Stephen J Inrig1, Robin T Higashi2, Jasmin A Tiro3, Keith E Argenbright4, Simon J Craddock Lee5. 1. University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX75390-9066, USA. Electronic address: sinrig@msmu.edu. 2. University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX75390-9066, USA. Electronic address: robin.higashi@utsouthwestern.edu. 3. University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX75390-9066, USA; Harold C. Simmons Comprehensive Cancer Center, 2201 Inwood Road, Dallas, TX 75390, USA. Electronic address: jasmin.tiro@utsouthwestern.edu. 4. University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX75390-9066, USA; Harold C. Simmons Comprehensive Cancer Center, 2201 Inwood Road, Dallas, TX 75390, USA; Moncrief Cancer Institute, 400 W. Magnolia Ave, Fort Worth, TX 76104, USA. Electronic address: keith.argenbright@moncrief.com. 5. University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX75390-9066, USA; Harold C. Simmons Comprehensive Cancer Center, 2201 Inwood Road, Dallas, TX 75390, USA. Electronic address: simoncraddock.lee@utsouthwestern.edu.
Abstract
BACKGROUND: Despite federal funding for breast cancer screening, fragmented infrastructure and limited organizational capacity hinder access to the full continuum of breast cancer screening and clinical follow-up procedures among rural-residing women. We proposed a regional hub-and-spoke model, partnering with local providers to expand access across North Texas. We describe development and application of an iterative, mixed-method tool to assess county capacity to conduct community outreach and/or patient navigation in a partnership model. METHODS: Our tool combined publicly-available quantitative data with qualitative assessments during site visits and semi-structured interviews. RESULTS: Application of our tool resulted in shifts in capacity designation in 10 of 17 county partners: 8 implemented local outreach with hub navigation; 9 relied on the hub for both outreach and navigation. Key factors influencing capacity: (1) formal linkages between partner organizations; (2) inter-organizational relationships; (3) existing clinical service protocols; (4) underserved populations. Qualitative data elucidate how our tool captured these capacity changes. CONCLUSIONS: Our capacity assessment tool enabled the hub to establish partnerships with county organizations by tailoring support to local capacity and needs. Absent a vertically integrated provider network for preventive services in these rural counties, our tool facilitated a virtually integrated regional network to extend access to breast cancer screening to underserved women.
BACKGROUND: Despite federal funding for breast cancer screening, fragmented infrastructure and limited organizational capacity hinder access to the full continuum of breast cancer screening and clinical follow-up procedures among rural-residing women. We proposed a regional hub-and-spoke model, partnering with local providers to expand access across North Texas. We describe development and application of an iterative, mixed-method tool to assess county capacity to conduct community outreach and/or patient navigation in a partnership model. METHODS: Our tool combined publicly-available quantitative data with qualitative assessments during site visits and semi-structured interviews. RESULTS: Application of our tool resulted in shifts in capacity designation in 10 of 17 county partners: 8 implemented local outreach with hub navigation; 9 relied on the hub for both outreach and navigation. Key factors influencing capacity: (1) formal linkages between partner organizations; (2) inter-organizational relationships; (3) existing clinical service protocols; (4) underserved populations. Qualitative data elucidate how our tool captured these capacity changes. CONCLUSIONS: Our capacity assessment tool enabled the hub to establish partnerships with county organizations by tailoring support to local capacity and needs. Absent a vertically integrated provider network for preventive services in these rural counties, our tool facilitated a virtually integrated regional network to extend access to breast cancer screening to underserved women.
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