful in a variety of single‐site and multisite health care delivery contexts, 26‐34 it has primarily been used in oncology to map processes within a single treatment modality 35‐39 . The literature reveals a notable gap in describing the application of process mapping to streamline interdisciplinary processes in cancer care delivery and patient navigation, and there is a dearth of evidence on best practices for collaborative regional process improvement in oncology 7 …”

Section: Discussionmentioning

confidence: 99%

“…[35][36][37][38][39] The literature reveals a notable gap in describing the application of process mapping to streamline interdisciplinary processes in cancer care delivery and patient navigation, and there is a dearth of evidence on best practices for collaborative regional process improvement in oncology. 7 Limitations to this process include the absence of a mechanism to determine whether any key stakeholders were omitted from the tool development process. Using an existing community stakeholder group (the Coalition) allowed us to partner with a variety of stakeholders representing multiple academic medical centers, but it is possible that stakeholders not affiliated with the Coalition were excluded.…”

Section: Process-improvement Teammentioning

confidence: 99%

“…The importance of mapping processes to enhance patient experiences within a given oncology program is well justified; however, mapping processes within a single institution do little to address treatment interruptions related to transfer of care between institutions 5,6 . Patients with breast cancer who are Black and classified with lower socioeconomic status are 2 to 3 times more likely to experience these interruptions, which can affect survival outcomes 7,8 …”

Section: Background/significancementioning

confidence: 99%

“…5,6 Patients with breast cancer who are Black and classified with lower socioeconomic status are 2 to 3 times more likely to experience these interruptions, which can affect survival outcomes. 7,8 Despite its well recognized promise for improving breast health equity among historically marginalized racial groups and low-income patient populations that may face systemic barriers to care, the implementation of patient navigation processes within even a single oncology program can be challenging. 1,9 One barrier is a lack of standardized tools to facilitate the organization and optimization of navigation activities within and across health care settings.…”

mentioning

confidence: 99%

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Development of a workflow process mapping protocol to inform the implementation of regional patient navigation programs in breast oncology

Casanova

LeClair

Xiao

et al. 2022

Cancer

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and the Translating Research Into Practice (TRIP) Consortium BACKGROUND: Implementing city-wide patient navigation processes that support patients across the continuum of cancer care is impeded by a lack of standardized tools to integrate workflows and reduce gaps in care. The authors present an actionable workflow process mapping protocol for navigation process planning and improvement based on methods developed for the Translating Research Into Practice study. METHODS: Key stakeholders at each study site were identified through existing community partnerships, and data on each site's navigation processes were collected using mixed methods through a series of team meetings. The authors used Health Quality Ontario's Quality Improvement Guide, service design principles, and key stakeholder input to map the collected data onto a template structured according to the case-management model. RESULTS: Data collection and process mapping exercises resulted in a 10-step protocol that includes: 1) workflow mapping procedures to guide data collection on the series of activities performed by health care personnel that comprise a patient's navigation experience, 2) a site survey to assess program characteristics, 3) a semistructured interview guide to assess care coordination workflows, 4) a site-level swim lane workflow process mapping template, and 5) a regional high-level process mapping template to aggregate data from multiple site-level process maps. CONCLUSIONS: This iterative, participatory approach to data collection and process mapping can be used by improvement teams to streamline care coordination, ultimately improving the design and delivery of an evidence-based navigation model that spans multiple treatment modalities and multiple health systems in a metropolitan area. This protocol is presented as an actionable toolkit so the work may be replicated to support other qualityimprovement initiatives and efforts to design truly patient-centered breast cancer treatment experiences.

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Section: Discussionmentioning

confidence: 99%

Section: Process-improvement Teammentioning

confidence: 99%

Section: Background/significancementioning

confidence: 99%

mentioning

confidence: 99%

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Development of a workflow process mapping protocol to inform the implementation of regional patient navigation programs in breast oncology

Casanova

LeClair

Xiao

et al. 2022

Cancer

Self Cite

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“…Some examples of local programs to reduce cancer disparities include the New York Citywide Colon Cancer Control Coalition, 185 the Boston Breast Cancer Equity Coalition, 186 and the Chicago Cancer Health Equity Collaborative 187 . For example, inception of the New York Citywide Colon Cancer Control Coalition was in 2003 and has coincided with the elimination of disparities in screening colonoscopy between White people and Black or Hispanic people in New York City 188 …”

Section: Programs and Resources Targeting Cancer Disparitiesmentioning

confidence: 99%

American Cancer Society’s report on the status of cancer disparities in the United States, 2023

Islami,

Baeker Bispo,

Lee

et al. 2023

CA A Cancer J Clinicians

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In 2021, the American Cancer Society published its first biennial report on the status of cancer disparities in the United States. In this second report, the authors provide updated data on racial, ethnic, socioeconomic (educational attainment as a marker), and geographic (metropolitan status) disparities in cancer occurrence and outcomes and contributing factors to these disparities in the country. The authors also review programs that have reduced cancer disparities and provide policy recommendations to further mitigate these inequalities. There are substantial variations in risk factors, stage at diagnosis, receipt of care, survival, and mortality for many cancers by race/ethnicity, educational attainment, and metropolitan status. During 2016 through 2020, Black and American Indian/Alaska Native people continued to bear a disproportionately higher burden of cancer deaths, both overall and from major cancers. By educational attainment, overall cancer mortality rates were about 1.6–2.8 times higher in individuals with ≤12 years of education than in those with ≥16 years of education among Black and White men and women. These disparities by educational attainment within each race were considerably larger than the Black–White disparities in overall cancer mortality within each educational attainment, ranging from 1.03 to 1.5 times higher among Black people, suggesting a major role for socioeconomic status disparities in racial disparities in cancer mortality given the disproportionally larger representation of Black people in lower socioeconomic status groups. Of note, the largest Black–White disparities in overall cancer mortality were among those who had ≥16 years of education. By area of residence, mortality from all cancer and from leading causes of cancer death were substantially higher in nonmetropolitan areas than in large metropolitan areas. For colorectal cancer, for example, mortality rates in nonmetropolitan areas versus large metropolitan areas were 23% higher among males and 21% higher among females. By age group, the racial and geographic disparities in cancer mortality were greater among individuals younger than 65 years than among those aged 65 years and older. Many of the observed racial, socioeconomic, and geographic disparities in cancer mortality align with disparities in exposure to risk factors and access to cancer prevention, early detection, and treatment, which are largely rooted in fundamental inequities in social determinants of health. Equitable policies at all levels of government, broad interdisciplinary engagement to address these inequities, and equitable implementation of evidence‐based interventions, such as increasing health insurance coverage, are needed to reduce cancer disparities.

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Outside Our Walls: the Case for City-Wide Collaboration to Reduce Disparities

Cited by 2 publications

References 3 publications

Development of a workflow process mapping protocol to inform the implementation of regional patient navigation programs in breast oncology

Development of a workflow process mapping protocol to inform the implementation of regional patient navigation programs in breast oncology

American Cancer Society’s report on the status of cancer disparities in the United States, 2023

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