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Service Delivery Innovation Profile

Monthly Clinic Enhances Access to Culturally Competent Cancer Screening and Primary Care for Rural, Low-Income Hispanic Women Over Age 40


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Snapshot

Summary

The Celebremos La Vida program, a collaboration of The Family Health Partnership Clinic and the Contegra Health System, seeks to enhance access to culturally competent cancer screening and educational information to rural, low-income Hispanic women over the age of 40 years. To that end, the program provides a monthly "women's clinic" that offers free breast and cervical cancer screening, preventive health education and information, and attractive amenities such as massages, music, makeup demonstrations, refreshments, and goodie bags. The clinic also provides information on cancer prevention to men who accompany the women. The program enhanced access to cancer screening and increased use of primary care.

Evidence Rating (What is this?)

Suggestive: The evidence consists of results from post-implementation surveys and anecdotal reports from participants.
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Developing Organizations

Contegra Health System; The Family Health Partnership Clinic
The program operates in McHenry County, IL.end do

Use By Other Organizations

As noted, the program also operates in two sites in Washington, DC.

Date First Implemented

2004
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Patient Population

Age > Adult (19-44 years); Gender > Female; Race and Ethnicity > Hispanic/latino-latina; Vulnerable Populations > Immigrants; Impoverished; Age > Middle-aged adult (45-64 years); Vulnerable Populations > Rural populations; Womenend pp

Problem Addressed

Across the United States, there has been a rapid growth in the Hispanic population over the last 20 years. In rural areas, Hispanic women have limited access to primary care providers and lower utilization of preventative care services, including breast and cervical cancer screening.1,2
  • Growing population of Hispanic women: The U.S. Hispanic population has grown from 9 percent of the population in 1990 to an estimated 15.5 percent in 2010.3 McHenry County has experienced a particularly large growth in its Hispanic population. Between 1990 and 2000, this population grew 223 percent, and, as of 2009, Hispanics accounted for more than 11 percent of the total county population.4
  • Lack of access to primary and preventive care: Rural Hispanic women have fewer visits to regular health care providers and lower utilization of breast and cervical cancer screenings.1,2 It is particularly difficult to reach Hispanic women older than 40 years, as they are no longer in their reproductive years and often go greater lengths of times between visits than younger women.

What They Did

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Description of the Innovative Activity

The Celebremos La Vida program, a collaboration of The Family Health Partnership Clinic and the Contegra Health System, seeks to enhance access to culturally competent cancer screenings and information for low-income Hispanic women over the age of 40 years. To that end, the program provides a monthly "women's clinic" that offers free breast and cervical cancer screenings; preventive health education and information; and attractive amenities such as massages, music, makeup demonstrations, refreshments, and goodie bags. Key elements of the program are described below:
  • Partner roles: Contegra Health System provides the space for the clinic at its Contegra Memorial Hospital in Woodstock, while the Family Health Partnership Clinic provides bilingual staff and equipment and covers the cost of the mammograms and pap tests.
  • Outreach to target population: To recruit the difficult to reach population of Hispanic women older than 40 years, Celebremos La Vida initially advertised the clinic at various community groups, neighborhood gatherings, work sites, and English as a Second Language classes at the local community college. After the first few years, the clinic became well known in the Hispanic community, and, as a result, it now depends on word-of-mouth referrals.
  • Monthly clinic: Once a month, the Contegra Memorial Hospital's women's clinic is transformed into the Celebremos La Vida clinic. Portable signs, written in Spanish, are posted to help non-English speakers find the clinic after arriving at the hospital. The clinic offers the following services:
    • Free cancer screenings: The hospital offers mammograms (using equipment already at the hospital) and pap tests (using equipment brought by Family Health Partnership Clinic staff). Bilingual staff provide these services.
    • Health education: Clinic participants and family members receive information on maintaining healthy lifestyles that they can review in the waiting room; men who accompany women to the clinic receive information on how they can prevent cancers that commonly affect men. Information is presented in videos and pamphlets and through one-on-one discussions with bilingual health educators. For example, educators emphasize the importance of being screened for diabetes and high blood pressure and encourage participants and their families to visit the Family Health Partnership Clinic for a checkup.
    • Amenities to encourage participation: To create a welcoming environment and encourage interest in receiving mammograms and Pap tests, the program offers spa-like treatments, such as massage therapy, makeup demonstrations, and goodie bags that help the women feel pampered. The goodie bag contents come from employee collection drives at Baxter Pharmaceuticals, a local drug manufacturer. Each clinic also features music (e.g., a mariachi band) and refreshments.
  • Assistance in accessing needed followup services: When screening identifies women needing additional medical attention, the program helps them to obtain these services. Women with an abnormal Pap test receive additional examinations and treatment at the Family Health Partnership Clinic during regular business hours. Women with an abnormal mammogram are enrolled in the hospital's charity care program and receive help from the Celebremos La Vida staff to fill out the qualifying paper work. If cancer care is required, the program works with the patient to identify an oncologist who accepts uninsured patients.

Context of the Innovation

Celebremos La Vida is a longstanding breast and cervical cancer screening program, developed by the Prevent Cancer Foundation, which operates in three sites: the Spanish Catholic Center and Georgetown University Lombardi Comprehensive Cancer Center (both in Washington, DC), and the Contegra Memorial Hospital in McHenry County, IL. The program was first implemented in Washington, DC, in 1994, with the McHenry County site added in 2004. The Prevent Cancer Foundation currently provides ongoing technical support to all three sites, including hosting quarterly calls with representatives of all Celebremos La Vida sites to allow them to share successful practices and strategies.

In McHenry County, the program is a collaboration between the Family Health Partnership Clinic, the only nonprofit primary health care clinic serving uninsured and underinsured county residents, and the Contegra Memorial Hospital in Woodstock, a nonprofit community hospital. The clinic and hospital leaders became interested in the program in response to high countywide rates of breast cancer for all populations compared with the surrounding counties and state and the limited availability of preventive/screening services for this population.

Did It Work?

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Results

The program enhanced access to breast and cervical cancer screening, increased use of primary care services, and generated high levels of patient satisfaction.
  • Enhanced access to cancer screening: The program has handled 1,188 patient visits since it began in 2004, an average of roughly 25 women each month. Among those served, 22 percent reported having never before received a breast examination, and 3 percent reported having never before received a Pap test.
  • Increased use of primary care services: Anecdotal reports from participants suggest that the program increased their awareness of health issues and that many later went to the regular clinic for more indepth examinations, especially for the evaluation of diabetes-related conditions. Many of these women and their families began using the clinic as their regular medical home.
  • High levels of patient satisfaction: Program evaluations indicate that participants are overwhelmingly happy with program services and with the friendly, bilingual staff.

Evidence Rating (What is this?)

Suggestive: The evidence consists of results from post-implementation surveys and anecdotal reports from participants.

How They Did It

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Planning and Development Process

Key steps in the planning and development process included the following:
  • Building on close working relationship: Before program implementation, the hospital and clinic had a good working relationship. Leaders at the two organizations built on this relationship, working closely together to determine program logistics, including payment arrangements, clinic location, equipment, schedule, and other operational details.
  • Determining how to provide followup care: A crucial detail involved how to assist patients with abnormal results in accessing followup care. The hospital agreed to provide free care after the detection of a breast lump, while the Family Health Partnership Clinic agreed to provide followup after an abnormal Pap test.

Resources Used and Skills Needed

  • Staffing: Program staff include a part-time coordinator, two nurses, one interpreter, and one bilingual clerk, all of whom are Family Health Partnership Clinic employees. An additional nurse practitioner works only during the monthly Celebremos La Vida clinic.
  • Costs: Total program costs are roughly $80,000 a year, or roughly $306 per patient visit. Major expenses include the cost of providing breast examinations, mammograms, Pap tests, pathology readings, refreshments, educational materials, and amenity-like services.
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Funding Sources

Gavers Community Cancer Foundation; Prevent Cancer Foundation
The program was initially implemented through funding provided by the Prevent Cancer Foundation. The Gavers Community Cancer Foundation also currently provides program funding to the Family Health Partnership Clinic.end fs

Adoption Considerations

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Getting Started with This Innovation

  • Develop and maintain close relationship among partners: Partners who have a close working relationship are better able to address the many logistical and operational details that arise as the program is planned and launched.
  • Develop plan for followup after abnormal results: The program's ultimate effectiveness depends on providing followup care to women with abnormal test results. Thus, it is critical to identify a process for assisting women in accessing this care.
  • Create checklist for equipment: Creating a master checklist can help to ensure that all necessary equipment is available at the clinic each month; this step is especially important if equipment must be transported to the clinic site.

Sustaining This Innovation

  • Continually pursue funding: Ongoing funding is required to maintain the program; potential sources of funds include local and state government agencies and local and national foundations.

Use By Other Organizations

As noted, the program also operates in two sites in Washington, DC.

More Information

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Contact the Innovator

Suzanne Hoban, MPH
Executive Director
Family Health Partnership Clinic
13707 W. Jackson
Woodstock, IL 60098
Phone: (815) 334-8987 Ext.15
E-mail: hpclinic@mc.net

Innovator Disclosures

Ms. Hoban has not indicated whether she has financial interests or business/professional affiliations relevant to the work described in this profile; however, information on funders is available in the Funding Sources section.

References/Related Articles

The Celebremos La Vida Web site is available at http://www.preventcancer.org/outreach2c.aspx?id=52.

The Family Health Partnership Clinic Web site is available at http://hpclinic.org/.
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Footnotes

1 Slifkin RT, Goldsmith LJ, Ricketts TC. Race and place: urban-rural differences in health for racial and ethnic minorities. March 2000. Available at: http://www.shepscenter.unc.edu/rural/pubs/finding_brief/fb61.pdf (If you don't have the software to open this PDF, download free Adobe Acrobat ReaderĀ® software External Web Site Policy.)
2 Agency for Healthcare Research and Quality. Health care disparities in rural areas, selected findings from the 2004 National Healthcare Disparities Report. Available at: http://www.ahrq.gov/research/ruraldisp/ruraldispar.htm
3 U.S. Census Bureau. Hispanics in the United States. Available at: http://www.census.gov/population/hispanic/
4 U.S. Census Bureau. State and County Quick Facts for McHenry County, IL. Available at: http://quickfacts.census.gov/qfd/index.html
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Original publication: March 17, 2010.
Original publication indicates the date the profile was first posted to the Innovations Exchange.

Last updated: May 07, 2014.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.

Date verified by innovator: April 25, 2014.
Date verified by innovator indicates the most recent date the innovator provided feedback during the annual review process. The innovator is invited to review, update, and verify the profile annually.