WellSpan Working to Make MAMMOGRAMS MORE AVAILABLE TO ALL

Julie Dionne put off getting a mammogram for about five years.

But after her cousin died from breast cancer and a friend was diagnosed with the disease last summer, she realized the dangers of ignoring the screening procedure.

“It was top of my mind,” says Julie, a 49-year-old mother of five children, who lives in Lancaster County. “I knew I needed to take care of it.”

Then her providers at WellSpan Family Health – Georgetown told her she could easily get the breast cancer screening on WellSpan’s mobile mammogram coach when it came to their office in rural, southeastern Lancaster County. So, in mid-November, Julie got a mammogram, which was negative for any issues.

“Robin (Robin Skosko, a nurse practitioner at Georgetown) talked about how I should do it,” Julie said as she waited for her appointment on the coach in its cozy, well-lit space on a rainy November day. “This seemed a little less intimidating to me, not being in a busy medical building.”

The mobile mammography coach — which looks like a giant blue and pink bus and takes advanced breast cancer screening directly to where people live and work — is just one way that WellSpan is working on reducing inequities in breast cancer screening rates among different demographic groups.

WellSpan was recently recognized for this work by being named a top finalist for the 2022 Bernard J. Tyson National Award for Excellence in Pursuit of Healthcare Equity Award. Established by The Joint Commission and Kaiser Permanente, the award recognizes health care organizations that directly deliver health care and their partners that led initiatives that achieved a measurable, sustained reduction in one or more health care disparities.

WellSpan began addressing discrepancies in breast cancer screening rates by digging into its electronic health record to examine the rates among different racial groups and designing ways to improve its outreach to underserved communities. This is part of WellSpan’s vision to be a trusted partner committed to improving access to care to all patients it serves.

What the health record revealed was that white women had a screening rate of 71 percent, as compared to 69 percent for Black women, and 70 percent for Hispanic women in November 2021. After WellSpan worked on improving rates, rates rose for all groups, increasing to 75 percent for white women, 74 percent for Black women, and 76 percent for Hispanic women by June 2022.

“One of the few things we can do to improve survivability with late-stage cancer is to diagnose it early,” said Dr. Carlos Roberts, the vice president and chief medical officer of women’s and children’s services at WellSpan, who oversaw the breast cancer screening project. “We can have a better outcome if we find the cancer sooner rather than later.”

Roberts has a grandmother, aunt, and another close relative who all died from breast cancer, and his sister also battled it. For him, this work was personal.

“Each of these patients is someone’s aunt, someone’s grandmother who, if we get this right, has more time they can spend with their other family members,” he said. “That’s what this work means to me.”

Here are some specific things WellSpan is doing to increase mammogram rates:

EDUCATE PATIENTS.

Focus groups revealed that some Hispanic patients mistakenly thought that most mammograms found cancer, and so they were avoiding the screening, fearing the disease. WellSpan set up meetings with Hispanic patients, using Spanish interpreters, to demystify the test and explain that, in fact, most screenings show no cancer. However, the test is important because the main goal is to catch any disease early so it can be treated earlier and help patients live healthier lives.

ADDRESS FINANCIAL BARRIERS.

WellSpan is working to more quickly identify patients who qualify for either Medicaid and Medicare and help them sign up for the insurance because the two federal insurance programs cover the entire cost of an annual screening mammogram. For patients who do not qualify for those programs nor have health insurance, WellSpan is working to connect them to financial resources to cover the cost. WellSpan also received a grant from Capital Blue Cross to help uninsured women receive screening mammograms on the mobile mammography coach. This grant allowed 50 women to get a screening in the last year.

MAKE IT EASIER TO SCHEDULE A MAMMOGRAM.

WellSpan uses its electronic health record to identify patients who are due for a mammogram and sends them a reminder message via MyWellSpan, the online portal for patients. The message provides a link to easily schedule the test.

MAKE IT EASIER TO GET A MAMMOGRAM.

In its first year, the mobile mammography coach provided mammograms to almost 600 women at 70 screenings at sites including a library, community centers, and local companies. The screenings were held in rural areas like Georgetown, where women do not always have easy access to a mammogram.

In fact, the Georgetown practice was the first WellSpan primary care office to host the coach, in October 2021. The coach returned again in April of 2022 and again in November of 2022, with about 25 patients receiving their mammograms during each visit. Some, like Julie, had not received a mammogram in quite a while but were attracted by the convenience of getting one on the coach parked right outside the practice, said Tyler Barnett, office manager. In fact, the practice has seen a nearly 50 percent increase in the number of patients who received their annual screening mammography since the coach began making visits to the practice.

The coach also has visited Delta, a town of less than 800 people in southern York County, close to the Maryland border, and an apple growers’ co-op in Peach Glen, a small community in northern Adams County. The coach also raised awareness by holding tours and sharing information about breast cancer at events that included a women’s motorcycle rally.