The ASTHO Breast Cancer Disparities Online Toolkit is a comprehensive and a coordinated guide of resources with piloted best practices and case studies of how public health agencies have mobilized their data collection and analysis efforts to advance health equity. Although it is structured around four phases, the toolkit is not intended to be interpreted as a step-by-step guide, but instead a call to actions to move forward beyond the phase you’re currently in to transform the functions of your healthcare system. In the toolkit, you will find the following phases detailing recommendations to define the burden of the problem, coordinate data collection across multiple stakeholder groups, utilize a quality improvement model to investigate best practices, and implement piloted interventions within the communities with the most need.

The purpose of the ASTHO Breast Cancer Disparities Online Toolkit is to provide resources on identifying, measuring, and addressing breast cancer disparities, and to detail lessons learned from ASTHO’s Breast Cancer Learning Community. The information in this toolkit is designed to provide state and local health departments, as well as other breast cancer stakeholders such as cancer registries, healthcare providers, and healthcare payers, with a comprehensive roadmap for how to work toward health equity by reducing disparities in breast cancer mortality.

The toolkit includes:

  • A set of phases to operationalize best practice interventions and mobilize data resources to address health disparities in breast cancer mortality and advance health equity in local health departments.
  • Recommendations public health agencies can reference to advance their current practice toward addressing breast cancer mortality.
  • 15+ case studies from public health agencies that describe how they advanced systems change, stakeholders that supported the work, and lessons learned to advise others.
  • 80+ resources from allied organizations and others who support the breast cancer care continuum.

The ASTHO Chronic Disease Prevention Division developed this resource with the support of funding from the Centers for Disease Control and Prevention in consultation with state and regional breast cancer prevention leaders.

Breast Cancer Community Logic Model

ASTHO’s Systems Change Framework

Health System Change FrameworkIn 2015, ASTHO developed the Breast Cancer Learning Community is to strengthen the ability of public health agencies from six states – Arizona, Mississippi, Pennsylvania, Tennessee, West Virginia, and Wisconsin – to mobilize data resources more effectively to address disparities in breast cancer mortality. This learning community was rooted in the ASTHO Systems Change Framework to methodically dismantle patterns of practice that disrupt high-functioning clinical-community linkages with the patient’s best interest in mind. This work required the adoption of transformation across the entire continuum of care, meticulously assessing the public health agency’s functions, capacity and engagement level among statewide partners.

Behind the scenes of a coordinated effort working to produce better health outcomes, ASTHO’s Systems Change Framework includes a network of elements operating hand in hand leveraging their unique contributions to achieve health improvements that lend themselves to widespread implementation:

  • policy change
  • financing
  • data-driven action
  • evidence-based programs
  • complementary sectors and partners
  • community-level resources
  • engaged individuals

The Institute of Medicine notes that breast cancer prevention and treatment efforts provide key opportunities for integrating public health and clinical care. The Breast Cancer Disparities Learning Community capitalized on this chance for collaboration and took it one step further, requiring each funded state to include a representative from state and local health agency leads, public and private health insurers, experts in health information technology, regional clinical partners such as a hospital service area, healthcare providers or community-level practitioners, performance improvement managers; and individuals with health equity expertise. This approach proved to be successful as it helped these entities to stop working in isolation and to start collaborating and learning what they can accomplish together. This approach allowed public health agencies to build both internal capacity of agency staff and external cohesion with community and clinical partners to address the social determinants of health and health equity. View the Tools For Change webpage »

Laboratories for Data-Driven Transformation

In the first year of the learning community, ASTHO convened a series of in‐person and virtual modules with national experts and a variety of state-based stakeholders to obtain and analyze state‐specific data using Geographic Information System (GIS) technology and mapping techniques. States focused their data analysis and mapping within three CDC‐recommended cancer continuum areas: screening, follow up after abnormal screening result, and treatment quality.

Year two introduced the quality improvement modeling and implementation. States worked to create, refine, and enhance collaboration between health systems, public health payers, and community partners to create a “systems of care” network spanning clinical, community, and public health settings that identify individuals with breast cancer. As a result of this coordinated format to address breast cancer disparities, ASTHO collected a number of recommendations on how public health agencies can best identify breast cancer disparities in their states and bring on appropriate stakeholders to reduce those disparities.

  • Recommendation 1: Identify populations facing disparities in breast cancer mortality. Disparities can occur along many different sociodemographic variables, including race, ethnicity, income level, health insurance status, urban/rural residence, and distance from the nearest mammography provider or accredited treatment facility. Whenever possible, data beyond breast cancer prevalence and mortality should be sought to determine the impact of each variable on breast cancer outcomes. Disparities often differ geographically, so GIS mapping is an essential tool to utilize as well.
  • Recommendation 2: Bring stakeholders on board that can help make a coordinated impact. Creating partnerships was essential to the success of the learning community. Partners helped to expand data sources, aid in analyzing and disseminating data findings, and were instrumental in enacting systems change. Examples of partners to bring on board include healthcare providers, insurance companies and other healthcare payers, researchers from academic institutions, and cancer prevention groups such as Susan G. Komen. Many stakeholders are eager to get involved with addressing breast cancer disparities, but may not know how to contribute, or may not know the extent of the disparities in one’s state. Having maps and data findings available can be helpful in the process of having partners come on board.
  • Plan Do Study Act FlowchartRecommendation 3: Implement evidence‐based interventions and create systems change to reduce disparities. The learning community focused on identifying and reducing disparities in three specific areas along the breast cancer continuum: screening, follow‐up time between abnormal screening and treatment initiation, and the delivery of quality treatment. The learning community also utilized the Plan, Do, Study, Act (PDSA) quality improvement model developed by the Institute for Healthcare Improvement to help state teams implement sustainable systems change with the cooperation of different healthcare stakeholders.

Year three was focused on sustainability and the expansion of this toolkit into a comprehensive roadmap to implement health equity interventions to address breast cancer mortality. As you will see, the toolkit is geared toward public health agencies who have prioritized health equity but outlines the contributions of various stakeholders who support efforts to move the needle on the prevalence and incidence of breast cancer mortality. We found that active involvement of executive leadership, including commissioners, division and branch directors, executives, senior program managers, and supervisors, and the expertise of programmatic staff best positioned funded states implement these interventions. View ASTHO Templates and Tools »

Geospatial Analysis

Geospatial VisualThe toolkit will also detail the ways in which public health agencies and their community and clinical stakeholders applied GIS mapping techniques to tell a story about the unique and complex challenges to reduce breast cancer disparities. Through recommendations, case studies and a host of resources, you will find a number of examples from the learning community and beyond on geospatial and hotspot analysis. State teams found that by utilizing GIS technology to mobilize support, their strategic decisions were guided by sound, relevant and timely data. Their careful data dissection and investigation of community-based root causes systematically addressed imbalances in the availability of services, drive times and distance to facilities, public transportation barriers and other forms of health inequities.