Characterizing participants in the North Carolina Breast and Cervical Cancer Control Program: A retrospective review of 90,000 women.

BACKGROUND: The North Carolina Breast and Cervical Cancer Control Program (NC BCCCP) provides breast cancer screening services to underserved women to mitigate disparities in access to care. The authors sought to characterize this understudied population. METHODS: Women 21 years old or older who underwent their first breast cancer screen through NC BCCCP from 2008 to 2018 were included. Demographic factors associated with the timeline of care and odds of a breast cancer diagnosis were identified with negative binomial and logistic regression, respectively. RESULTS: Of the 88,893 women identified, 45.5% were non-Hispanic (NH) White, 30.9% were NH Black, 19.6% were Hispanic, 1.7% were American Indian, and 1.1% were Asian. Breast cancer was diagnosed in 2.5% of the women (n = 2255). Hispanic women were the least likely to be diagnosed with breast cancer (odds ratio vs NH White women, 0.40; 95% confidence interval [CI], 0.34-0.47). Among patients with breast pathology, the median time to diagnosis was 19 days (interquartile range [IQR], 10-33 days), and the time to treatment was 33 days (IQR, 19-54 days). After adjustments, a longer time to diagnosis was significantly associated with age (incidence rate ratio [IRR], 1.01; 95% CI, 1.01-1.02) and being NH Black (vs NH White; IRR, 1.17; 95% CI, 1.06-1.29). A longer time to treatment was significantly associated with age (IRR, 1.01; 95% CI, 1.01-1.01), being NH Black (vs NH White; IRR, 1.20; 95% CI, 1.10-1.31), and being Hispanic (vs NH White; IRR, 1.22; 95% CI, 1.05-1.41). CONCLUSIONS: NC BCCCP participants with breast cancer received treatment within approximately 1 month of presentation, and this finding aligns with quality care benchmarks. Nevertheless, racial/ethnic disparities in timeliness of care persist, and this suggests opportunities for improvement. LAY SUMMARY: This review of approximately 90,000 participants in a breast cancer screening program for uninsured and underinsured women highlights the importance of safety net programs in providing timely care to underserved patients. The authors found that the North Carolina Breast and Cervical Cancer Control Program met timeliness benchmarks from the Centers for Disease Control and Prevention across all racial/ethnic groups. However, non-Hispanic Black women experienced relative delays in the time to diagnosis, and both non-Hispanic Black women and Hispanic women experienced relative delays in the time to treatment. These findings demonstrate how racial/ethnic disparities in the timeliness of care can persist even within a program intended to reduce barriers to access.

Community-responsive research priorities: health research infrastructure.

THE PROBLEM: A disconnect exists between research resources and the health and health care needs of people those resources are designed to serve. While a great deal of research is being produced at academic institutions across the country, the topics investigated are often driven by researchers' interests or by funding announcements focused on specific research areas of interest to the funder. PURPOSE OF THE ARTICLE: The purpose of this article is to describe a process that connects community identified health priorities with research funds as well as capacity building efforts. KEY POINTS: The North Carolina Translational and Clinical Sciences Institute (NC TraCS) developed a process to identify the health priorities of North Carolina communities through a partnership with the network of county Healthy Carolinians partnerships. The priorities identified were obesity, youth issues, healthcare delivery/access, mental health/ substance abuse, specific chronic diseases, cancer/tobacco, and injury/ violence. NC TraCS then used these research priorities to guide pilot funding and facilitate research capacity building. CONCLUSIONS: Tapping into an established community-based network and linking researchers to community-identified priorities ensures that NC TraCS addresses the most pressing health needs of North Carolina's residents.

NC CATCH: Advancing Public Health Analytics.

The North Carolina Comprehensive Assessment for Tracking Community Health (NC CATCH) is a Web-based analytical system deployed to local public health units and their community partners. The system has the following characteristics: flexible, powerful online analytic processing (OLAP) interface; multiple sources of multidimensional, event-level data fully conformed to common definitions in a data warehouse structure; enabled utilization of available decision support software tools; analytic capabilities distributed and optimized locally with centralized technical infrastructure; two levels of access differentiated by the user (anonymous versus registered) and by the analytical flexibility (Community Profile versus Design Phase); and, an emphasis on user training and feedback. The ability of local public health units to engage in outcomes-based performance measurement will be influenced by continuing access to event-level data, developments in evidence-based practice for improving population health, and the application of information technology-based analytic tools and methods.