Overcoming challenges through an academic-community health center collaborative to conduct cancer screening, prevention, & control among Asian Americans and sustainability initatives

ABSTRACT

The purpose of this presentation is to report accomplishments of a 3-year [5/1/2018-4/30/2021] Bristol-Meyers Squibb Foundation-funded collaboration between UC Davis and the Health and Life Organization (HALO), a Federally Qualified Health Center Look-Alike in increasing cancer screenings and cancer prevention/control behaviors among Asian Americans. HALO was selected for this study becuase it is the largest health system serving Asian Americans in Sacramento Co., CA. About one-third of their patients (9000) are Asian [primarily Hmong and other SE Asains). The hypothesis we tested was based on UC Davis's prior completed research that bilingual/bicultural Hmong lay health workers significantly increased screenings for HBV and colorectal cancer screening in randomized controlled community trials among Asians who largely had limited English proficiency. Our premise was to apply this concept to a clinical setting through HALO's bilingual/bicultural medical assistants (MAs). By comparing baseline (prior to the initiation of our funding) to 3 years of collaboration, we observed an overall 13.3% increase (surpassing our 10% goal) in cancer screenings & prevention/control behaviors. The largest percentage increases were in mammography (20.3%), colorectal cancer screening (11.6%), and Pap tests (7.9%).vaccination (2.8%). Since this was our first collaboration, much was shared through our monthly UCD-HALO leadership meetings where adjustments were made. A major adjustment was to learn that the electronic health systems used by community health centers such as HALO were not intended for reseearch purposes. While primary care provider time was less flexible, we found that MAs who reflect the HALO patient population were very receptive to training. We provided training through 10 Saturday academies, in-person and later delivered virtually during the COVID-19 pandemic. All of the topics related to the above metrics as well as other topics such as cultural competence, resources for patients, and optimizing patient workflows. Effectiveness of these academies were documented through gains in average scores from pre-tests [58%] to post-tests [84%] and qualitative feedback. Fifity-eight participants attended. More rigorous evaluation approaches to link our efforts to the impact of our work would have been preferred, but would have needed to be more resource-intensive. However, we anticipate that the equipping of MAs in new competencies and tools we provided for patients in various languages as infographics will be the bases for sustained effectiveness. Another measure of success was that this collaborative contributed to the receipt of a major Federal grant to eliminate perinatal HBV transmission through HALO. A UC Davis You-Tube style interactive modules as refresher materials and for new MAs will be another means of sustaining impact.