Abstract P5-14-04: Alleviate the pain in the system: Using process improvement and systems design tools to strive for a high quality breast healthcare system in the District of Columbia metro area.
Authors: Brousseau MK , Graham L , Kaye P , Nolan T , Moraras N 
Published: August 2014

Background: Throughout the District of Columbia Metro Area, breast cancer mortality rates are higher than the national average due in part to limited service coordination and lack of access to breast health services along the continuum. The Primary Care Coalition of Montgomery County (PCC) and the Regional Primary Care Coalition (RPCC) are collaborating to improve the efficiency and effectiveness of breast cancer screening, referral, and follow-up so that jurisdictions and clinics in the DC metro area are better positioned to provide 100% low-income women residents with access to breast healthcare. The Regional Initiative builds upon the successes of the PCC Breast Healthcare Process Improvement Project.

Objectives: 1) Adopt the Primary Care-Based Model in three clinics in three other jurisdictions and implement process improvement approaches to show improvements in breast cancer screening, referral, and follow-up; and 2) Develop a cross-jurisdiction learning community to enhance spread throughout the Region.

Methods: The Regional Initiative employs a multi-tiered learning community framework to share data, address systems level barriers, and design new systems for the provision of high-quality care regardless of insurance status. Partners use the Model for Improvement to improve processes at the micro-system level and system design theory drives larger systems changes.

Results: Objective 1: The three adaptation sites represent Prince Georges County, Maryland, Washington, DC, and Fairfax Virginia. After a year of focused process improvement, partnership development, and data collection, initial analysis demonstrates: – All three clinics show increased screening rates approaching 65%, representing the 90th percentile performance in the Healthcare Effectiveness Data and Information Set (HEDIS) for Medicaid breast cancer screening.– At Greater Baden Medical Services in Prince Georges County, Maryland, cycle time between referral and mammography screening decreased from 48 to 27 days.– The Community Health Care Network, Fairfax County, Virginia, worked closely with one mammography provider to decrease the no-show rate for mammography appointments from 26% to 6%.– The Project Team developed a change package to share recommended interventions and successful strategies that have been tested and documented, and can be used by clinics certified as primary care medical homes or in the process of adopting those standards.

Objective 2: The Cross-Jurisdiction Learning Collaborative brings representatives from each jurisdiction together to share breast health measures, success stories, and plan/discuss process improvement activities from a regional perspective. Participants include over 50 breast health providers from around the region: – 17 safety-net clinics– 11 hospital and/or mammography providers– All County and/or State National Breast and Cervical Cancer Early Detection Programs in the Region

Next Steps: Spread learnings regionally and nationally to foster collaboration, replicate the PCC Primary Care-Based Model using the change package, and further improve breast health outcomes for the safety-net population.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P5-14-04.