Student Initiative Update
Students Affecting Positive Change: The Success of the Pritzker Mammography Access Partnership
By Laura Dilly, MS2
Laura Dilly, MS2
Imagine waiting two years for a critical doctor's appointment. Unthinkable, right? That couldn't possibly happen in America, could it? Turns out it's been happening right in our backyard on the south side of Chicago, where more than 11,000 uninsured women have long faced a 24-month backlog for mammograms, a test used to determine the presence of breast cancer. The waiting lists became so insurmountable that Stroger Hospital—the city's largest health care provider to poor and uninsured patients—ceased offering screening mammograms at the end of 2007. Now imagine you're part of a group of eager first-year medical students who have just learned about this problem. It's exactly the kind of eye-opening revelation that makes your insides burn as you and your fellow classmates yearn to make a difference but lack the training and experience to do so.
Connecting Pritzker's newest arrivals with these kinds of problems, however, is exactly what Dr. Monica Vela does as director of the first-year course Health Care Disparities in America. In the fall of 2008, she pushed me and several of my classmates to explore further the issue of uninsured mammogram access. Where, Dr. Vela asked, are uninsured women receiving their mammograms? What are the consequences of these enormous delays? Most importantly, what can we do about it? Unsure of ourselves but chomping at the bit, we began seeking answers to these questions by interviewing referral specialists at 10 mammogram centers on Chicago's South Side, where medical insurance is rare among the predominantly African-American population.
(left to right) Sara Foley, Ajay Sampat, Kevin Chang, Kyle Karches, Laura Dilly, Becky Levine, Geoff Stetson participate in the 2009 Medical Education Day
To our distress, we learned uninsured women from the South Side faced an obstacle-laden process to getting essential mammogram services. Only two centers offered evening or weekend appointments, an important option for working women. In addition, the tests cost as much as $600 in out-of-pocket fees, an enormous figure by many accounts. Finally, most centers lacked accurate or helpful information about free services which they could give to patients. One respondent conceded, "I simply don't know where to refer you."
These unsettling findings were clear: real barriers have been preventing the South Side's uninsured women from getting the mammogram services they need, and were likely contributing factors to the breast cancer mortality rate being 116% higher among African-American women than white women in Chicago (Cancer Causes Control, 2009).
We presented these sobering results to our Health Disparities class and assumed our investigation was finished. Dr. Vela, however, urged us to share our work with a larger audience. Encouraged, we presented posters at the 2009 Medical Education Day and the Department of Medicine Research Day in 2008. We were legitimately giddy at the feedback we were receiving. Faculty and physicians were spurring us on to help break down the barriers we identified. Emboldened, we were also collectively stunned that a simple class project had taken on a life of its own.
(left to right, back) MS2 students Ming Zhong, Kevin Chang, Laura Dilly, Jeanie Paik, Ajay Sampat; (left to right, front) Kyle Karches, Becky Levine, Geoff Stetson, Sara Foley
First, eight of the group members and I established the Pritzker Mammography Access Partnership (PMAP), a student organization dedicated to promoting mammogram access for all Chicago women. Dr. Vela became our faculty sponsor, while mentors Lisa Vinci, MD, and Janice Phillips, RN, PhD added experience in quality improvement and breast cancer advocacy, respectively.
"Establishing PMAP helped us to leverage the IBCCP resources uncovered during our research," says member Becky Levine. The IBCCP, or Illinois Breast and Cervical Cancer Program, is a state-funded program providing free breast and pelvic exams, mammograms, Pap smears, and cancer therapy for Illinois's uninsured women. More than 66,000 women have been screened for breast or cervical cancer through the IBCCP since its inception in 1995. Only 7.5% of eligible women are using the program, however, and just two of our surveyed centers knew of its existence.
With the encouragement of Shannon Lightner, deputy director of the IBCCP, we probed for awareness of the program's services within the South Side Healthcare Collaborative (SSHC), a far-reaching network of 25 primary care centers. Laura Derks, the Collaborative's director, kindly connected us with each center's referral specialists, whom we surveyed about mammogram referral procedures and familiarity with the IBCCP.
The results were eye-opening. Only 57% of primary care centers providing referrals for mammograms were familiar with the IBCCP, and those that were typically lacked complete knowledge about eligibility requirements and the range of IBCCP services. Still, after many months of digging, PMAP members and I were thrilled to realize we could begin addressing a major health disparity by connecting SSHC referral specialists with IBCCP resources.
Today, we're partnering with the IBCCP and SSHC to raise awareness of free mammogram services in Illinois. Of note, we hope to host educational outreach sessions for referrals specialists early this year. Our efforts now extend to collaborations with advocacy groups, such as Susan G. Komen for the Cure, and making presentations at additional medical conferences. Perhaps the most rewarding outcome of PMAP's efforts, however, is the University of Chicago Medical Center's decision to become a member of the IBCCP this past September, opening access for these services at our home institution for the uninsured women of the South Side.
"Many people don't get to improve the health care process," says Dr. Vela. "But the ongoing success of PMAP is inspiring proof that medical students can have a significant positive impact on community health care."