Dr Edward Partridge: Prioritizing Social Determinants Key to Addressing Cancer Disparities

It's the social determinants of health that cause differences in cancer outcomes, and leveraging care navigators/guides is crucial to overcome barriers to care and clinical trial participation, as well as reduce preventable hospitalizations for underserved communities, said Edward Partridge, MD, chief medical officer of Guideway Care.

Transcript

Can you speak on Guideway Care’s “service-as-a-solution” model and its major effects on adherence, cost savings, and overall patient outcomes?

We have a 25-year history of working in cancer disparities. We initially started by training women and a few men from underserved communities in Alabama and Mississippi to promote screening for breast cancer, and we closed a 17% disparity in mammography rates between African Americans and Whites in that area.

We then took it a next step. We were diagnosing patients with cancer, breast or cervical cancer because that's the screening that we were promoting, and they were in rural areas where there were no oncologists so we had to get them from the rural areas to the urban areas for oncology specialty care. And we were able to get 93% compliance with the treatment appointments, which is really remarkable—something like 1283 scheduled appointments, and we've made 1276 of them or something.

We then actually were underrecruiting African Americans to clinical trials at the university where I was working and doing this research, and so we trained 4 African American women to serve as clinical trial navigators or guides. If a African American patient was eligible for a clinical trial, they would come to the navigator who would overcome the barriers to their participation—financial, babysitters, transportation. So, we doubled our accrual; e went from 11% to 22%, which actually overrepresented the African American population.

That work and some other work led then to our getting a grant from CMS through the Innovation Center. And we trained, again, non-nurse, nonsocial workers, but women with college education, to serve as care guides or navigators for Medicare patients with cancer. And if they were guided by the care guides, there was a significant reduction in ER [emergency room] visits, hospitalizations, and ICU [intensive care unit] admissions, which led really in a 3-year period of time to $57 million in savings for Medicare in that group of patients—8 to 12 institutions across the deep South.

So, that's how Guideway Care was born, out of that 25 years of work. And so what we do is provide turnkey services to institutions or practices that won't provide care guidance to the patients to deal with the social determinants.

Frankly, it's the social determinants that cause the differences in outcomes. It's not what happens in the hospital or the clinics, that's fairly standard nowadays in terms of the care that they get, with a lot of quality improvement and so forth—efforts inside the walls of the hospital. It’s what happens outside that's the real difference maker in terms of outcomes. So, that's what we provide, and it works every time. I mean, it increases screening, reduces unnecessary admissions, does away with readmissions for chronic disease, [which is] particularly important in bundles and value-based medicine.