STRATEGIC QUESTION 2
How can the community partner to provide a seamless, highly coordinated network of services that address an individual's physical health issues?
IMPLEMENTATION PLAN
Chester County Hospital will partner with community organizations to increase screening program participation for underserved, uninsured and low-income population.
Improving Access to Mammograms Among Hispanic Women
Imagine hearing the words "You have breast cancer." Now imagine hearing them in a language that is not your native tongue and in a country that is not your homeland.
According to the American Cancer Society, approximately 232,670 new cases of invasive breast cancer were expected to be diagnosed in the United States in 2014, along with another 62,570 cases of in situ, or noninvasive, breast cancer diagnoses. Only lung cancer accounts for more cancer deaths in U.S. women than breast cancer. And as with any cancer situation, early detection is key for effective breast cancer treatment. However, for those who face language barriers, transportation obstacles, or insurance deficits, getting that early detection might be out of reach.
Enter the alliance between Chester County Hospital and La Comunidad Hispana (LCH), a Kennett Square-based organization that acts as a facilitator between immigrant families -- primarily Hispanic -- and the services they need. Established in 1973 to serve the needs of area Latino mushroom farm workers, LCH has grown into a multi-faceted agency that has received numerous awards and grants for their work, and they offer assistance with everything from housing and literacy, to legal services and English as a Second Language (ESL) classes. LCH also offers comprehensive health care services through their Federally Qualified Health Center. There, in keeping with LCH's mission, the idea is for the client to take control of his or her own well-being, which LCH facilitates with immunizations, physical exams, and educational outreach. But when it comes to things like breast cancer screenings, even the best self-motivation practices can only take one so far.
And that's where Chester County Hospital comes in. "For 40 years, La Comunidad Hispana has been serving (primarily) the Latino community in southern Chester County," said Paul Huberty, Senior Vice President of Strategic Planning and Marketing at Chester County Hospital. "Chester County Hospital has been serving the county for 122 years, and in many ways, we share similar missions and serve many of the same people and communities." Huberty joined the Board of Directors at LCH in 2010, and in 2013, became chairman of that board. Since then, the hospital and LCH have partnered in several ways.
For instance, Sandra Mancilla, MD, became the collaborating physician for LCH's nurse practitioners (CRNP). "In this capacity," Huberty said, "she meets with the clinical team on a regular basis to review the clinical practices and address challenging clinical questions. She is also available to consult with the CRNPs with particularly complex patients." The fact that Dr. Mancilla grew up in Mexico only enhances the benefit to the community.
In 2014, collaborative agreements were put in place between the hospital and LCH. "Uninsured LCH patients who need laboratory studies or specific radiology studies -- such as X-ray and mammograms -- can be seen at a hospital radiology site, and there will be no charge to LCH," he said. "More technical studies, like MRIs and CTs, are offered to uninsured patients at deeply discounted rates. Our next goal is to develop a stronger partnership in prenatal care. The hospital has also partnered with LCH in the area of diabetes management, childbirth education and breast cancer screenings." And the hospital does this, according to Huberty, both to meet its mission and to reduce some of the barriers to both care and services.
Cindy Brown, RN, has seen this firsthand. Her role as the Breast Care Nurse Navigator for the hospital sometimes puts her in contact with patients who, quite simply, "lacked care because they lacked funds," she said. Brown has been with the hospital since 2008, her dedication due in part to the loss of her own mother to breast cancer. Part of her job has Brown following the treatment and care of the women whose screenings have come back with challenging results. And she is equally dedicated to the idea of access to those screenings being available to the clients at LCH. "We designate two days a year -- 'Linda Creed Days,' made possible through the Linda Creed Foundation -- one in the spring, one in the fall, for screenings. The collaboration with LCH allowed us the opportunity to dedicate one of those days to their clients," she said.
Last spring, Penn Medicine also recognized the importance of this relationship and awarded a $2,000 CAREs Grant to expand access to mammograms for LCH patients.
Rebecca Bixby, LCH's Medical Director, agrees that it's an excellent alliance. "At LCH, we look to leverage the strength of our community partnerships to increase access for our patients to essential health screenings, such as mammography," she said. "Chester County Hospital has been an outstanding partner to us, particularly in the area of women's health." Indeed, LCH is Chester County's sole provider of the Healthy Woman Program, noting that women's health care is a big priority. Now, with LCH's new relationship with the hospital's Radiology service, any uninsured LCH patient should have no financial barriers preventing them from getting a mammogram as recommended.
Alisa Maria Jones is the interim President and CEO of La Comunidad Hispana, and her connection is both professional and personal. "Growing up in a Hispanic immigrant family myself I understand first-hand the struggle of raising a family and having no health insurance. An acute illness that requires emergency service or hospitalization can be financially devastating for low-income, uninsured families. Choosing between having medical care and having funds to feed your family is an impossible choice. LCH is here to help families from having to make that choice. By managing illness and treating conditions proactively we are able to help low-income and insured families prevent expensive emergency services. It's best for the person, the family and the community." Jones shares the example of one LCH patient named "Juana," whose story illustrates the benefits of the partnership between La Comunidad Hispana and Chester County Hospital. Juana was guaranteed a spot for the free hospital mammography screening day when she presented to LCH and a lump was palpated by her nurse practitioner. Juana was concerned, but told LCH's referral coordinator that she did not have the money for follow-up testing. Not only was she screened for free at the hospital, through enrollment in LCH's Healthy Woman Program, she also received follow-up diagnostic testing -- including a breast biopsy -- at no cost to her. Today, Juana is happy that her biopsy was benign, and she credits both LCH and the hospital for the smooth continuous process from screening to detection and diagnosis.
LCH's focus on primary care, and especially getting and staying healthy means they aim to catch conditions early and help patients manage chronic diseases to prevent further complications. This is better for the patient and is more cost effective in the long-run. The goal of getting and staying healthy is one that Chester County Hospital is happy to support. Jones puts it together succinctly: "The rewards of this program for our clients are that it provides them with access to primary health care, and it signals that our community values and cares about them. Providing these types of services ultimately means a healthier community." Mission accomplished.
Written by Kate Chadwick
Photography by Peggy Peterson