Equal Hope

BackgroundIn Chicago, Illinois, USA, Black and Latinx populations experienced disproportionate rates of COVID-19 mortality compared to White populations. By February 2023, Black residents had the lowest levels of completing the primary vaccine series of any racial or ethnic group. The Chicagoland CEAL Program surveyed an urban minoritized population about COVID-19 beliefs and vaccination status. The purpose of this study was to evaluate this association and to determine if it could be explained by health care connectedness and discrimination.MethodsResponses were collected from December 2021 to February 2023. Descriptive statistics were used to examine differences by vaccination status. Logistic regression was used to determine associations between each of the eight COVID-19 beliefs and not completing the primary vaccine series. Models were adjusted for sociodemographic factors, health care connectedness, and discrimination.ResultsFrom 760 surveys analyzed, 76% had completed the primary vaccine series. Most participants were women (74%), identified as nH Black (61%), and did not complete higher education (70%). Individuals who agreed that the vaccine was developed too quickly (aOR: 1.55 (0.99–2.43, p = 0.05)) and that the vaccine went against religious beliefs (aOR: 2.72 (1.67–4.43, p = < 0.0001)) had a greater likelihood of not completing the vaccine series.ConclusionBuilding and sustaining trustworthiness should be at the center of messaging surrounding vaccine uptake for Black and Latinx residents in an urban setting. Messaging should consider the importance of religion on vaccine uptake and collaborate with trusted messengers to address negative sentiment towards health behavior recommendations.

TPS6653 Background: Black women are more likely to die from breast cancer than women of any other race/ethnicity. Contributing factors to this inequity include structural and socioeconomic determinants of health, differential access to novel therapies, tumor biology and comorbidities. In 2020, only 7.2% of enrollees in clinical trials that led to approval of 3 novel drugs for breast cancer were Black. Underrepresentation of patients from racial/ethnic minority groups in clinical trials is a contributing factor to health disparities. The first aim of this study is to conduct multiple qualitative methods with multi-level stakeholders to identify barriers, facilitators, and intervention priorities that would assist Black breast cancer patients to make informed decisions about participating in clinical trials. Secondly, we aim to create a culturally sensitive, narrative intervention designed to support decision making and motivate Black breast cancer patients to participate in clinical trials. Aim 3 will pilot a study to determine acceptability of the intervention among patients and assess whether it increases clinical trial participation in a safety net oncology practice. Methods: Community-based participatory research approaches are guiding our research methodologies. First, we are conducting interviews and story circles with Black women with breast cancer, community partners and advocates, and oncologists and clinical trials office staff. These interviews will identify themes to inform intervention content. Next, interviews and focus groups will invite feedback on the educational/motivational content of the intervention and will be used to develop a culturally sensitive script and storyboards. A video production company will produce the narrative intervention. Finally, focus groups and interviews with participant cohorts will provide feedback on the completed intervention. Black women diagnosed with breast cancer will view the intervention in an oncology clinic. Using a pretest/posttest design, we will analyze the acceptability of the intervention and its effect on intention to participate in clinical trials. We will then conduct a quasi-experimental study in a safety net oncology practice to determine whether the rate of clinical trial participation among Black breast cancer patients increases following implementation of the intervention as a standard component of new patient education. Recruitment started in July 2022, and currently, 14 of 30 interviews with patients are completed. Aim 1 interviews with patients, oncologists, clinical trial staff, and advocates are expected to finish by April 2023, and results will be presented.

The goal of this study was to understand the extent to which mammography facilities were able to recover monthly screening and diagnostic mammography volumes to their prepandemic levels and to determine what facility and patient mix factors were associated with recovery. Facilities, located in and adjacent to Cook County, Illinois, were eligible. In all, 58 screening and 30 diagnostic mammogram facilities submitted mammogram volumes by month with a cross-listing of patient ZIP codes by screening volumes. Monthly screening and diagnostic volumes for the 6-month immediate postpandemic period (July-December 2020) and for the subsequent postpandemic period (January-June 2021) were compared with the same months in 2019. ZIP code distributions were used to define patient mix characteristics related to disadvantage. Compared with the prepandemic period, Breast Imaging Centers of Excellence conducted roughly 50 fewer monthly screening mammograms (95% CI: -91, -9) but 50 more diagnostic mammograms (95% CI: 24, 82) on average in the immediate postpandemic period. Facilities serving a predominantly Black population conducted roughly 50 fewer monthly screens (95% CI: -93, -13) without any increase in monthly diagnostics. Highly accredited (and typically higher volume) facilities appeared to actively triage diagnostics, whereas lower resource facilities appeared to struggle to recover to prepandemic volumes without triage to diagnostics. The pandemic disproportionally impacted minority populations already affected by differential access to and utilization of high-quality mammography. Potential explanations are discussed. Policies should be strengthened to facilitate triaging of services during times of stress to the healthcare system.

Abstract Background: The Metropolitan Chicago Breast Cancer Task Force (MCBCTF) began its mission of eliminating Black/White breast cancer disparities in 2007. At the time, Black women in Chicago were 62% more likely to die from breast cancer than their White counterparts; which at the time represented one of the highest breast cancer mortality disparities of any urban area in the nation. Here we describe the current status of this quality improvement program, its successful expansion statewide, the variety of data collection and feedback approaches being undertaken, and some preliminary results. Methods: The MCBCTF created the Chicago Breast Cancer Quality Consortium (consortium) in response to 2007 report of stakeholders that called for such a QI program. The consortium is the first patient safety organization in the nation that addresses breast cancer care. Initially, the consortium collected aggregate counts on screened patients across approximately 50 facilities in metropolitan Chicago. A set of 11 quality benchmarks were based on data from the Breast Cancer Surveillance Consortium. Aggregate counts were used to calculate 11 corresponding measures including those pertaining to recall rate, timely follow up care, and cancer detection. In 2013 the initiative went statewide and was tied to supplemental reimbursement for screening mammography of Medicaid patients to equal that of Medicare. The statewide initiative includes the following data collection initiatives: benchmarks measures described earlier; a mammography facility survey; a survey of radiologists at these facilities; facility counts of the number of screened patients by zip code of residence, an estimate of patient mix regarding recent prior screening (how well screened a facility's patient population is impacts ability to meet benchmarks). Future initiatives will include obtaining an estimate of patient mix with respect to race/ethnicity and age (age affects risk which in turn impacts benchmarks). Data are analyzed and reported back to the facility. Metrics are reviewed and revised after each collection cycle. Results: Data submitted in 2016 for screenings conducted in calendar year 2013 represented over 700,000 screening mammograms performed in Illinois at 174 facilities, representing nearly 80% of Medicaid volume and a 54% increase in facility participation from 2015. In addition, 354 radiologists completed the radiologist survey, providing input on their attitudes regarding audits, and other aspects of performance. Of the 174 participating facilities, 168 facilities submitted patient residential zip codes, allowing the MCBCTF to map where the women each facility serves live. Conclusion: By enabling facilities the opportunity to participate in activities to improve the quality of care, by helping facility staff in collecting and reporting out measures and in feeding results back to institutions, this initiative strives to create substantial change in quality of care that will translate into reductions in breast cancer mortality and mortality disparities. Additionally, understanding the landscape in which women receive care allows the MCBCTF to employ interventions to reduce disparities. Citation Format: Bethliz Irizarry, Garth H. Rauscher, Anne-Marie Murphy. Towards more equitable quality of breast cancer care: The role of the Chicago Breast Cancer Quality Consortium and expansion throughout the state of Illinois. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C68.

Abstract Purpose: The purpose of this study was to use data collected from a recent Metropolitan Chicago Breast Cancer Task Force (MCBCTF) survey to explore racial/ethnic and socioeconomic disparities in access to screening and diagnostic services for breast cancer in Illinois and to compare equitable access to services for Chicago versus the rest of the state. Methods: Facilities that performed mammography were recruited to participate in a quality improvement project that included completing a facility survey. Participants who completed surveys received an increased mammogram reimbursement for Medicaid patients to equal the Medicare rate from the Illinois Department of Healthcare and Family Service. The survey included the following data elements: number of digital and analog machines, number of radiologists dedicated (&amp;gt;75% of their time) to breast imaging and number of general radiologists, number of dedicated and general mammography technicians, monthly volumes of screening and diagnostic mammograms, and whether breast ultrasound, MRI, or image-guided biopsy services were available at the site. In addition, sites reported the percentage of patients who were African-American (AA) or Hispanic, and the percentage of patients who were uninsured and on Medicaid, in categories of &amp;gt;10, 10-25, 25-40, 40-60, 60-75, 75-90, and &amp;gt;90%. Within each patient group defined by ethnicity and health insurance status, we estimated the number of screening mammograms performed separately for facilities with none, partial and sole reliance on dedicated radiologists, and separately by facility availability of breast MRI and image-guided biopsy. In all, 156 out of 359 facilities accredited by the Food and Drug Administration completed the survey, representing approximately 8.2 million screening mammograms conducted in calendar year 2012 in Illinois. Results: Overall, about 3/4 of screening mammograms were performed in nH whites and 4/5 in privately insured patients. Within the city of Chicago, 47% and 30% were performed in ethnic minorities and those without private insurance, compared to 21% and 15% in the rest of the state. Within Chicago, mammograms were more than twice as likely to be performed at facilities relying solely on dedicated radiologists when compared to the rest of the state (39% vs. 17%). In Chicago, non-Hipanic Whites were more likely than their AA and Hispanic counterparts to be screened at facilities relying solely on dedicated radiologists (50% vs. 27% and 15%, respectively) and at facilities with MRI (90% vs. 57% and 71%) and biopsy services (92% vs. 63% and 79%). In a similar manner, privately insured patients were more likely than Medicaid and uninsured patients to be screened at facilities that relied solely on dedicated radiologists (44% vs. 13% and 18%, respectively). When examining equitable access to these services for the rest of the state as a whole, very little was noted in the way of disparities by race/ethnicity or insurance status. Conclusions: Disparities in equitable access to breast cancer screening and diagnostic services exist within Chicago that are generally absent outside of the city. The concentration of academic medical centers within Chicago, while increasing access to quality breast healthcare, has also introduced racial/ethnic and socioeconomic disparities due to unequal access to these academic medical centers. Citation Format: Bethliz Irizarry, Katherine Y. Tossas-Milligan, Garth Rauscher, Anne Marie Murphy. Racial/ethnic and socioeconomic disparities in access to screening mammograms in a statewide sample of mammography facilities in Illinois. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B84.

In a racially and ethnically diverse sample of recently diagnosed urban patients with breast cancer, we examined associations of patient, tumor biology, and mammography facility characteristics on the probability of symptomatic discovery of their breast cancer despite a recent prior screening mammogram. In the Breast Cancer Care in Chicago study, self-reports at interview were used to define patients as having a screen-detected breast cancer or having symptomatic awareness despite a recent screening mammogram (SADRS), in the past 1 or 2 years. Patients with symptomatic breast cancer who did not report a recent prior screen were excluded from these analyses. Characteristics associated with more aggressive disease [estrogen receptor (ER)- and progesterone receptor (PR)-negative status and higher tumor grade] were abstracted from medical records. Mammogram facility characteristics that might indicate aspects of screening quality were defined and controlled for in some analyses. SADRS was more common among non-Hispanic black and Hispanic than among non-Hispanic white patients (36% and 42% vs. 25%, respectively, P = 0.0004). SADRS was associated with ER/PR-negative and higher-grade disease. Patients screened at sites that relied on dedicated radiologists and sites that were breast imaging centers of excellence were less likely to report SADRS. Tumor and facility factors together accounted for two thirds of the disparity in SADRS (proportion mediated = 70%, P = 0.02). Facility resources and tumor aggressiveness explain much of the racial/ethnic disparity in symptomatic breast cancer among recently screened patients. A more equitable distribution of high-quality screening would ameliorate but not eliminate this disparity.

Black women present with later stage breast cancers compared to white women, and their cancers are more likely to be larger, receptor negative, and undifferentiated. This study evaluated black:white differences in the stage and biology of breast cancer among women who had a screening mammogram at one of two Chicago academic medical centers within two years of the breast cancer diagnosis (regularly screened) and compared them to the black:white differences in the stage and biology of breast cancer in women who had not received mammographic screening within two years of a breast cancer diagnosis (irregularly screened.) There were no significant black:white differences in the proportion of early breast cancers (black = 74 %; white = 69 %, p = NS) in the regularly screened population or in the irregularly screened group (black = 60 %; white = 68 %, p = NS.) The regularly screened population received significantly more mammograms (58 % ≥4 mammograms) compared to the irregularly screened population (41 % ≥4 mammograms.) Black women in the regularly screened population were less likely than irregularly screened black women to have estrogen negative breast cancers (26 vs. 36 %, p < .05), progesterone negative breast cancers (35 vs. 46 %, p < .05), and poorly differentiated breast cancers (39 vs. 53 %, p < .05.) White women in the irregularly screened population also had worse prognostic factors than white women in the regularly screened population, though these were not statistically significant. Regular mammographic screening can contribute to the narrowing of black:white differences in presentation of breast cancer.

e16531 Background: In Chicago, Illinois, black women are 62% more likely to die from breast cancer (ca) than white women, a disparity exceeding that of the US (41%) and New York City (27%). Geographically disparate rates may suggest health system drivers of the disparity. The Chicago Breast Cancer Quality Consortium was established in 2008 to examine the quality of screening and breast cancer care to answer the question of whether variations in quality contribute to the known disparity while identify opportunities for quality improvement interventions. Methods: Mammography (mammo) screening data was collected from each site. Treatment (tx) data for each woman with a primary breast ca diagnosis who received her first course of tx at that site was collected. Measures, methods and benchmarks were developed using existing guidelines and approved by expert advisory groups. Analysis was performed to determine if sites could demonstrate they met benchmarks. Results: CY2009 aggregate screening and tx data was collected from 52 and 21 sites respectively. Only 61% (32) of sites could demonstrate that they met &gt;50% of the screening mammo benchmarks, while 76% (16) of sites could demonstrate they met &gt;50% of tx benchmarks. Conclusions: A lower proportion of sites could show they meet quality mammo benchmarks as compared to tx benchmarks. There was room for improvement in both. Further site-specific inquiry is underway to determine if results are reflective of data collection issues or actual quality issues. [Table: see text] [Table: see text]