Predominately African American Community Areas.

Non- African American Community Areas.

Hospitals with American College of Surgeons Approved Cancer Programs

LIFTING ALL BOATS: Quality Improvement as a Means to Reducing Racial Health Disparities

Anne Marie Murphy, PhD1, Danielle Dupuy, MPH 2, Garth Rauscher, PhD 3, Terry Macarol, RT(R)(M)(QM)C-BPN-IC 4, , Ryan Alvarez, MS 2. (1) Chicago Breast Cancer Quality Consortium, Metropolitan Chicago Breast Cancer Task Force, 1645 W. Jackson Blvd., Suite 450, Chicago, IL 60612. (2) Chicago Breast Cancer Quality Consortium, The Metropolitan Chicago Breast Cancer Task Force, 1645 W.

Jackson Blvd., Suite 450, Chicago, IL 60612. (3) School of Public Health, University of Illinois at Chicago, Division of Epid/Bios (M/C 923), 1603 West Taylor Street, Chicago, IL 60612. (4) Advocate Health Care, 2025 Windor Dr, Oak Brook, IL, 60523.

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The City of Chicago:In 2007, research was published that demonstrated a large and growing disparity in breast cancer mortality between Black and White women in Chicago. In 1980, the rates were roughly similar. Between 2005-2007 however, the mortality rate from breast cancer among Black women in Chicago was 62% higher than the White rate

looking across a 3 year average. Findings suggest that this disparity is a result of both access and system issues. When looking at access to care, the location of American College of Surgeons approved Cancer Programs were largely absent in communities of color where breast cancer mortality rates were the highest . When thinking about Chicago as opposed to other urban areas, Chicago’s breast cancer mortality disparity is one of the highest in the nation, higher than New York City or the U.S. as a whole. This data suggests that there are system of care issues that need to be addressed.

In response to the evidence, a ‘Call to Action’ Summit was held that brought together clinicians, researchers, breast cancer survivors and other interested community members. Three areas were hypothesized to be at the root cause of the disparity: Access to Mammography, Quality of Mammography and Quality of Treatment. From the Call to Action Summit, a report was released in October 2007 detailing 37 recommendations to Chicago on how to improve breast cancer outcomes for all women in the city. One recommendation was to develop a Consortium of Chicago area health care institutions that would review quality data and implement quality improvement interventions around breast cancer screening and treatment.

All Screening Measures: - Recall Rate - Loss to Follow up Imaging - Loss to Follow up Biopsy- Cancer Detection Rate- Proportion of minimal cancers- Proportion of early stage cancers

All Treatment Measures: - % Received Radiation Therapy after breast conserving surgery - % Tested for Hormone Receptors - % ER/PR + that received hormonal therapy - % Tested for HER-2 - % HER-2 + that were recommended for herceptin

The Consortium far exceeded it’s initial goal of bringing 10 institutions on board. This important quality endeavor has solicited participation from 53 institutions representing over 70% of mammography in Metropolitan Chicago. We credit this high level of participation not only to our diverse and involved board but also to the fact that the Consortium is the first Patient Safety Organization (PSO) dedicated exclusively to breast health. This federal designation as a PSO provides protection around the data that is collected assigning it’s use strictly for the purpose of quality improvement.

The first round of data collection resulted in submissions from a total of 40 sites . Institutions could submit on screening data , treatment data or both and by race where possible. Specifically we asked for data pertaining to screening and treatment measures for a patient population screened for or diagnosed with breast cancer in calendar year 2006.

Data Collection(Cycle 1)

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1st Symposium:Based on the high level of participation and the energy around this project, the Consortium teamed up with Med-IQ and the Illinois Hospital Association to put on its first symposium: “Improving Quality and Reducing Disparities in Breast Cancer Care and Outcomes”. Representatives from over 60 institutions attended the event. Multi-disciplinary teams in breast care from participating hospitals discussed the significance of the data and the challenges they deal with in their attempts to deliver high quality breast care.

Continuing the Fight for High Quality Breast Cancer Care

A BIG JOB AHEADAs of October 18, 2010 the state of Illinois announced the

implementation of SB 1174: the Reducing Breast Cancer Disparities Act. As part of the implementation of the bill, the state will be requiring all Illinois hospitals to report quality data to the Chicago Breast Cancer Quality Consortium: an amazing demonstration of the states’ commitment to quality health care.

We will continue to work with all hospitals to help assess quality and implement improvement interventions.

In working to address the disparities through quality improvement, the Consortium does not just gather data. We are dedicated to helping institutions acquire the resources they need to implement quality improvement interventions. We have received a second Komen grant to:1. Take a deeper look into the results of our first cycle of data collection, and the processes in breast care that are integral to quality 2. Determine appropriate interventions and provide resources to institutions to implement them. Next Steps (in short):• Begin Cycle 2 of data collection in January, 2011 to gather information on

patients screened with mammography or diagnosed with breast cancer in calendar year 2009

• Begin to look into the role of the primary care provider • Begin to look at quality of survivorship care• Implement the 2nd Komen Grant

Predominately African American Communities

Non African American Communities

Chicago Community Areas with the Highest 2000 -2005 Average Annual Breast Cancer Mortality Rates

Hospitals with American College of Surgeons approved Cancer Programs

Prepared by the Sinai Urban Health Institute

Black and White Breast Cancer Mortality Disparity (3-year averages) New York City, U.S. & Chicago, 2005-2007

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The Chicago Breast Cancer Quality Consortium

Cancer Detection Rate= cancers found/1000 screening mammograms

ACR benchmark: 2-10 cancers/ 1000Our benchmark: 4-9 cancers/ 1000

Proportion Minimal Cancers= # of cancers, DCIS or ≤ 1 cm )/ # of cancers found

ACR Benchmark: > 30%Our Benchmark: > 30%

Follow-up Imaging= Abnormal Mammograms with no follow-up

imaging)/ Total abnormal mammogramsACR Benchmark: NoneOur Benchmark: < 20%

Timely Treatment= Patients receiving treatment within 30 days of

diagnosis/ All patients receiving treatmentOur benchmark: ≥ 80%

Radiation after BCS=Patients receiving radiation after BCS/ All

patients who had BCSOur benchmark: ≥ 80%

Hormone Receptor Testing=Patients who were tested for hormone

receptors/ All patients diagnosed with cancerOur benchmark: ≥ 80%

Characteristics of Mammography Services Offered, by Race, to Women Living in Chicago (2007)

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It is known that access and quality of care can vary by race. In the city of Chicago it is likely that such differences play a major role in the mortality disparity.

Presented by: Terry Macarol RT,(R)(M)(QM)C-BPN-IC