Regional Breast Health Care Improvement Initiative

The National Capital Area Regional Breast Health Care Improvement Initiative


The Primary Care Coalition of Montgomery County (PCC) and the Regional Primary Care Coalition (RPCC) are collaborating to improve the efficiency and effectiveness of breast cancer screening, referral, and follow-up for low-income women in the region through the National Capital Area Regional Breast Health Care Improvement Initiative funded by Susan G. Komen for the Cure. The 3-year Regional Initiative is focusing on expanding PCC’s successful process improvement work in community-based primary care clinics in Montgomery County, MD to adaptation sites at Greater Baden Medical Services (Walker Mill Health Center) in Prince George’s County, MD, Community of Hope in Washington, DC and Community Health Care Network (North County site) in Fairfax County, VA. The Initiative also encourages collaboration and care coordination among breast health care providers and creates learning communities that cross geographic boundaries.

the state assessment

These efforts are being informed by an assessment of the state of breast health care in the region, conducted for the Initiative by Mosaica: The Center for Nonprofit Development and Pluralism.  The assessment was based on data review, a survey of 22 safety net clinics, key informant sessions involving over 70 people and interviews. Clinics, hospitals, community-based outreach groups, and other providers  identified many  challenges to timely and high quality breast health care for low-income women 40 and over throughout the region. These include:

  • Lack of service coordination, including access to specialty care, especially oncology and surgery
  • Great differences in the availability of federal, state, and local public funding for diagnosis and treatment
  • Administrative complexities in helping patients obtain charity care, apply for state-supported diagnostic or treatment services, or get timely approval for diagnosis or treatment for women served through Medicaid MCOs
  • Lack of affordable care for women with incomes just above 200% of the federal poverty level

The Assessment identifies several implications for breast health care in the region, including the need for:

  • Systems change and service integration throughout the region
  • Better data collection and tracking of low-income population health data
  • Stronger provider coordination:
    • Community-based outreach and education providers need to be linked to safety-net clinics.
    • Clinics and mammography providers need to develop close relationships.
    • Hospitals need to establish a coordinated process for arranging hospital-based charity care.
    • The role of patient navigators should be enhanced so they can arrange patient access to a continuum of service
  • A regional perspective and strategy as well as funding coordination from both public and private funders
  • Consideration of the social determinants of health, which may be a factor in mortality rates

View the assessment here:

regional implementation

The Initiative builds upon the successes of the PCC Breast Health Care Process Improvement Initiative, which is anchored in community-based primary care clinics serving as medical homes.  It started in three clinics serving uninsured, low income women and is expanding to eleven clinics.  The project focused on developing models and protocols that increase mammography screening rates, and improve the efficiency and efficacy of moving from screening to diagnosis, treatment and follow-up.  From 2007 to 2009, the PCC Initiative increased the availability of mammograms to the clinics by 30%, increased screening rates from 20% to 58%, more than doubled the percentage of women completing mammograms after referrals, and reduced the time interval from referral to screening in one clinic from 100 days to less than 40 days.

Process improvement work is currently underway in three sites: Greater Baden Medical Services (Walker Mill Health Center) in Prince George’s County, MD, Community of Hope in Washington, DC, and Community Health Care Network (North County site) in Fairfax County, VA. Two sites are Federally Qualified Health Centers (FQHCs); and one is a county funded program (Virginia site). In the two FQHCs (Maryland and DC sites), provider teams have agreed to focus the project on improving screening rates for women 50 and over while the Fairfax County program is focusing on women 40 and over. Baseline screening rates for the three sites vary, ranging from 26% to 55%. All are aiming to reach the annual target of referring 95% of women for screening and, as based on the current HEDIS benchmark, having at least 65% of the women complete screening. These targets are the same as those that were implemented in Montgomery Cares clinics in Montgomery County, MD.

concept spread beyond the region