title: County-level outcomes of a rural breast cancer screening outreach strategy: a decentralized hub-and-spoke model (BSPAN2).
abstract: Rural mammography screening remains suboptimal despite reimbursement programs for uninsured women. Networks linking non-clinical community organizations and clinical providers may overcome limited delivery infrastructure in rural areas. Little is known about how networks expand their service area. To evaluate a hub-and-spoke model to expand mammography services to 17 rural counties by assessing county-level delivery and local stakeholder conduct of outreach activities. We conducted a mixed-method evaluation using EMR data, systematic site visits (73 interviews, 51 organizations), 92 patient surveys, and 30 patient interviews. A two-sample t test compared the weighted monthly average of women served between hub- and spoke-led counties; nonparametric trend test evaluated time trend over the study period; Pearson chi-square compared sociodemographic data between hub- and spoke-led counties. From 2013 to 2014, the program screened 4603 underinsured women. Counties where local "spoke" organizations led outreach activities achieved comparable screening rates to hub-led counties (9.2 and 8.7, respectively, p = 0.984) and did not vary over time (p = 0.866). Qualitative analyses revealed influence of program champions, participant language preference, and stakeholders' concerns about uncompensated care. A program that leverages local organizations' ability to identify and reach rural underserved populations is a feasible approach for expanding preventive services delivery.
authors.affiliation: University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA. simoncraddock.lee@utsouthwestern.edu.|Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA. simoncraddock.lee@utsouthwestern.edu.
authors.forename: Simon J Craddock
authors.initials: SJC
authors.lastname: Lee
authors.affiliation: University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA.
authors.forename: Robin T
authors.initials: RT
authors.lastname: Higashi
authors.affiliation: University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA.|Mount St. Mary's University, Los Angeles, CA, USA.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Inrig
authors.affiliation: University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA.
authors.forename: Joanne M
authors.initials: JM
authors.lastname: Sanders
authors.affiliation: University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA.|Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA.
authors.forename: Hong
authors.initials: H
authors.lastname: Zhu
authors.affiliation: University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA.|Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA.|Moncrief Cancer Institute, Fort Worth, TX, USA.
authors.forename: Keith E
authors.initials: KE
authors.lastname: Argenbright
authors.affiliation: University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA.|Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA.
authors.forename: Jasmin A
authors.initials: JA
authors.lastname: Tiro
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000453:epidemiology / Q000517:prevention & control*; D003695:Delivery of Health Care / Q000379:methods*; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D007802:Language; D008327:Mammography; D008875:Middle Aged; D015397:Program Evaluation; D036301:Qualitative Research; D012424:Rural Population; D035862:Vulnerable Populations
keywords: Breast cancer; Health disparities; Health services delivery; Mixed methods; Program implementation; Rural