Can eHealth help a full population of low income breast cancer patients.

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Can eHealth help a full population of low income
breast cancer patients.
Dave Gustafson, Bill Stengle, Karen Julesberg And
many others UW Center for Health Systems Research
and Analysis North Central and Midwest Cancer
Information Services
Funded by National Cancer Institute and the
Markle Foundation
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Research issue

• All women diagnosed w breast cancer
• With a family income
• How many can you reach?
• What effect does it have?
• What would it cost to deliver?

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CHESS Acceptance and use

• 75 DTW poor 95 WI poor
• Typical use rates
• 1 time per day over 3 month period
• more frequent at first
• 48 of uses between 9PM and 7AM

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Use minorities elderly use info analysis
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100 is maximum possible score
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But can you impact a low income population?
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Redesigned CHESS for diversity

• Focus groups face-to-face interviews
• Patients want information support
• Need to counter breast cancer myths
• Change how CHESS works
• Strategies for recruiting

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CIS Outreach Targets

• Hospitals and Clinics
• Medical Social Workers/Discharge Planners
• Home Health Agencies
• Churches
• Media
• Public Health Departments
• American Indian Tribes
• Medicaid (16/22/72) (35)

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Outreach Methods

• Mailings
• Outreach Packets
• Invitation letters
• Monthly postcards
• Presentations
• Phone calls
• Press Releases

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Referral Sources
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Demographics

• Detroit and Wisconsin women are similar, with
  some important exceptions
• Detroit women are more likely to live alone (32
  vs. 18)
• Detroit women less likely to have private
  insurance (37 vs. 50)

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Effects of having CHESS

• Pre vs. post comparison shows improvement on all
  10 dependent measures
• Control group from previous study had significant
  improvement for 4 of 10 outcomes.
• Suggests patients improving faster than on their
  own

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Reaching underserved women

• Our goal reach 30 of eligible women
• Reached 21 (275 low income women).
• Also 265 above income threshold, all from CIS
  phone service.

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Medicaid sub-study

• 110 letters sent to Medicaid recipients recently
  treated for breast cancer.
• 38 opt-ins (35)
• Computers sent via Fed Ex
• Telephone training w CD

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Overall Potential Penetration

• Medicaid patients 35 (38 of 110)
• Non-Medicaid 18 (80 of 440)
• Total penetration is (.35X240.18X440) 24
• These numbers do not equal all poor because not
  all Medicaid got letters.

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Cost to serve a Medicaid Patient

• Medicaid data runs and mailing
  Donated
• Invitation/response mailing 1
• Recruitment call (30 minutes)
  13
• Fed Ex computer mail out/pick up 38
• ISP dial up cost (6.75/mo) 21
• Telephone training (1 hour)
  26
• Trouble shooting (35 min/3mo) 14
• Computer prep/pack 10
• Computer cost (900/12pts/4yrs) 75
• Total Cost 208

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Marginal cost for non-Medicaid pt.

• 25 referrals recruited (30 min)
• 13 cant reach (5 min)
• 62 not eligible (20 min)
• Time to get one recruit 77 min (33/pt)
• Care/feeding of key referral org (45/wk)
• (62/25)X20 (13/25)X5 (25/25)X30 77
  minutes

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Total cost for state w 1000 low income breast
cancer pts.

• Medicaid
• 35 Medicaid w 35 penetration
• 122 patients _at_ 208/pt 25,500
• Non-Medicaid
• 65 Other w 18 penetration
• 118 patients _at_ 241/pt 28,000
• Cost for care and feeding 2,500
• Total cost 56,000 for 240 patients
• Not considered start up updating costs

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Conclusions

• Is 24 penetration enough to be encouraged?
• Takes time to build institutional connections
• Institutions (hospitals clinics) are good ways
• Medicaid is key!
• LL Bean approach (mailing) to delivery works
• If they have CHESS, they will use it
• eHealth can improve quality of life

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Chess Services

• Library Articles
• Personal Stories
• Quick Answers
• Resource Guide
• Video Gallery
• Web Links
• Evaluating Web Info
• Ask an Expert
• Past Answers from the Expert
• Discussion Group
• Past Discussion Groups
•  

• Assessments
• Decision Notebook
• Action Plan
• Health Tracking
• Relief Through Writing

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CHESS use

• Once they get CHESS, will underserved women use
  it?

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Plans to get to 30

• Hospitals, clinics and doctors are best
• Building relationships with institutions and
  people takes time
• Grassroots efforts to show presence in community
• Medicaid has real promise

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Sending people to internet sites may not help
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Communication service use
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Information service use
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Analysis service use
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Underserved problem not solved

• Equivalent total use, maybe better use
• Equal and sometimes greater benefits
• But these are of those recruited
• Reaching underserved still big problem

CIS to the Rescue!