While higher income and education levels are frequently connected with better health outcomes, there are exceptions among some individuals or groups — like Asian-Americans, who earn and learn more than most, statistically speaking, but are also more likely to die of cancer.
Holy Name Medical Center is now looking to address one aspect of this racial gap with an initiative designed to increase screening for colorectal cancer among Asian-American residents in the region.
The Bergen County facility is one of only ten hospitals nationwide, and one of only two in the northeast (along with a teaching hospital in Vermont), to be participating in a 16-month pilot program designed to improve equity in healthcare in diverse communities.
Led by the American Hospital Association and its affiliate organization, the Institute for Diversity and Health Equity, with support from the Aetna Foundation, the program — called the Hospital Community Cooperative, or HCC — provides some funding ($10,000 to each facility), guidance and additional technical support to help the hospitals and their community partners on targeted efforts to reduce racial gaps relevant to their region.
The pilot program, which began in September and lasts through the end of 2019, builds on work done by AHA to improve public health by reducing healthcare disparities, a process that led to the #123forEquity Campaign to Eliminate Health Care Disparities. The #123 program challenged hospitals to dig into their data to identify racial gaps in certain healthcare outcomes, and take specific steps to improve care to those who were missing out.
New focus on racial gap
In New Jersey, concerns about racial disparities in infant and maternal care — including a mortality rate for black women of nearly five times the rate for white mothers — have become a priority for a growing number of leaders. Department of Health Commissioner Dr. Shereef Elnahal has invested $4.7 million recently to expand community-based, culturally appropriate services; lawmakers have introduced a 14-bill package to boost birth standards and insurance coverage; and first lady Tammy Murphy kicked off a maternal-mortality public awareness campaign, Nurture New Jersey, last week.
For Holy Name, a 361-bed facility in Teaneck nestled amid municipalities with some of the largest Asian populations in New Jersey, the focus on Asian-Americans made sense. A diverse mix of at least a half-dozen cultures (including Chinese, Filipino, Korean, South Asian and Vietnamese), Asian residents make up at least 9.4 percent of New Jersey’s population, and more than 10 percent of the Bergen County citizenry.
The project also “aligns with our focus on improving cultural competency in healthcare for every patient,” said Kyung Hee Choi, vice president of Asian Health Services at Holy Name. “We believe it is our responsibility to not only treat sick people, but to also keep people healthy through education and preventive care programs.”
Part of this message is about early detection, which is especially important when it comes to cancer, including colorectal cancer. Screening for this condition has traditionally involved a colonoscopy, an invasive procedure that involves significant and unpleasant prep work, although home-based tests — with a toilet-paper “swipe” that is sent to a lab — are quickly becoming a more popular option.
Information not reaching Asian-Americans
But this information is not effectively reaching Asian-American communities, according to a 2017 report by the National Colorectal Cancer Roundtable and others. Researchers found that, nationwide, just over half of Asian-Americans between the ages of 50 and 75 have been screened for these cancers, versus nearly two-thirds of white residents. While colorectal cancer is the third most common form of cancer overall, it is the second most common for Asian-Americans.
“Despite many identification and early detection methods available, cancer (in general) still stands as the leading cause of death amongst Asian-Americans,” added Dr. Sung Kwon, a surgical oncologist at Holy Name.
The national report, which included input from the University of Chicago’s Center for Asian Health Equity, found the colorectal cancer gap was based in part on logistical challenges, like limited access to programs where providers speak the same language, a lack of transportation or insurance coverage. But cultural factors also came into play, including patients’ modesty and a preference for avoiding potentially bad health news.
To overcome these barriers, the report stressed the need for healthcare providers to work with community-based partners who possess the language skills and cultural competence to reach the Asian-American communities in question. It also stressed the need for more education outreach, since a high proportion of community members felt they were at low risk for cancers due to their overall good health, the researchers found.
Screening kits that can be used at home
For the project, Holy Name will partner with three local organizations — the Korean Community Center, Asian Women’s Christian Association and Korean American Family Service Center — to distribute 300 home-use colorectal cancer-screening kits during community events. The goal is to also connect those who test positive with a primary-care provider, or gastrointestinal specialist, to coordinate follow-up care.
In addition to some financial support, Holy Name’s project will benefit from guidance by a team of diverse experts assembled by AHA to assist the participating facilities. All the hospitals involved will complete evaluations and share their findings at a conference later this year.
“The 2018-19 program is a pilot to help us strengthen our understanding of how to build a meaningful national community of practice for health care organizations that supports the cultivation of strong, sustainable partnerships through local health equity interventions,” said Jay Bhatt, senior vice president and chief medical officer for AHA, which represents more than 5,000 hospitals nationwide.
The facilities participating in the program are:
1. Parkland Health and Hospital System, Parkland, TX
2. Truman Medical Center Behavioral Health, Kansas City, MO
3. CHRISTUS St. Vincent, Santa Fe, NM
4. Holy Name Medical Center, Teaneck, NJ
5. Grady Health System, Atlanta, GA
6. UChicago Medicine, Chicago, IL
7. Sharp Healthcare, San Diego, CA
8. University of Vermont Medical Center, Burlington, VT
9. Hurley Medical Center, Flint, MI
10. Multicare Health System, Tacoma, WA