Health Care Delivery and Health Policy: Serving Women's Needs

If research findings are going to lead to action and change, gathering information that will be important for policy makers at the national, state, and local level is vital. Research in this area is aimed at developing strategies to serve women more effectively by investigating the organizational and sociopolitical context of breast cancer prevention, detection and treatment.

The BCRP funds research aimed at making the health care system more responsive to the needs of women with breast cancer and better at preventing the disease. We're looking at ways to cut waste and increase access to breast cancer care. And we encourage research on actions that will reduce inequalities in access to breast cancer services among California's geographically and ethnically diverse population The BCRP encourages more research in this area.

Research Conclusions

The Breast Care Center: Innovative Care for the Underserved

Imperfections in the coordination of care and provider communication adversely affect the cancer care provided in many facilities. The problem is particularly severe for patients with advanced disease, as is often the case with indigent patients. Jay K. Harness, M.D., at the Northern California Cancer Center, Union City conducted a study of the effectiveness of Breast Care Centers in bridging the gap between professionally-trained providers and indigent patients with breast cancer. The project's goal was to foster care for indigent women with breast cancer at the highest professional level, which makes it more likely that the women will follow appropriate recommendations. Dr. Harness evaluated the experience of women treated at the Highland Campus of the Alameda County Medical Center, which is working to develop a Breast Care Center.

When he compared women treated at a Breast Care Center to those treated in a general hospital setting, he found differences in: family backgrounds; medical care histories; the short term effects of the care; the psychosocial effects of being evaluated for clinically suspicious findings; and satisfaction with different aspects of the care received. He found that disorganization and delays were major problems with the care. Many of the difficulties were linked more to institutional coordination problems than to the low income or cultural backgrounds of the patients. To address this, the project team developed, and implemented at Highland, a prospective computerized database.

The database generates concise summaries of current patient status and clinical recommendations made by the Highland Tumor Board, and facilitates tracking the system's adherence to these recommendations. Steps have been made to extend this approach to cancer care in other facilities. The database techniques and a relatively inexpensive organizational model can improve coordination of care and communication among providers in different facilities. This will foster more consistent and timely provision of care.

Study of Inadequate Follow-up of Mammographic Abnormalities

Daramola Cabral Evins, Dr.P.H., P.A., of the San Francisco Department of Public Health, Arthur H. Coleman, M.D., of the Bay View Hunters Point Health Care Task Force, and Marion M. Lee, Ph.D., of the University of California, San Francisco investigated barriers to African American women getting timely follow-up care when they have abnormal mammograms. Working with breast cancer experts, they developed and pilot-tested a culturally specific questionnaire in community focus groups that included a total of 51 African American women with abnormal mammograms. The team found that factors in the personal and social environment of women, as well as in the health care delivery system, are associated with inadequate follow-up of abnormal mammograms. Barriers included lack of access to care, previous dissatisfaction with the health care system, competing family priorities, and inadequate physician communication. The need for information and social support were also important. The women in the study expressed fear most often, which they linked to the expectation of a painful mammogram procedure and the possibility that the results might reveal cancer. Fear was also linked to the loss of a breast or breasts. Fear was both a barrier and a promoter to follow-up of abnormal mammograms and was often the cause of denial. The investigators are planning a full-scale study of inadequate follow-up.

Research in Progress

Research Initiated in 2000