1. Patient Navigation Process
Standard 3.1
September 9, 2013

2. Patient Navigation Process
A patient navigation process, driven by a community needs assessment, is established to address health care disparities and barriers to care for patients.

3. Patient Navigation Process
Prior to establishing the navigation process the cancer committee conducts a community needs assessment at least once during the 3 yr. cycle to identify: the needs of the population served, potential to improve cancer health disparities, and gaps in resources. The results from this community needs assessment can serve as the building blocks for program development, implementation and evaluation. The community needs assessment can be used to guide the initiatives planned to comply with the community outreach standards.

4. Patient Navigation Process
Health Disparities Identified
Description of the Navigation Process
Population served & barriers identified by CNA
Activities & Metrics
Areas for QI & Future Enhancements

5. Community Needs Assessment
Community Health Data Base (CHDB)
* 2012 Southeastern Pennsylvania Household Health Survey
TUH zip codes compared to all Philadelphia zip codes
Identifies areas of higher risk, areas of health disparity
Provides screening rates for PAP, colonoscopy, mammography, and breast exam
Rates are broken down into age, gender, race/ethnicity, insurance status, & poverty status
Supports current initiatives & identifies where resources need to be directed
TUH Zip codes 19111, 19120, 19121, 19122, 19124, 19125, 19132, 19133, 19134, 19140, 19141, 19144, and 19149

6. Demographics Target region TUH Zip codes (13 zips)
Population size ,168
Age - ¾ are over the age 17
Gender
47% male
53% female
Population - <1% growth in next 5 Yrs According to The Nielsen Company
No surprise that Black & Hispanic make up 66% of Temple’s backyard population
* Source: 2012 TUHS Business Intelligence - The Neilson Company, Truven Health Analytics Inc.

7. Demographics 40% have only up to a high school degree
25% of adults 25+have less than a high school degree
44% make <$25K or less
* Source: 2012 TUHS Business Intelligence - The Neilson Company, Truven Health Analytics Inc.

8. Leading Cancers * Source: TUH Cancer Registry 1st – Lung 211 cases
2nd – Prostate 152 cases
3rd – Breast 143 cases
4th – Gyn 130 cases
5th – Colorectal 75 cases
* Source: TUH Cancer Registry

9. Leading Cancers * Source: TUH Cancer Registry
Stg 3 & 4 comprise 35% of all Cancers
* Source: TUH Cancer Registry

10. Leading Cancers – (Lung)
64% of all lung cases are advanced disease, we know survival rates are not very good!
* Source: TUH Cancer Registry

11. Leading Cancers (Prostate)
71% of all cases are early stage, offering more options and ultimately better overall survival
* Source: TUH Cancer Registry

12. Leading Cancers (Breast)
84% of all cases are treated in early stage which provides more options
* Source: TUH Cancer Registry

13. Leading Cancers (GYN) * Source: TUH Cancer Registry
38% of all cases are advanced disease
* Source: TUH Cancer Registry

14. Leading Cancers (Colorectal)
54% of all cases are advanced disease
* Source: TUH Cancer Registry

15. Women Who Had a Pap Test in the Past Year
TUH
Total
Projected %
Yes
98,464
65%
383,348
62% No
54,278
36%
230,836
38%

16. Women Who Had a Pap Test in the Past Year
Pap Test in the Past Year by Race/Ethnicity
TUH
Total
Proj. %
White
Yes
16,774
53%
136,729
56% No
14,915
47%
107,115
44%
Black
55,463
71%
184,254
69%
23,136
29%
82,717
31%
Latino
20,694
60%
40,065
62%
13,995
40%
24,540
38%
Asian
599
48%
6,149
61%
655
52%
3,943
39%
Other
3,641
79%
11,939
959
21%
7,377
Pap Test in the Past Year by Age
TUH
Total
Proj. %
18-39
Yes
45,248
71%
164,127
72% No
18,382
29%
64,841
28%
40-59
39,907
67%
149,223
63%
19,618
33%
87,443
37%
60 & Over
13,308
45%
69,998
47%
16,278
55%
78,551
53%
White & Asian women had significantly lower rates than all women

17. Women Who Had a Pap Test in the Past Year
Pap Test in the Past Year by Insurance Status
TUH
Total
Proj. %
Insured
Yes
87,371
67%
350,322
65% No
42,272
33%
192,186
35%
Not Insured
11,092
48%
33,026
46%
12,006
52%
38,650
54%
Pap Test in the Past Year by Poverty Status
TUH
Total
Proj. %
Poor
Yes
38,462
69%
100,936
62% No
17,344
31%
60,809
38%
Non Poor
60,001
282,412
36,934
170,026

18. Adults 50+ Who Had Colonoscopy/ Sigmoidoscopy in Past Year
TUH
Total
Projected %
Yes
28,180
25%
115,854
22% No
86,354
75%
402,338
78%

19. Adults 50+ Who Had Colonoscopy/ Sigmoidoscopy in Past Year
TUH
Total
Proj. %
50-59
Yes
13,990
23%
53,252
22% No
46,723
77%
191,961
78%
60 and Over
14,190
26%
62,601
39,631
74%
210,377
Adults 50+ Who Had Colonoscopy/Sigmoidoscopy in Past Year by Gender
TUH
Total
Proj. %
Male
Yes
11,921
25%
56,631 No
36,420
75%
170,720
Female
16,259
59,222
20%
49,933
231,618
80%

20. Adults 50+ Who Had Colonoscopy/ Sigmoidoscopy in Past Year
Adults 50+ Who Had Colonoscopy/Sigmoidoscopy in Past Year by Insurance Status
TUH
Total
Proj. %
Insured
Yes
27,222
27%
112,486
23% No
74,517
73%
369,655
77%
Not Insured
958 8%
3,368 9%
11,836
93%
32,682
91%
Adults 50+ Who Had Colonoscopy/Sigmoidoscopy in Past Year by Poverty Status
TUH
Total
Proj. %
Poor
Yes
8,554
25%
23,964
23% No
25,636
75%
79,206
77%
Non Poor
19,626
24%
91,889
22%
60,718
76%
323,132
78%
Uninsured population had a significant decrease in screening rates

21. Adults 50+ Who Had Colonoscopy/ Sigmoidoscopy in Past Year
Adults 50+ Who Had Colonoscopy/Sigmoidoscopy in Past Year by Race/Ethnicity
TUH
Total
Proj. %
White
Yes
2,776 8%
43,442
17% No
30,337
92%
216,493
83%
Black
19,339
32%
57,354
29%
41,542
68%
144,141
72%
Latino
4,185
33%
7,550
31%
8,474
67%
16,886
69%
Asian
117
21%
974
34%
438
79%
1,896
66%
Other
1,432
27%
3,825
24%
3,842
73%
12,434
77%
White population had significantly lower rates compared to all races
Asain population had lower rates compared to Philly zip codes

22. Women Who Underwent a Mammogram in Past Year
TUH
Total
Projected %
Yes
60,061
67%
251,655
65% No
29,379
33%
135,563
35%

23. Women Who Underwent a Mammogram in Past Year
Mammogram in Past Year by Race/Ethnicity
TUH
Total
Proj. %
White
Yes
11,223
51%
104,143
61% No
10,924
49%
66,513
39%
Black
36,712
73%
119,798
69%
13,617
27%
53,269
31%
Latino
9,672
75%
16,466
3,235
25a%
7,430
Asian
378
68%
2,935
76%
178
32%
918
24%
Other
1,509
58%
5,162
53%
1,103
42%
4,628
47%
Mammogram in Past Year by Age
TUH
Total
Proj. %
40-59
Yes
39,244
66%
147,838
62% No
20,180
34%
89,156
38%
60 and Over
20,817
69%
103,816
9,198
31%
46,406
White population had significantly lower rates compared to all races
Asian population had lower rates compared to Philly zip codes

24. Women Who Underwent a Mammogram in Past Year
Mammogram in Past Year by Insurance Status
TUH
Total
Proj. %
Insured
Yes
56,216
70%
237,890
67% No
24,611
30%
118,230
33%
Not Insured
3,845
45%
13,764
44%
4,768
55%
17,332
56%
Mammogram in Past Year by Poverty Status
TUH
Total
Proj. %
Poor
Yes
22,181
71%
59,922
64% No
9,098
29%
34,024
36%
Non Poor
37,880
65%
191,732
20,281
35%
101,538

25. Women Who Have Had a Clinical Breast Exam in Past Year
TUH
Total
Projected %
Yes
99,610
65%
419,352
69% No
52,654
35%
192,085
31%

26. Women Who Have Had a Clinical Breast Exam in Past Year
Women Who Have Had a Clinical Breast Exam in Past Year by Race/Ethnicity
TUH
Total
Proj. %
White
Yes
20,386
66%
160,805
67% No
10,668
34%
81,091
Black
57,942
74%
198,747
75%
20,700
26%
67,694
25%
Latino
16,437
47%
35,426
55%
18,497
53%
29,423
45%
Asian
683
7,007
69%
571
46%
3,088
31%
Other
3,168
68%
12,663
65%
1,523
33%
6,929
35%
Women Who Have Had a Clinical Breast Exam in Past Year by Age
TUH
Total
Proj. %
18-39
Yes
34,802
55%
149,683
66% No
28,483
45%
76,735
34%
40-59
42,389
71%
165,283
70%
17,135
29%
71,476
30%
60 and Over
22,418
76%
104,386
7,035
24%
43,873
Latino population had significantly lower rates compared to all races
Asian population had lower rates compared to Philly zip codes
Ages had lower rates compared to Philly zip codes

27. Women Who Have Had a Clinical Breast Exam in Past Year
Women Who Have Had a Clinical Breast Exam in Past Year by Insurance Status
TUH
Total
Proj. %
Insured
Yes
90,633
70%
384,248
71% No
38,690
30%
156,701
29%
Not Insured
8,976
39%
35,104
50%
13,964
61%
35,384
Women Who Have Had a Clinical Breast Exam in Past Year by Poverty Status
TUH
Total
Proj. %
Poor
Yes
36,399
66%
103,329
65% No
18,982
34%
56,223
35%
Non Poor
63,210
316,023
70%
33,672
135,862
30%
Insurance status had a significant affect on women who had a clinical breast exam

28. Adults who Smoke Cigarettes
TUH
Total
Projected %
Yes
144,738
26%
278,875
23% No
412,428
74%
918,234
77%
Does not Healthy People 2020 target goal of 12.0%.

29. Adults Who Smoke Cigarettes
Adults Who Smoke by Race/Ethnicity
TUH
Total
Proj. %
White
Yes
36,695
22%
85,938
20% No
127,429
78%
343,477
80%
Black
55,991
27%
118,440
151,104
73%
325,201
Latino
36,824
28%
51,414
25%
96,647
72%
153,209
75%
Asian
8,660
31%
11,897
18%
19,249
69%
53,726
82%
Other
2,465
24%
3,323
21%
7,702
76%
12,529
79%
Adults Who Smoke by Gender
TUH
Total
Proj. %
Male
Yes
75,387
31%
145,142
28% No
165,644
69%
383,414
73%
Female
69,351
25%
133,733
20%
246,783
75%
534,820
80%
Male population rates are noticeably higher than Female (6% higher)
Asian population had higher rates compared to other races

30. Unmet Needs In the past year:
Nearly two in five women did not have a pap smear;
One in two White & Asian women did not have a pap smear
One in three women 40+ did not have a mammogram;
One in two White women did not have a mammogram
Latino population had significantly lower rates compared to all races
One in five adults 50+ reported it had been ten years or longer since their last colonoscopy.
White population had significantly lower rates compared to all races

31. Summary
1 out of 4 adults (age 25+) have less than a high school degree
Nearly 1 out every 2 households earns $25K or less
Stg 3 & 4 comprise 35% of all Cancers cases
64% of all lung cases are advanced disease
38% of all GYN/ONC cases are advanced disease
54% colorectal cases are advanced disease
Cigarette smoking is more prevalent in Male adults

32. Next Steps
Develop Targeted Outreach Plans based on Cancer Screening findings
Emphasize patient education & coordination
Promote smoking prevention, interventions, and cessation programs
Cancer Committee Discussion