This document summarizes Parkland Center for Clinical Innovation's breast cancer health equity initiative. The initiative aims to understand and address socioeconomic inequities leading to breast cancer disparities. Analysis found late-stage diagnoses were more common for patients without recent mammograms or Parkland touchpoints. Focus groups revealed barriers like cost, transportation, and need for more education. Next steps include expanding data analysis, using data to drive operational and policy changes, and measuring improvements through mobile mammography unit deployment and partnerships.

1. Breast Cancer Health Equity
Using Outcomes to Drive Future Work
Vikas Chowdhry (vikas@pccinnovation.org)
Parkland Center for Clinical Innovation

2. • Integrated Health System for Dallas County, TX
• 1 acute care hospital, 30 community-based outpatient clinics
• Medicaid managed care plan
• 61,000 admissions & 1,000,000 outpatient visits
• Primary teaching hospital for UTSW
• Non-profit, advanced R&D organization
• Focus on:
• Hospital Quality & Safety
• High-Risk Populations
• High Risk Conditions
• By leveraging data science and social determinants of health, we
are able to better support underserved populations across our
community

3. Breast Cancer Health Equity Initiative
3
Part of the AHA
Hospital Community
Cooperative Program
Parkland is 1 of 10 hospitals
selected across the country to
address a health equity issue
Parkland team with
Dr. Esmaeil Porsa,
Charles Horne, Colette
White and Teresita Oaks
leading the program
• Understand socio-economic inequities
that lead to health disparities
• Understand cancer and mammogram
history from Correctional Health Data
• Use outcomes to guide workflows and
operations

4. Plan Of Action
Understand quantitative impact on
outcomes of health inequity across:
Geography
Demographics
Correctional Health
Analyze qualitative data for actionable information
Propose solutions

5. ANALYSIS OF BREAST CANCER REGISTRY DATA
• 890 unique patients in Parkland Breast Cancer Registry Data
• 195 unique patients are late dx (stage 3 or 4)
Quantifying
geographical
health disparities

6. PROFILE OF LATE DX COHORT
Of the 199 cases (195 patients) late dx
122 cases (119 patients) were first diagnosed at Parkland
• Group 1 – 12 cases (12 patients) had mammogram records within one year
of dx
• Group 2 – 110 cases (109 patients) had no mammogram history within one
year
• 89 patients had encounter touchpoints with Parkland within one year of
dx
77 cases (77 patients) were not diagnosed at Parkland

7. PROFILE OF LATE DX COHORT
Of the 199 cases (195 patients) late dx
122 cases (119 patients) were first diagnosed at Parkland
• Group 1 – 12 cases (12 patients) had mammogram records within one year
of dx
• Group 2 – 110 cases (109 patients) had no mammogram history within one
year
• 89 patients had encounter touchpoints with Parkland within one year of
dx
77 cases (77 patients) were not diagnosed at Parkland
Propose building a point of care
alert in EHR

8. 2018 CORRECTIONAL HEALTH DATAANALYSIS
Top 3 Cancers in CH Female Population
8,337 (25.1%) female in
2018 CH population
1,589 (19.1%) eligible
for mammograms (aged
45 to 74 years old)
6,750
not eligible
54 (3.4%) had screening within
last year, if aged 45 to 54 years old;
last two years, if aged 55 to 74 years old.
1,535 (96.6%)
need immediate
screening!

9. 2018 CORRECTIONAL HEALTH DATAANALYSIS
Top 3 Cancers in CH Female Population
8,337 (25.1%) female in
2018 CH population
1,589 (19.1%) eligible
for mammograms (aged
45 to 74 years old)
6,750
not eligible
54 (3.4%) had screening within
last year, if aged 45 to 54 years old;
last two years, if aged 55 to 74 years old.
1,535 (96.6%)
need immediate
screening!
Considering mammogram unit in
correctional health

10. Qualitative Analysis Through Focus Groups
1. Why is a mammogram done?
2. How often do women need to have a
mammogram?
3. What is a self -breast exam?
4. Tell us what you know about breast cancer in
your ZIP Code
5. What can be done in your ZIP Code to reduce
the number of women with advanced breast
cancer?
6. What stops you from getting a mammogram
done?
7. If you had a choice, where is the best place to
get a mammogram done?
8. Who do you talk to when you have questions
about breast health?
9. Where would you feel comfortable talking
about breast health?
What can be done in
your ZIP Code to
reduce the number of
women with advanced
breast cancer?
Finances
Not able to afford
insurance
transportation
have
facility/access in
areas
Education, dates for
people to come for
workshop, show them
how to do breast cancer
examination.

11. NLP ANALYSIS OF FOCUS GROUP QUESTIONNAIRE
12
7
8
18
10
2
3
7
0
2
4
6
8
10
12
14
16
18
20
Anywhere Women Church Doctor's Office /
Nurses
Family Friends Who had breast
Cancer
Others
Q9: Where would you feel comfortable talking about breast health?
NLP provides a scalable way to
quantitatively analyze qualitative
data.

12. Actionability from Qualitative Data
• Need for education:
• In the community
• In primary care clinics
• In oncology
• Mobile mammogram unit deployment needs to be more
strategic
485
662
0 100 200 300 400 500 600 700
2018
2019
(through Aug)
Number of Mobile Unit Mammograms

13. Next Steps
• Expand analysis to TX Cancer Registry Data
• Use Collective Impact framework to drive
operational and public health policy changes
• Use data to measure process and outcomes
improvements