For the health centers without mammogram equipment, staff refer patients to the most convenient breast cancer screening location. Centers then receive results via paper or fax, which are then attached manually to a patient’s record. This former workflow and lack of technology integration created a pitfall for clinicians and patients.
- It was difficult to track patients who did not get a mammogram,
- the hard copy file made it a challenge to interpret screening results, and
- critical patient follow up plans could be overlooked.
Improving breast cancer screening has the potential to save lives, lower costs, and pilot methods for managing abnormal diagnostics. Using the data analytics tools and a patient registry provided by Azara DRVS, AQuIN set out to improve breast cancer screening rates using a new data-driven model set forth at the Data Summit. Health centers identified patients due for a mammogram using the new patient registry. Once identified, health centers would outreach to patients to encourage screenings and use the DRVS Visit Planning Report to ensure care team intervention at the health center. The new workflow and available referral data also enabled the care team to track mammogram completion.
The availability of structured data and reports within DRVS also empowers AQuIN and their health centers to access accurate, trustworthy performance data. For the first time, they can solve issues and synthesize statewide and health center-based information for funding and advocacy opportunities using real data available at their fingertips.
Methods
Through contracts with the State of Alaska (SOA), APCA staff has the opportunity to work with health centers to retrieve their data and create reports that help identify and manage their populations and provide outreach and patient education on breast cancer screening. Training staff on using the Referral Module as a tracking tool to help manage and coordinate care patients received outside of the health center has been invaluable in providing access to referrals and closing the loop. The contract that allowed for the purchase of the Referral Module required health centers to report their data and work on improvement, incentivizing health centers to quickly learn how to use the tool and develop Plan-Do-Study-Act’s (PDSA) around improving breast cancer screening.
Results
Measuring the use of recommended breast cancer screenings is important for identifying groups that might not be receiving the full benefits of screenings, ultimately resulting in cost reductions and lives saved. By June 2018, four health centers had adopted the use of Azara DRVS. Within 7 months of using DRVS these four health centers improved breast cancer screening rates from 31% to 46% for their patients age 50-74 and realized a potential $1.5 million dollars of savings to the Alaska health system. This 15% improvement set the stage to continue training other health centers to transform their practices using the same data-driven model. As APCA continues to add additional participating health centers to Azara DRVS, Alaska’s breast cancer screening rates continue to improve; currently breast cancer screening rates among Alaska health centers using Azara DRVS is at 52%.
Scalability
Health centers are now using the new workflows and available data to improve breast cancer screening rates at their sites. The scalability of the data-driven model has enabled the Alaska PCA to acquire additional funding from the Centers for Disease Control (CDC) through the State of Alaska (SOA), Alaska Native Tribal Health Consortium (ANTHC), and the National Association of Community Health Centers (NACHC). They are expanding use of the data-driven model of care to improve measures for additional cancer screenings, diabetes, hypertension, and immunizations.