Transcript Document 7652601

Keeping clients healthy: Integrating proactive
health screening and referral into 2-1-1 systems
Kate Eddens
Matthew W. Kreuter
Health Communication Research Laboratory
Washington University in St. Louis
Eliminating health disparities by increasing the
reach and effectiveness of cancer information in
low-income and minority populations.
- Integrating cancer communication into practice
- System-level interventions
- Real-world settings
- 2-1-1
- Food Stamps
- Public Housing
- Low-income Energy Assistance
Why this approach?
Three key points
• Basic needs supersede cancer prevention
Why this approach?
Three key points
• Basic needs supersede cancer prevention
• Systems addressing basic needs reach millions
Why this approach?
Three key points
• Basic needs supersede cancer prevention
• Systems addressing basic needs reach millions
• Integration of health could be a Win-Win-Win
Today’s presentation
1.
Our study results
2.
Activities nationally
3.
Questions & discussion
Study 1: Is it feasible?
Kate Eddens, Matthew Kreuter, Kay Archer, Debbie Fagin
Pilot study
November, 2007 – February, 2008
• Aim 1: Estimate cancer control needs of callers
• Aim 2: Determine feasibility of cancer referrals
- Mammography
- Pap testing
- Colonoscopy
- HPV vaccine
- Smoking
- Smoke-free home policies
Why these six?
Disparities associated with all of them
Effective tests or interventions for all
Programs available that provide them for free
Mammograms
Pap smears
Colonoscopies
HPV vaccination
Smoking cessation
Smoke free home policy
Current cancer control needs of 2-1-1 callers
Need at least one
85%
Need two or more
54%
Need three or more
30%
Eddens K, Kreuter MW, Archer K. J of Social Services Research (under review).
No health insurance
2-1-1 callers (n=297) vs. Missouri vs. U.S.
40
percent
30
26
20
13
10
15
0
2-1-1 callers
Missouri
U.S.
Current cigarette smoker
2-1-1 callers (n=297) vs. Missouri vs. U.S.
40
percent
30
33
23
20
20
10
0
2-1-1 callers
Missouri
U.S.
Has a smoke-free home policy
2-1-1 callers (n=297) vs. Missouri vs. U.S.
80
70
72
percent
60
50
64
52
40
30
20
10
0
2-1-1 callers
Missouri
U.S.
Ever had a colonoscopy (ages ≥ 50)
2-1-1 callers (n=107) vs. Missouri vs. U.S.
80
70
percent
60
50
58
57
Missouri
U.S.
50
40
30
20
10
0
2-1-1 callers
Pilot study
November, 2007 – February, 2008
• Aim 1: Estimate cancer control needs of callers
• Aim 2: Determine feasibility of cancer referrals
Telephone follow-up 2 weeks later
- What did they think of the mailed referrals?
- Did they make a call and/or schedule an appointment?
Reactions to mailed referrals (n=39)
Outcome
Recall getting referral
Recall getting mailing
Read all of mailing
Liked mailing a lot
Very easy to understand
Called referral agency
Made an appointment
%
92%
54%
41%
62%
67%
26%
13%
Willingness to participate
Among 2-1-1 callers in pilot study
• 58% agreed to answer cancer risk questions
• 91% agreed to participate in randomized trial
• 81% could be contacted at 2-week follow-up
Appropriateness of health questions
Among 2-1-1 callers in pilot study
• Should 2-1-1 be asking about health? (56%)
• Health questions too private? (5%)
• Comfortable with mailed health info? (81%)
• Health referrals make 2-1-1 more appealing? (100%)
How is call length affected?
Time to administer survey & provide referrals
• Mean = 4:54 minutes
Enroll into study
• Mean = 2:52 minutes
Conclusions
• High level of need among 2-1-1 callers
• Proactive health referrals are feasible via 2-1-1
• Mailed reminder referrals seem promising
What do we still need to learn?
• Is it scalable?
• How strong a referral is needed?
• Does it work equally well for all callers?
Study 2: National prevalence study
Jason Purnell, Kate Eddens, Matthew Kreuter
2-1-1s of Missouri, King County, Houston, North Carolina
Cancer Prevention and Control Research Network
Administered in four 2-1-1 systems
2-1-1 callers vs. U.S. population
- 2-1-1 callers (n = 1,413)
- 2008 BRFSS (n = 415,194)
Cancer needs of 2-1-1 callers (n=1,413)
- Need at least one
72%
- Need two or more
42%
- Need three or more
17%
No health insurance
2-1-1 callers vs. U.S. (p < .001)
Current smokers
2-1-1 callers vs. U.S. (p < .001)
Smoke-free home policy
2-1-1 callers vs. U.S. (p < .001)
Ever had colonoscopy (50+)
2-1-1 callers vs. U.S. (p < .001)
Up-to-date mammogram (women 40+)
2-1-1 callers vs. U.S. (p < .001)
Up-to-date Pap test (women 18+)
2-1-1 callers vs. U.S. (p < .001)
HPV vaccination (women 18-26)
2-1-1 callers vs. U.S.
Study 3: Statewide intervention study
Matthew Kreuter, Kate Eddens, Nikki Caito
Kassandra Alcaraz, Jason Purnell, Anjanette Wells,
Debbie Fagin, Nikisha Bridges, Tiffany Aziz
- Mammography
- Pap testing
- Colonoscopy
- HPV vaccine
- Smoking
- Smoke-free home policies
Mammograms
Pap smears
Colonoscopies
HPV vaccination
Smoking cessation
Smoke free home policy
Telephone follow-up 1 and 4 months later
- Did they contact referrals?
- Did they obtain needed services?
Telephone follow-up 1 and 4 months later
- Did they contact referrals?
- Did they obtain needed services?
Telephone follow-up 1 and 4 months later
- Did they contact referrals?
- Did they obtain needed services?
Telephone follow-up 1 and 4 months later
- Did they contact referrals?
- Did they obtain needed services?
Coach
Help callers act on referrals by:
• Making appointments
• Answering questions
• Providing reminders
• Addressing barriers
• Arranging transportation
• Explaining systems
Enrollment and contact
- 31 enrolled in pilot
- 29 contacted in 3 weeks (94%)
- 2.7 contacts per person (range 1-6)
- 35% success rate (11 of 31)
Needs and resolution
- 21 smokers (10 called Quitline)
- 6 needed Pap test (1 obtained, 1 in progress)
- 5 needed mammogram (1 in progress)
- 3 needed smoke free home (2 called hotline)
- 3 needed HPV vaccination (0 obtained)
- 2 needed colonoscopy (0 obtained)
Key questions
1.
Which approach works best?
2.
What’s the impact on 2-1-1 quality indicators?
3.
What factors influence effectiveness?
Factors that could affect outcomes
1. Problem resolution
2. Unmet basic needs
3. Sense of coherence
- comprehensibility
- manageability
- meaningfulness
What will we learn?
• Need for cancer prevention in 2-1-1 callers
• Effectiveness of 2-1-1 referrals for health
• Added benefit of mailed referrals vs. coaches
• Effects when original problem is solved by 2-1-1
• Effects by level of basic needs, SOC
Activities nationally
2-1-1 and Research Collaboration
Presentations to major organizations
• National Cancer Institute
• U.S. Centers for Disease Control and Prevention
• American Society of Preventive Oncology
• The International Communication Association
• Substance Abuse and Mental Health Association
2-1-1 and Research Collaboration
Health Screening and I&R webinar
• Invited webinar to AIRS members
• 104 attendees
2-1-1 Health and Human Services
Research Consortium
• Pairing 2-1-1 systems and researchers
• Combining, refining, and analyzing data
• Providing evaluation and funding assistance
• Laying ground rules for collaboration
• Setting a research agenda
2-1-1 Research Consortium
Who is participating now?
• United Way
• 2-1-1 systems
• Health care systems
• National Cancer Institute (CECCR)
• Centers for Disease Control (CPCRN)
• University-based researchers
2-1-1 Research Consortium
Special Journal Supplement
• Full issue dedicated to research with 2-1-1
• Published in wide-reaching scientific journal
• Expected to be published in 2011
• Funded by the National Cancer Institute
Special Journal Supplement
Why should I care?
• Raise awareness of 2-1-1
• Present opportunities for collaboration
• Show the value and reach of 2-1-1
• Lend credibility to 2-1-1
Special Journal Supplement
Table of Contents
• Introductions
• Brief empirical reports
• Summary and commentary
Table of Contents
Introductions
Introduction to the Supplement I: Rationale
for 2-1-1 embracing research partnerships
Table of Contents
Introductions
Introduction to the Supplement II: A grand
vision for 2-1-1 research collaboration
Table of Contents
Introductions
The case for collaboration between 2-1-1
systems and health researchers
Table of Contents
Brief empirical reports
Cancer risks of 2-1-1 callers in Missouri,
North Carolina, Texas and Washington
Table of Contents
Brief empirical reports
Findings from cost-benefit studies of 2-1-1
systems: A review
Table of Contents
Brief empirical reports
Media strategies to increase use of 2-1-1
during the mortgage crisis
Table of Contents
Brief empirical reports
Unmet health needs in Texas during disaster
and recovery, Katrina-Rita, 2005
Table of Contents
Brief empirical reports
Other brief reports to be solicited from 2-1-1
systems nationally
Table of Contents
Summary and commentary
Guiding principles for collaborative research
with 2-1-1
Table of Contents
Summary and commentary
A research agenda and future directions for
collaborative research with 2-1-1
Table of Contents
Summary and commentary
Commentary on the Special Supplement
Special Journal Supplement
Call for Papers
• Surveillance
• Special initiatives
• H1N1 / SARS / Other health initiatives
• Disaster
• Aging and disability
Ongoing interaction with 2-1-1s
AIRS meetings
• Survey of system leaders
How would you rate your evaluation
process for standard services? (n=22)
percent
How would you rate your evaluation
process for special initiatives? (n=23)
percent
Have you ever worked with researchers?
(n=23)
percent
How would you rate your experience
working with researchers? (n=22)
percent
What is your greatest concern about
working with researchers? (n=23)
percent
What would be the greatest benefit of
working with researchers? (n=23)
percent
Contact information:
Kate Eddens ([email protected])
Matthew Kreuter ([email protected])