Patient Navigation Process Standard 3.1 September 9, 2013

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.

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.

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

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

Demographics Target region TUH Zip codes (13 zips) Population size - 589,168 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.

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.

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

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

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

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

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

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

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

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%

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

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

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%

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%

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

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

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%

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

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

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%

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 18-39 had lower rates compared to Philly zip codes

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

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%.

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

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

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

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