Improving and Using Data
Award recipients in CDC’s National Breast and Cervical Cancer Early Detection Program have found many innovative ways to help those in need of cancer screening get the tests they need. Below, we share highlights from some programs that took steps to ensure patients’ screening data were correct and used data to reach women who needed cancer screening services.
Texas Makes Sure Screening Data Are Correct
During a quality assurance review in 2016, the Texas Breast and Cervical Cancer Services program noticed an increasing number of errors in their computer system about the women it served. This was a problem because it is important to make sure that women receive timely, appropriate, and high-quality care.
In the Texas program, multiple contract organizations enter data in their computer system. Some had entered the data incorrectly even though they received training every three months. The program couldn’t tell which contract organization entered the wrong data, which made it harder to correct the errors.
The program’s data manager started a new process to provide more specific feedback and support to each contract organization. This feedback included a full list of errors along with instructions on how to correct the errors. The program also held one-on-one calls with contract organizations to solve the problems quicker.
As of April 2019, the program saw far fewer errors. The Texas Breast and Cervical Cancer Services staff now work more closely with contract organizations; as a result, they feel more comfortable asking for help if needed. This commitment to having accurate data helps the Texas program and CDC ensure high-quality cancer screening services nationally.
Data Help Reduce Screening Disparities in Louisiana
The Louisiana Breast and Cervical Health Program prioritizes serving members of racial and ethnic minorities who are dying of breast cancer at a higher rate than White women in the state. However, program staff didn’t know where women who were eligible for the program lived and whether their efforts were reaching their intended audience.
To address this, the program used the U.S. Census Bureau’s Small Area Health Insurance Estimates and American Community Survey data to identify the areas within the state with high rates of death due to breast cancer. The program created community profiles, which included estimates of age, income, geography, and race and ethnicity. It also collected information about doctors in those areas. The program used the community profiles to plan screening services and activities and help doctors meet the needs of women in those communities.
During fiscal years 2016 through 2018, 47% of the women served were Black and 18% were Latina, a large reach into these communities.
Data Sharing Agreement Helps More Women Get Screened in Montana
The Montana Cancer Control Program wanted to help clinics increase the number of patients who were screened for breast and cervical cancer. The Bozeman Health Deaconess Hospital operates a mammography van. The Gallatin City-County Health Department wanted to enroll the women who got mammograms on the van in the Cancer Control Program’s screening voucher program. For two years, they worked to build a partnership, resulting in the hospital and the Cancer Control Program signing an agreement to share information about the patients who got mammograms on the van. Before they get a mammogram on the van, women now sign a privacy release statement giving the health department and the Cancer Control Program permission to use their information for tracking purposes.
A contractor for the Cancer Control Program attends at least three-fourths of the mammogram van events to get information about the patients so that each can receive follow-up services. The program helps patients get cancer screening tests or more follow-up tests and refers them to other chronic disease prevention programs if needed. As a result, in 2019, more women are using breast and cervical cancer screening vouchers, and more women are getting screened at the hospital.
Arkansas Program Uses Data Maps to Increase Breast Cancer Screenings
Arkansas has some of the lowest breast and cervical cancer screening rates in the U.S. Rural counties have trouble maintaining enough mammography facilities, doctors, and treatment centers, and have high numbers of cancer cases. From 2017 to 2019, the number of counties with mammography facilities dropped from 31 to 26.
Using data from women who got mammograms, a national health survey, and the state cancer registry, the Arkansas BreastCare and Cancer Survivorship Program made maps showing which counties needed the most help. The maps showed counties with high numbers of women who never had a mammogram or whose last mammogram was more than two years ago, places where women could get a mammogram in each county, and counties with high rates of women getting and dying from breast cancer. The maps, called data maps, helped the program figure out how to reach women most in need.
Informed by the data maps, the program offered mammograms at the Arkansas State Fair, and 19 women were screened for breast cancer there. Of those women, six had never had a mammogram and 12 had a mammogram more than two years ago. From 2018 to 2019, the program has used the data maps to raise the total number of women screened from nearly 11,000 to nearly 13,000. The number of women who used its mobile mammogram service increased from nearly 1,000 to more than 1,350, and the number of women enrolled in the program grew from about 220 to more than 300. During this time, 102 cases of precancer were found.
The data maps guided other new activities to reach women who found it hard to get screened. For example, the mobile mammogram service was expanded. Program staff educated women in shelters, recovery and addiction centers, and prison rehabilitation facilities about the importance of getting mammograms and helped them enroll in the program. The program worked with the Arkansas Coalition of Marshallese to refer women to a community health system and helped them design educational brochures in their native language.
Using Data to Identify Target Population in New Hampshire
“The Let No Woman Be Overlooked Program saved my life! I hadn’t been to the doctor in more years than I can remember, and I had found a breast lump. I didn’t know what to say when I called, and I was scared and afraid of what they might find during my appointment. I ended up being diagnosed with breast cancer, but at an early stage. Through the kindness, support, and resources made available to me through the program and staff, I was able to get the care and treatment I needed and am alive today because of it!”
In 2018, the New Hampshire Breast and Cervical Cancer Program used a national data source (the U.S. Census Bureau, American Community Survey) to find areas in the state where more women may need its breast and cervical cancer prevention and screening services. The program found places where many people have low incomes, little or no health insurance, disabilities, and trouble getting transportation; some are ethnic minorities, some don’t speak English, and some are single mothers.
The program used this information to contract with health care systems in the identified areas to focus services, outreach, and patient navigation to serve more women in need in 2019 and beyond.
More Detailed Reports Help Calculate Cancer Screening Rates in Colorado
In 2014, Women’s Wellness Connection Colorado funded community organizations and health systems to make it easier for residents to get screened for cancer. Those funded partners were asked to report on how well they were reaching women. The combined information in the reports did not have enough detail for the program to know which activities worked best for the groups of women they were trying to reach. Also, the funded clinics could not tell which women were being screened for cancer as a result of these community efforts.
In July 2018, Women’s Wellness Connection Colorado developed a data collection guide and a web portal for partners to report information on the women who were helped through the program. The program reviewed the data regularly to look for unclear data that needed follow-up. Also, when possible, they connected the data in the portal with screening data reported to CDC to make sure all of the information was correct.
The web portal lets Women’s Wellness Connection Colorado see how funded partners are helping women in the community and whether their efforts are increasing the number of women who get screened. The program can see the type of help each woman received, how it was received, and whether she was screened. Partners also can get quarterly reports from the portal to see how they are doing.
After the funded partners began to report data for individual patients instead of combined data, the program was better able to calculate cancer screening rates. For instance, breast cancer screening rates went up from 48% to 63%. The program now has the information it needs to know whether outreach efforts are working and which factors lead to success.
Data Validation Decreases Missed Cancer Screening Numbers in Missouri
Missouri’s Show Me Healthy Women Program helped review medical records in eight federally qualified health centers in southeast Missouri in late 2018 and learned that they were not reporting cancer screening numbers correctly. Clinic staff were not entering screening information in the part of the computer system that doctors could access, and patient-reported screenings were entered in the system without test results.
Staff who greatly supported making the clinic better, called quality improvement champions, reviewed each clinic’s workflow and trained doctors and nurses on how to enter cancer screening information into the computer correctly. The quality improvement champions also trained clinic staff on how to upload paper copies of test results from other clinics, and made it easier for clinic staff to request patients’ test results. Patients now complete a release of information form so the clinic can get their medical records from other clinics. Patients who are referred to other clinics for tests are also given a business card with contact information, including a fax number, to send test results back to the clinic.
The computer highlights patients with outside tests and tells staff if the results are not received by a certain time. Also, each clinic has a person who answers questions about record reviews and is responsible for staff training. Every week, 10% of each clinic’s records are checked by a quality control team to make sure they are right. As of late 2019, doctors at the clinics now get better reports each month telling them how well they’re doing.