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Health Care Discrepancies Among Women in Boston
BWH Collaborates in Effort to Close Gap in Health Disparities
Angela Hall-Jones, a case manager in Brigham Internal Medicine Associates (BIMA), carefully scans the list of female patients who miss appointments for a mammogram or a follow-up to a Pap smear. Those individuals are among the women who Hall-Jones contacts and invites to participate in the Women’s Health Demonstration Project, a program of the REACH Boston 2010 Breast and Cervical Cancer Coalition. REACH Boston 2010 is a collaborative project sponsored by the Boston Public Health Commission that seeks to eliminate disparities in breast and cervical cancer mortality among women in Boston.
At the appointments, Hall-Jones meets with the women and discusses her role in supporting their needs—health and social —including helping to facilitate transportation or mediate housing issues.
“If a patient is worried about being evicted or about the care of her child, she is not going to place her own care at the top of the list,” said Hall-Jones.
BWH’s JudyAnn Bigby, MD, medical director, Community Health Programs, is leading evaluation of the REACH Boston 2010 project. One of 23 REACH programs across the country, the Women’s Health Demonstration Project is just one of several efforts under way to help accomplish this national goal.
“When the request for proposal for this funding came about, we had already begun developing many of the programs with the Boston Public Health Commission and programs like the Boston Healthy Start Initiative. It was the perfect opportunity for us to get these programs rolling,” Bigby said of the $1 million grant that the Boston initiative received.
Now, having completed one year of planning and one year of implementation, this effort is entering its third year and is beginning to evaluate the results. Women participating in the Women’s Health Demonstration Project are keeping appointments and responding positively to support provided by case managers.
Working closely with colleagues in BIMA, Brookside Community Health Center, Boston Medical Center and three other community health centers in Boston, the Office for Women, Family and Community Programs is collaborating with a coalition to identify the needs and perspectives of women in the community.
Already, they have found that there is a great need for interpreter services. Moving forward, the program will advocate for increased availability of interpreters, as well as funding for case managers if outcomes demonstrate positive results.
Public education also is moving forward, with the Boston Public Health Commission developing a campaign, and outreach workers—lay women in the community—speaking at hair salons, supermarkets, schools and libraries. Still another effort involves the training of health care providers and mammography technologists about health disparities and cultural competence.
“While we’ve only recently begun collecting data on the results, anecdotally, the project is clearly having an impact,” said Bigby. “For example, one woman who had missed 29 mammogram appointments finally kept an appointment after meeting with Angela.”
The City of Boston recently applied for a four-year renewal of the grant.