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. 2017 Jun;7(2):349-357.
doi: 10.1007/s13142-016-0427-3.

County-level outcomes of a rural breast cancer screening outreach strategy: a decentralized hub-and-spoke model (BSPAN2)

Simon J Craddock Lee  1   2 , Robin T Higashi  3 , Stephen J Inrig  3   4 , Joanne M Sanders  3 , Hong Zhu  3   5 , Keith E Argenbright  3   5   6 , Jasmin A Tiro  3   5
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County-level outcomes of a rural breast cancer screening outreach strategy: a decentralized hub-and-spoke model (BSPAN2)

Simon J Craddock Lee et al. Transl Behav Med. 2017 Jun.

Abstract

Rural mammography screening remains suboptimal despite reimbursement programs for uninsured women. Networks linking non-clinical community organizations and clinical providers may overcome limited delivery infrastructure in rural areas. Little is known about how networks expand their service area. To evaluate a hub-and-spoke model to expand mammography services to 17 rural counties by assessing county-level delivery and local stakeholder conduct of outreach activities. We conducted a mixed-method evaluation using EMR data, systematic site visits (73 interviews, 51 organizations), 92 patient surveys, and 30 patient interviews. A two-sample t test compared the weighted monthly average of women served between hub- and spoke-led counties; nonparametric trend test evaluated time trend over the study period; Pearson chi-square compared sociodemographic data between hub- and spoke-led counties. From 2013 to 2014, the program screened 4603 underinsured women. Counties where local "spoke" organizations led outreach activities achieved comparable screening rates to hub-led counties (9.2 and 8.7, respectively, p = 0.984) and did not vary over time (p = 0.866). Qualitative analyses revealed influence of program champions, participant language preference, and stakeholders' concerns about uncompensated care. A program that leverages local organizations' ability to identify and reach rural underserved populations is a feasible approach for expanding preventive services delivery.

Keywords: Breast cancer; Health disparities; Health services delivery; Mixed methods; Program implementation; Rural.

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Conflict of interest statement

Funding

This study was funded by the Cancer Prevention Research Institute of Texas (PP120097-Lee), which underwrote the BSPAN clinical screening and navigation program. Additional support was provided by the National Cancer Institute (5P30CA142543) to the Harold C. Simmons Comprehensive Cancer Center and National Institutes of Health (NCATS UL1TR001105) to the UT Southwestern Center for Translational Medicine. Drs. Lee and Tiro are also supported by funding from the Agency for Healthcare Research and Quality (R24 HS022418) to the UT Southwestern Center for Patient-Centered Outcomes Research.

Conflicts of interest

All authors declare that they have no conflict of interest.

Statement of human rights

All study procedures were performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study in accordance with the research protocol approved by UT Southwestern’s Institutional Review Board (STU 022012-009 Lee).

Figures

Fig 1
Fig 1
Screening services by “hub-led” and “spoke-led” counties by month, 2013–2014
Fig 2
Fig 2
County crossover for services by “hub-led” and “spoke-led” counties, 2013–2014
See this image and copyright information in PMC

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