Standardized Breast Imaging with Centralized Interpretation Using Academic-Community Collaboration Helps Small Community Hospital(s) Improve Breast Cancer Disparity - Abstract
We are a rural hospital with access to care barriers historically linked to geography. We see a disproportionate percentage of late stages of breast cancer, with correspondingly worse mortality rates. A decade ago, screening mammogram rates were low rurally compared to elsewhere, and particularly evident to us locally. We recognized this as a geographic barrier to care and collaborated with an academic institution to improve access to breast imaging rurally using a network hub-and-spoke wheel model. In 2016, we standardized breast imaging by offering identical screening and diagnostic radiology services at all our community hospitals (N=7: the “spokes”), while centralizing image interpretation at the “hub” with a team of imaging specialists. Utilizing fellowship specialty-trained breast radiologists for all central review, along with uniform imaging regionally, our hypothesis was we could improve our diagnostic results rurally and move the bar away from disparity. The Outer Banks Hospital is now the largest volume imager for breast care within the community hospital network and it has leveraged this collaborative model with East Carolina University Health to improve access and achieve American College of Radiology certification locally, as well as American College of Surgeons cancer accreditation (Commission on Cancer). This report reviews a favorable change in stage at presentation over time and other quality outcomes for breast cancer rurally as the result of this academic-community collaborative, which is feasible anywhere.