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Integrating proactive health screening and referral into 2-1-1 Matthew W. Kreuter, PhD, MPH* Kate Eddens-Meyer, MPH* Kay Archer AIRS 2009 I & R Training.

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Presentation on theme: "Integrating proactive health screening and referral into 2-1-1 Matthew W. Kreuter, PhD, MPH* Kate Eddens-Meyer, MPH* Kay Archer AIRS 2009 I & R Training."— Presentation transcript:

1 Integrating proactive health screening and referral into Matthew W. Kreuter, PhD, MPH* Kate Eddens-Meyer, MPH* Kay Archer AIRS 2009 I & R Training & Education Conference; Reno, NV; June 3, 2009 *Washington University in St. Louis United Way Missouri

2 Kay Archer

3 Overview Health disparities as a solution Pilot study results The current study Strategic thinking A grand vision

4 Eliminating health disparities by increasing the reach and effectiveness of health information in low-income and minority populations.

5 Health disparities

6 Cancer death rates Men, by county poverty rate Death rate 246 deaths per 100, deaths per 100,000

7 Cancer death rates Low income men, by race Death rate 270 deaths per 100, deaths per 100,000

8 St. Louis, MO

9 St. Louis, MO African American population by census tract, 2000

10 St. Louis, MO Incidence of late-stage breast cancer 2X expected rates for MO, by census tract

11 Why are there cancer disparities? Known differences include… Cancer risk behaviors Early detection Treatment quality Adherence and follow-up care

12 Why are there cancer disparities? Known differences include… Cancer risk behaviors Early detection Treatment quality Adherence and follow-up care

13 Why are there cancer disparities? Known differences include… Cancer risk behaviors Early detection

14 Why are there cancer disparities? Known differences include… Cancer risk behaviors Early detection Proven strategies

15 Why are there cancer disparities? Known differences include… Cancer risk behaviors Early detection Proven strategies Free programs

16 Linking populations with services What have we done to date? Public access computer kiosks Outreach through Laundromats News service for minority serving newspapers Food Stamps, Public Housing FQHCs, CMHCs

17 2-1-1 as part of the solution

18 The promise of A perfect fit? High reach Common mission Existing infrastructure Disadvantaged populations

19 Financial assistance (rent, utilities)71% Material resources (clothes, furniture) 9% Housing (shelter, home repair) 5% Food (pantries) 3% Health 1% Why do people call?

20 Women73-90% Unemployed 54-59% Household income < $15, % Disproportionately minorities Who calls?

21 Pilot study

22 Pilot study November, 2007 – February, 2008 Aim 1: Estimate cancer control needs of callers Aim 2: Determine feasibility of cancer referrals

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26 Mammography Pap testing Colonoscopy HPV vaccine Smoking Smoke-free home policies Assessing six cancer control actions

27 Disparities associated with all of them Effective tests or interventions for all Programs available that provide them for free Why these six?

28 Need at least one85% Need two or more54% Need three or more30% Current cancer control needs of callers Eddens K, Kreuter MW, Archer K. J of Hlth Care Poor & Underserved (under review).

29 No health insurance callers (n=297) vs. Missouri vs. U.S.

30 Current cigarette smoker callers (n=297) vs. Missouri vs. U.S.

31 Has a smoke-free home policy callers (n=297) vs. Missouri vs. U.S.

32 Ever had a colonoscopy (ages 50) callers (n=107) vs. Missouri vs. U.S.

33 Getting a mammogram* (women 40+) callers (n=146) vs. Missouri vs. U.S.

34 Getting a Pap test (women 18+) callers (n=255) vs. Missouri vs. U.S.

35 Pilot study November, 2007 – February, 2008 Aim 1: Estimate cancer control needs of callers Aim 2: Determine feasibility of cancer referrals

36 Mammograms Pap smears Colonoscopies HPV vaccination Smoking cessation Smoke free home policy

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38 Telephone follow-up 2 weeks later - What did they think of the mailed referrals? - Did they make a call and/or schedule an appointment?

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40 Reactions to mailed referrals (n=39) Outcome % Recall getting referral 92% Recall getting mailing 54% Read all of mailing 41% Liked mailing a lot 62% Very easy to understand 67% Called referral agency 26% Made an appointment 13%

41 Willingness to participate Among callers in pilot study 58% agreed to answer cancer risk questions 91% agreed to participate in randomized trial 81% could be contacted at 2-week follow-up

42 Appropriateness of health questions Among callers in pilot study 56% said should be asking about health Only 5% felt health questions were too private 81% were comfortable with mailed health info 100% said health referrals made more appealing

43 How is call length affected? Administer risk assessment and provide verbal referrals Mean = 4:54 minutes Enroll into study Mean = 2:52 minutes

44 Conclusions High level of need among callers Proactive health referrals are feasible via Mailed reminder referrals seem promising

45 What do we still need to learn? Is it scalable? How strong a referral is needed? Does it work equally well for all callers?

46 Current study

47 5-year project, randomized trial October, 2008 – September, 2013 NCI-funded $250,000 to United Way Missouri

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52 Telephone follow-up 1 and 4 months later - Did they contact referrals? - Did they obtain needed services?

53 Telephone follow-up 1 and 4 months later - Did they contact referrals? - Did they obtain needed services?

54 Telephone follow-up 1 and 4 months later - Did they contact referrals? - Did they obtain needed services?

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58 Coach Help callers act on referrals by: Making appointments Providing reminders Arranging transportation Answering questions Addressing barriers Explaining systems

59 1. Which approach works best? 2. Whats the impact on quality indicators? 3. What factors influence effectiveness? Key questions

60 1. Problem resolution 2. Unmet basic needs 3. Sense of coherence - comprehensibility - manageability - meaningfulness Factors that could affect outcomes

61 What will we learn? Need for cancer prevention in callers Effectiveness of referrals for health Added benefit of mailed referrals vs. coaches Effects when original problem is solved by Effects by level of basic needs, SOC

62 Some strategic thinking

63 Five stages of awareness What do health researchers know? Never heard of it Surprised Interested Excited Love

64 Health researchers will love Heres why: Populations served Call volume Existing infrastructure Data system

65 Whos already in love? Some recent recruits to health research UCLA Harvard Wisconsin U. of Washington UNC-Chapel Hill U. of Texas at Houston

66 2-1-1 Cancer research consortium Two primary goals: Describe opportunity for collaborative research Lay out guiding principles for collaboration

67 Collaborating with researchers Whats in it for systems? Rigorous evaluation Data analysis Health programs & services New sources of funding

68 Five big trends that favor New priorities for research and funding Translational research Social impact Prevention Disparities Cancer

69 A grand vision

70 10-year goals for The three pillars Education Income Health Reduced risk Improved health Disease prevention

71 Mission of 2-1-1… Excellence, Everywhere, Always Proactive, Comprehensive, Evidence-based

72 Thank you!


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