Transportation Shouldn’t be a Roadblock — Communiride, LLC
Submission Date: February 2020
Entry Type: Case Study
State/Territory Submitted on the Behalf of: Tennessee
States/Territories Involved: Tennessee
Funding Source: NACDD
Other Funding:NACDD funding
Domain Addressed:Community-Clinical Linkages
Public Health Issue:Every day, 14 Tennessee women are diagnosed with breast cancer. Failure to detect breast cancer in the early phase has resulted in Tennessee experiencing the 12th highest breast cancer mortality rate in the US during 2011 and 2015. Although white women are diagnosed at higher rates, black women carry a higher mortality rate, especially in the Memphis/Shelby County zip codes. Access to early detection of breast cancer, regardless of race or socioeconomic status, is critical to increase the chances for successful treatment. Consequences of delayed or inaccessible cancer care are a lower likelihood of survival, higher morbidity of treatment, emotional exhaustion, increased patient and support team stressors, and higher costs of care. Early diagnosis improves cancer outcomes by detecting breast cancer at the earliest stage for the patient and is therefore an important public health strategy. Early diagnosis of symptomatic women and men relies on breast cancer awareness for patients, their community, and health providers. It requires women and men to have timely access to breast evaluations, follow-up diagnostic services, and appropriate cancer treatment. To reduce a physical barrier to care for Memphis/Shelby Co. women and men, we used funding to provide free, non-emergent rides to screening, diagnostic, follow-up, and treatment appointments. We marketed the program as a stress reduction and to provide a sense of independence for the patient. Patients rely heavily on family and friends, but this provides them an option to get to and from appointments without feeling like a liability.
Reference: Cancer in Tennessee 2011-2015
Project Objectives:- Increase number of 50-74 year old women screened on a bienniel basis based on USPSTF recommendations
- Increased number of early stage breast cancer cases detected
- Decrease in mortality rates for black women living in Memphis/Shelby Co.
- Decrease in number of missed appointments (screening, diagnostic, and treatment)
- Reduced environmental stress to patients, their friends, and family
To improve access to care we took a coordinated approach of data analysis, capacity building, and community empowerment. We initially analyzed state data, which demonstrated a higher incidence and mortality rate in the southwest corner of Tennessee. Our epidemiologists concentrated their focus on the Memphis/Shelby Co. zip codes to produce maps demonstrating incidence, mortality, percent of women living in poverty and without insurance, breast cancer risk, and where mobile mammography units traveled. Results of the study were disseminated among state and local officials and citywide stakeholders, validating previously stated concerns for the region. Findings resulted in increased enrollment of mobile units and local vendors as TBCSP enrollment sites. The TBCSP targeted their enrollment efforts in high-risk areas, but have demonstrated increased enrollment across the county in general. Despite these concentrated efforts we were still hearing concern about physically getting to screening facilities. The bus system in the county is limited and laborious; rides which would take 20 minutes by car can take three bus transfers, a half-mile of walking, and 90 minutes to traverse. Traveling for half a day, missing work, or toting children was deemed a major deterrent for seeking care. Our program plan is driven by empowering the women and men of the county. Our goal is to design a culturally sensitive, personalized intervention to empower and sustain involvement in their screening and treatment of chronic diseases thus improving population health.
Data/Other Information Collected:- Data from Communiride: number of round trips, number of canceled or missed trips, average distance traveled and cost, average days before appointment, frequency of type of appointment, most frequent zip codes rides were initiated from, patients average age, gender of patient, and number of multiple rides performed
- Cancer Registry Data
- TBCSP data via PTBMIS
- Qualitative data from patients and providers
- As a result of the yearly ASTHO project we have been able to increase the number of vendors who participate in the TBCSP.
- Through state funding we have been able to onboard a prominent health system in the region to include electronic patient and provider reminders regarding breast screening.
- Rider zip codes correlate with previous mapping of the highest risk and lower socioeconomic status.
- In May, 45 rides were provided screening, treatment, diagnostic, and physician consults.
- There is a higher risk of breast cancer in women over 50 years with the USPSTF recommending biennial screening mammography. Tennessee’s average age of diagnosis falls between 45-65+ years*. Our average rider was 59.3 years; hitting the target age range.
*Reference: Cancer in Tennessee 2011-2015
Challenges/Lessons Learned:With a short period of time to execute the contract we realized the need for focused efforts on bringing the right stakeholders to the table. We referred to our ongoing relationship with Memphis Breast Cancer Consortium, experts in the region, for stakeholder input. With their assistance, two TN Breast and Cervical Cancer Screening Program coordinators in Shelby Co., mobile mammography units, and TN Comprehensive Cancer Coalition members, we were able to build capacity and support for the transportation platform. Advocates for the project include support groups, cancer supply companies, hospitals, health systems, OB-GYNs, screening facilities, etc. A total of 26 usernames were issued to patient navigators in the region.
Next Steps:- Communiride is actively seeking government funding to continue this project in the region.
- Health care facilities are considering use of the non-emergant ride-share as an option instead of bus or gas passes due to accountability and data collection capabilities.
- Continue to grow our stakeholder database including the addition of screening and imaging facilities within Memphs/Shelby Co. region.
Cancer, Social Determinants of Health
State Contact Information:
TN
Crissy Hartsfield
TN Department of Health
615-741-5253
crissy.hartsfield@tn.gov