SUSAN G. KOMEN CENTRAL GEORGIA EXECUTIVE SUMMARY

Transcription

1 SUSAN G. KOMEN CENTRAL GEORGIA EXECUTIVE SUMMARY

2 Acknowledgments would like to extend its deepest gratitude to the Board of Directors and the following individuals who participated on the 2015 Community Profile Team: Rachel Hollar Affiliate Coordinator Susan G. Komen Central Georgia Jill Vanderhoek Executive Director Susan G. Komen Central Georgia Abraham Deng Community Profile Intern MPH Candidate at Mercer University Emily French Public Health Intern MPH Candidate at Mercer University Allie Micheli Community Health Intern Georgia College and State University Jordyn Sessoms Community Health Intern Wesleyan University Marissa Swanson Community Health Intern Georgia College and State University The Affiliate is appreciative to the individuals who contributed their time and knowledge to this project by participating in focus groups, key informant interviews, and surveys. A special thank you to the following organizations for providing information included in this report: Bellevue Baptist Church of Macon Cancer Wellfit Central Georgia Breast Care Center, Navicent Health Central Georgia Family Medicine Coliseum Hospital Community Foundation of Central Georgia Community Health Works First Choice Primary Care 2 P age

3 Fort Valley Housing Authority Fort Valley State University s Department of Public Health Magnolia Manor Macon Volunteer Clinic Macon-Bibb County Health Department Macon s Daybreak Center Mercer University s Department of Public Health Monroe County Diagnostics Center Monroe County Health Department Monroe County Hospital Peach County Health Department The Medical Center of Peach County Report Prepared by: 277 Martin Luther King Jr. Blvd. Suite 101 Macon, GA P age

4 Executive Summary Introduction to the Community Profile Report was established in 1999 by a dedicated group of health care providers and volunteers who wanted to find a way to fund breast health programs for uninsured and underserved populations in Central Georgia. Over the past 16 years, the Affiliate has grown from a small, core group who knew more needed to be done to address the breast health needs in Central Georgia, to a network of thousands of survivors, activists, and community leaders. The Affiliate serves eight counties, including Baldwin, Crawford, Houston, Jones, Macon-Bibb, Monroe, Peach, and Twiggs. Susan G. Komen s promise is to save lives and end breast cancer forever by empowering others, ensuring quality care for all and investing in science to find the cures. Working to meet this promise, Komen Central Georgia distributes 75.0 percent of its net income to fund local community-based breast health education, screening and treatment programs. The remaining 25.0 percent funds Komen Research Programs to find the cures for breast cancer. In the past seventeen years, Komen Central Georgia has raised more than $2.5 million through donations and fundraising events to fund the fight against breast cancer. The Affiliate has awarded more than $1.8 million to local organizations for screening, education, and treatment and more than $680,000 to Susan G. Komen Research Programs. The Affiliate partners with community leaders, organizations and participates in several collaborative groups in its service area, including the Healthcare Coalition, the Central Georgia Cancer Coalition, and Family Connection groups to reduce the burden of breast cancer services and educate the population about breast health. The first Susan G. Komen Central Georgia Race for the Cure was held in Macon, Georgia in The Race is Komen Central Georgia s signature fundraising event, raising nearly $200,000 in 2014 to use on efforts to address disparities related to breast cancer in the community. The Race raises considerable funds and awareness for the fight against breast cancer, celebrates breast cancer survivorship, and honors those who have lost their battle with the disease. Although the Race is the Affiliate s most substantial fundraising event, there are many additional opportunities for financial development including third party events, annual giving, private donations, and grant opportunities for mission programs. Komen Central Georgia service area is home to approximately 451,970 residents according to 2013 census estimates and is spread over eight counties, including Baldwin, Crawford, Houston, Jones, Macon-Bibb, Monroe, Peach, and Twiggs. The service area covers approximately 2,505.3 square miles and is located just south of the Atlanta metropolitan area in the geographic center of Georgia. Approximately 66.9 percent of the population lives in the service area s largest counties, Houston and Macon-Bibb. The majority of the Central Georgia service area is rural with two distinct metropolitan cities: Macon and Warner Robins. The area is served by three interstate highways: I-16 (connects the area to Savannah and Coastal Georgia), I-75 (connects the area to Atlanta and Florida), and I-475 (Macon s city bypass highway). 4 P age

5 In Central Georgia, the US Census Bureau estimates White individuals make up approximately 53.8 percent of the population; 39.6 percent are Black/African-American; additionally, 0.4 percent are American Indian/Alaska Natives, 2.0 percent are Asian/Pacific Islanders, and 4.3 percent of the population identify themselves as Hispanic/Latina. One in eight women in the United States will be diagnosed with breast cancer in her lifetime. This challenge is particularly acute in the Komen Central Georgia service area. Thirty-nine percent of the Central Georgia population lives 250 percent below the poverty level, 9.6 percent are unemployed, 45.6 percent live in medically underserved areas and 17.5 percent do not have health insurance. The Affiliate s education level and income level are slightly lower than the US as a whole. Each of these socioeconomic factors may contribute to increased late-stage diagnosis and death rates. The 2015 Community Profile is a needs assessment of the Komen Central Georgia service area conducted to learn about breast health issues within the service area and to make the best decisions about how the Affiliate can use its resources to make the greatest impact. The Community Profile determines priorities that assist with grantmaking decisions in the community. Examples of the most commonly funded interventions thus far include but are not limited to: outreach programs, reduced costs to patients for mammography, group education, patient navigation, and support programs. The Affiliate aligns its funding towards meeting the most noteworthy needs in the service area. Additionally, the Community Profile will allow Komen Central Georgia to: Align strategic and operational plans Drive inclusion efforts in the community Drive public policy efforts Establish focused education needs Establish directions for marketing and outreach Strengthen sponsorship efforts The Community Profile will be a resource for the Affiliate, community members, grantees, partners, sponsors, and others to direct and commonly align efforts to fight breast cancer in Central Georgia. Quantitative Data: Measuring Breast Cancer Impact in Local Communities The Quantitative Data report measured the breast cancer impact in the Komen Central Georgia service area. Data were collected from many credible sources. The results of the collected data were used to identify the highest priority areas in the service areas. Overall, the breast cancer incidence rate in Komen Central Georgia s service area was slightly lower than that observed in the US as a whole and the incidence trend was lower than the US as a whole. The incidence rate and trend of the Affiliate service area were not significantly different than that observed for the State of Georgia. 5 P age

6 Overall, the breast cancer death rate in Komen Central Georgia s service area was slightly lower than that observed in the US as a whole and the death rate trend was not available for comparison with the US as a whole. The death rate of the Affiliate service area was significantly lower than that observed for the State of Georgia. Overall, the breast cancer late-stage incidence rate in Komen Central Georgia s service area was slightly higher than that observed in the US as a whole and the late-stage incidence trend was higher than the US as a whole. The late-stage incidence rate and trend of the Affiliate service area were not significantly different than that observed for the State of Georgia. The breast cancer screening proportion in Komen Central Georgia s service area was not significantly different than that observed in the US as a whole. The screening proportion of the Affiliate service area was not significantly different than the State of Georgia. None of the counties in the Affiliate service area had substantially different screening proportions than the Affiliate service area as a whole. Proportionately, Komen Central Georgia s service area has a substantially smaller White female population than the US as a whole, a substantially larger Black/African-American female population, a substantially smaller Asian and Pacific Islander (API) female population, a slightly smaller American Indian and Alaska Native (AIAN) female population, and a substantially smaller Hispanic/Latina female population. The Affiliate s female population is slightly younger than that of the US as a whole. The Affiliate s education level is slightly lower than and income level is slightly lower than those of the US as a whole. There are a slightly larger percentage of people who are unemployed in the Affiliate service area. The Affiliate service area has a substantially smaller percentage of people who are foreign born and a substantially smaller percentage of people who are linguistically isolated. There are a substantially larger percentage of people living in rural areas, a slightly larger percentage of people without health insurance, and a substantially larger percentage of people living in medically underserved areas. Peach County has the lowest screening percentage, and it is the only county to show a rising incidence rate. The screening percentage within Komen Central Georgia s service area is significantly lower than that observed for the State of Georgia. Komen Central Georgia s service area as a whole is likely to miss the HP2020 late-stage incidence rate target. The Affiliate service area had a base rate of 47.8 new late-stage cases per 100,000 females per year from 2006 to 2010 (age-adjusted). This rate coupled with the recent late-stage incidence rate trend, indicates that Komen Central Georgia s service area is likely to miss the HP2020 target of 41.0 new late-stage cases per 100,000. The following counties are likely to miss the HP2020 late-stage incidence rate target unless the late-stage incidence rate falls at a faster rate than currently estimated: Jones, Macon-Bibb, Monroe, and Peach Counties. Based off the findings of the Quantitative Data Report, the following counties were selected as Targets: Macon-Bibb, Monroe, and Peach. Komen Central Georgia will focus strategic efforts on these counties over the course of the next four years. Selected target counties demonstrate key indicators showing an increased chance of vulnerable populations likely at risk for experiencing gaps in breast health services and/or barriers in access to care. 6 P age

7 Macon-Bibb County is a high priority county due to the amount of time needed to meet the Healthy People 2020 goals; it will take 13 years or longer to achieve the incidence rate goal and at least seven years to achieve death rate goal. Macon-Bibb County is the metropolitan center of the Central Georgia service area and provides more available services compared to the other counties in the service area. A high percentage of Macon-Bibb citizens (45.3 percent) live below the poverty level and require access to reduced or no-cost breast services. Additionally, there is substantially higher percentage of underserved Black/African-American females that live in Macon-Bibb County. Monroe County is considered a target county because a majority of the county is rural (80.2 percent) and is categorized as medically underserved (100 percent). Monroe County has been identified as a highest priority area due to the amount of time needed to meet the Healthy People 2020 goals; it will take 13 years or longer to achieve its late-stage reduction target. Like Monroe County, a majority of the residents in Peach County live in rural areas and are considered medically underserved. A high percentage of the population lives below the poverty level (41.7 percent). Also, a low percentage of women reported receiving recommended screenings in the service area. Specifically, 66.8 percent received a mammogram in the last two years. Among these women, there are a substantially high percentage of Black/African- American females (48.9 percent). Peach County is the only county in the service area to show a rising incidence rate. Peach County has also been identified as a highest priority area due to the amount of time needed to meet the Healthy People 2020 goals; it will take about 13 years or longer to achieve its late-stage reduction target. Health System and Public Policy Analysis The Breast Cancer Continuum of Care (CoC) is a model that shows how a woman typically moves through the health care system for breast care (Figure 1). Ideally, a woman would enter the continuum of care by getting screening for breast cancer and move through the continuum quickly and seamlessly to yield the best possible outcomes. Education plays an integral role throughout the entire continuum of care. Overall, Komen Central Georgia s service area has facilities and organizations that provide services across the entire continuum of care and each target county receives limited federal funding through the BCCP program to offer qualified women free services. Figure 1. Breast Cancer Continuum of Care However, the Health System s Analysis reveals there are major gaps in access to care within the target counties. Monroe County and Peach County each have one health department which offers clinical breast exams and one hospital that offers screening and diagnostic mammograms and ultra-sounds. These services are limited. There are no additional diagnostic services and absolutely no 7 P age

8 treatment or survivorship services in these two counties. There are no nurse navigators at the county hospitals. Patients must rely on their doctor to direct them to treatment. If someone is diagnosed with breast cancer they are usually referred to either a hospital in Macon-Bibb County or to the hospital in Houston County. Houston County is a reasonable drive from Peach County, but Macon-Bibb County is not within reasonable driving distance from either of the counties. The lack of local breast health services in Peach and Monroe Counties creates a major burden to breast cancer patients or survivors who have been diagnosed with breast cancer and need further medical attention or support services. Poor breast health outcomes, such as high deaths and high incidences of late-stage diagnosis could be related to lack of access to care within each county. Macon-Bibb County has accessibility to and quality care available; there are services across the entire continuum of care in Macon-Bibb. There is a community health center, a volunteer clinic, and a health department providing screening services and referrals for screening mammograms. There are two major hospitals offering breast health services across the entire continuum of care. A recent strength of Macon-Bibb County is the opening of a new cancer center in November 2014 at the major hospital where most of the population in the Affiliate s service area seeks breast health services beyond clinical breast exams and screening and diagnostic services. The new Peyton Anderson Cancer Center will create less confusion for patients by offering a one-stop shop facility for all cancer treatment, from screenings to survivorship services. With everything in one place, patients will receive lower costs and be able to receive quicker care. Weaknesses of Macon-Bibb County include no mobile mammography units and limited BCCP funding. A mobile mammography unit or transportation system would allow the hospitals to extend services to surrounding rural areas to women who have trouble accessing treatment and survivorship services due to distance. Since there is a high population of uninsured women in Macon-Bibb, the health department experience strained funding for BCCP services, limiting availability to screening and diagnostic mammograms to all eligible women. Georgia is not expanding Medicaid eligibility so many residents will remain uninsured because they do not fall within Medicaid eligibility guidelines and their income tax is too high to receive a health insurance premium tax credit through the Marketplace. Many women will continue to rely on BCCP services and clinics to receive screenings. These facilities do not have enough funds to provide services for the entire population. Also, NBCCEDP does not extend coverage to men, causing major challenges for uninsured men diagnosed with breast cancer. Treatment for patients who are diagnosed with breast cancer but who do not have health insurance can be paid through Women s Health Medicaid for qualified applicants. The Affiliate does not currently participant in Public Policy activities. The Affiliate will work on sharing the 2015 Community Profile with local officials, city mayors, and county mayors to inform them of the work and needs in the service area. 8 P age

9 Qualitative Data: Ensuring Community Input The qualitative data collection focused on barriers to screening, diagnosis, and treatment for individuals in the three target counties indicating high concentrations of Black/African-American females, medically underserved populations, and high late-stage diagnosis and death rates. Data were collected using key informants interviews and focus groups. While Komen Central Georgia recognizes the uniqueness of Macon-Bibb, Monroe, and Peach Counties, the qualitative data process revealed that these three counties are experiencing similar barriers and challenges related to accessing breast health information and services. Overall, qualitative data collection suggests the high late-stage diagnosis rates may be related to issues in access to services (cost and proximity), lack of breast health education and knowledge, lack of knowledge on available services and resources, and lack of transportation to get to those services. Key informants and focus group participants were asked about the means of transportation in their county and the Affiliate found that lack of transportation is a common barrier among all three target counties. Health care resources differ across target counties. One hundred percent of the population living in Monroe and Peach Counties are considered medically underserved. Participants in Monroe and Peach Counties described having to travel to Macon-Bibb County for treatment or support services. Macon-Bibb County is the only target county offering public transportation. This makes getting to doctor s appointment difficult and may cause missed appointments or disregard for scheduling an appointment. Key informants in Macon-Bibb and Monroe Counties said a mobile mammography unit would be convenient and beneficial to individuals without personal transportation living in rural counties. Another common barrier discussed was the lack of knowledge of available services and resources. When asked about breast health concerns in the county, lack of knowledge was often addressed by key informants and focus group participants. Individuals in all three counties need more information about screening, diagnostic, and treatment opportunities that are available and accessible. Many women are discouraged from going to the doctor for breast health services because they cannot afford the cost of services. However, many of these women are unaware of local programs that offer free or reduced costs mammograms and additional services. Additionally there are a lot of issues with access to breast health and breast cancer services. First, there is a lack of proximity to services. In the Komen Central Georgia service area, 45.6 percent of the population lives in a medically underserved area. Second, the cost of breast health and breast cancer services scares many women. Uninsured women are unaware of assistance programs available to them. Finally, there is a lack of breast health and breast cancer education in the target counties. Individuals living in target counties need educational opportunities related to breast health and the benefits of screening and early detection. There are often language barriers between the doctors and Hispanic/Latina patients. Education materials may not be offered in someone s language. Education literature also forms a problem as there is a high illiteracy rate in the 9 P age

10 service area. Doctors may give a patient literature about breast cancer, but it does not help if they cannot read it. Mission Action Plan Based off of the triangulation of data, the Affiliate s Mission Action Plan has identified the following problem statements and objectives to improve breast health in the target counties: Problem Statement 1: Macon-Bibb, Monroe, and Peach Counties are unlikely to meet HP2020 targets for both breast cancer death rates and late-stage incidence rates. Priority 1: Revise grant Request for Applications (RFA) to give funding priority to programs that use evidence-based approaches to building programs that result in positive changes in early screening and/or reduces rates of late-stage diagnosis in the target counties of Macon- Bibb, Monroe and Peach Counties. Objective: From FY16 to FY19, establish a Community Grants Committee consisting of at least three members, including the Mission Coordinator that meets quarterly to continually cultivate new opportunities for funding in the Komen Central Georgia service area. Objective: In 2016, the Affiliate s Small Grants Request for Application (RFA) will include evidence-based programs and services for Macon-Bibb, Monroe, and Peach Counties as funding priorities. Objective: By October 2016, identify two community partners who can improve transportation to services from Monroe and Peach Counties. Objective: FY16 and FY17 Community Grants and Small Grants will include transportation assistance programs for residents in Monroe and Peach Counties as a funding priority. Priority 2: Increase breast self-awareness and knowledge of available community services in the target counties of Macon-Bibb, Monroe and Peach Counties. Objective: By March 2016, develop one publicly accessible and accurate resource guide of breast health services in Macon-Bibb, Monroe and Peach Counties that meet the identified community needs and promote the availability of the resource to the public. Objective: From FY to FY19, organize and form an Education Committee consisting of at least 3 members, including the Mission Coordinator, to meet at least four times per year that will focus on Macon-Bibb, Monroe and Peach Counties. Objective: By March 2017, organize and host one volunteer orientation to expand accurate messaging at outreach opportunities throughout the target counties of Macon-Bibb, Monroe and Peach Counties. Objective: By March 2017, develop and implement methods to disseminate a breast selfawareness resource that facilitate a greater reach and understanding of breast health among patients/constituents to five providers and five public facilities in each of the target counties of Macon-Bibb, Monroe and Peach Counties. Objective: By March 2018, develop and implement a mobilized education series to promote self-awareness education and available resources in target counties. 10 P age

11 Priority 3: Diversify grants to include programs that promote a healthy lifestyle to reduce one s risk of breast cancer and/or improve support services for breast cancer survivors within the health care continuum. Objective: By March 2017, reach out to at least three nonprofit organizations in Macon-Bibb, Monroe and Peach Counties to discuss the Affiliate s Community Grants and Small Grants funding opportunities for programs that empower individuals to make healthy lifestyle choices to reduce one s risk of breast cancer. Objective: Beginning in September 2015, Community Grant RFA will include evidence-based grants that address support services for specific populations of survivors, i.e. young women, metastatic, men, etc. as a funding priority for Macon-Bibb, Monroe and Peach Counties. Objective: By March 2016, develop and distribute a quarterly e-newsletter for survivors, including topics addressing local wellness opportunities, up to date information about accessible support services, and notifications of recent Komen research advancements. The e-newsletter will be sent to all breast cancer survivors in Komen Central Georgia s database from Macon-Bibb, Monroe and Peach Counties. Objective: From FY17-FY19, organize, execute and conduct at least one annual ongoing outreach activity targeted towards breast cancer survivors in Macon-Bibb, Monroe and Peach Counties. Priority 4: Strengthen collaborative relations throughout the service area to identify advocacy opportunities that address community needs identified in the Community Profile. Objective: By March 2016, Komen Central Georgia representatives will meet with a minimum of three elected officials to discuss Community Profile results as well as budget and policy action items related to increasing screening and access to care for breast cancer. Objective: By March 2017, attend at least two meetings with all Georgia Affiliates and at least one meeting with a Georgia cancer coalition organization to promote Komen advocacy priorities. 11 P age

12 Problem Statement 2: African-Americans, Hispanic/Latinas and uninsured and underserved populations have limited access to culturally competent health care services, education and outreach. Priority 1: Partner with community-based organizations to promote breast self-awareness and available health care services which reduce socioeconomic status, cultural, and/or language barriers. Objectives: By October 2016, meet with at least two new community-based organizations in Macon-Bibb, Monroe, and Peach Counties to discuss potential partnerships and opportunities for funding to decrease socioeconomic status, cultural, and/or language barriers. Objective: By March 2017, distribute specific breast health information to at least 300 people that fall at or below the federal poverty level in the target counties through efforts unique to that population s needs. Objective: The FY16 Community Grants RFA will include programs that are both culturally relevant and aim to eliminate cultural barriers that preclude African-Americans and Hispanic/Latinas from receiving information and from accessing breast cancer screening and treatment as funding priorities for Macon-Bibb, Monroe and Peach Counties. Objectives: By March 2016, reintroduce the African-American Circle of Promise program to motivate and empower the Black/African-American community to get active about their breast health through education and outreach. The Affiliate will recruit at least five ambassadors per target county annually. Objective: By March 2017, at least five faith-based organizations will hold a Worship in Pink event in each target county (Macon-Bibb, Monroe, and Peach Counties). Objective: By March 2017, establish a presence and partnership with two Hispanic/Latina organizations to promote effective dissemination of information and services to Hispanic/Latina women in each target county (Macon-Bibb, Monroe, and Peach Counties). Disclaimer: Comprehensive data for the Executive Summary can be found in the 2015 Susan G. Komen Central Georgia Community Profile Report. 12 P age