Crabtree, Benjamin F, PhD

Kieber-Emmons, Autumn, MD, MPH

Miller, William L, MD, MA

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksDepartment of Family MedicineA novel mixed method using GeographicInformation Systems (GIS) and ethnographicmethods to study disparities in cervical cancermortality in Hispanic womenAutumn Kieber-Emmons MD, MPHLehigh Valley Health Network, Autumn.Kieber-Emmons@lvhn.orgWilliam L. Miller MD, MALehigh Valley Health Network, william.miller@lvhn.orgBenjamin F. Crabtree PhDFollow this and additional works at: https://scholarlyworks.lvhn.org/family-medicineThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtKieber-Emmons, A. Miller, W. L., Crabtree, B. F. (2018, November 10-13). A novel mixed method using Geographic Information Systems(GIS) and ethnographic methods to study disparities in cervical cancer mortality in Hispanic women. Poster Presented at: (NAPCRG) TheNorth American Primary Care Research Group, IL.LVHN.org© 2018 Lehigh Valley Health NetworkLehigh Valley Health Network & Rutgers Robert Wood Johnson Medical SchoolFunding: NIH Grant #3R01CA176545-02S1 and ACS Grant CCCDA -17-100-01Acknowledgements: Robert Graham Center, GIS maps Cancer data have been provided by the Texas Cancer Registry, Cancer Epidemiology and Surveillance Branch, Texas Department of State Health Services, 1100 West 49th Street, Austin, TX 78756, https://www.dshs.texas.gov/tcr/.A novel mixed method using Geographic Information Systems (GIS) and ethnographic methods to study disparities in cervical cancer mortality in Hispanic women Autumn M. Kieber-Emmons, MD, MPH,1,2 William L. Miller, MD, MA,1,2 Benjamin F. Crabtree, PhD3 1Lehigh Valley Health Network Department of Family Medicine, Allentown, PA, 2University of South Florida School of Medicine, 3Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ BACKGROUNDThere are currently 16 million cancer survivors in the U.S. with many individuals having a history of cancer and living longer, healthier lives. However, disparities in cancer survivorship management, coordination and quality of care are apparent in the literature, including in primary care where many survivors access care OBJECTIVETo investigate cancer survivorship mortality disparities seen with cervical cancer in Hispanic women through the comparative study of three Texas counties3 Counties with Different Disparity Profiles were IdentifiedPHASE I: quantitative phase of the methods - county and zcta level differences through GIS mapping PHASE II: qualitative phase of the methods investigating cancer survivorship and identifying potential change targets Examples of Phase II qualitative phase procedures:•  Qualitative Week-long Immersion visits to each county•  Key Informant Interviews•  Participant Observation•  Community Drive-Throughs•  Field Notes Total PopulationDallas County2,618,148Tarrant County2,054,475Bexar County1,958,578Texas28,304,596Cervical Cancer Mortality Rate – Hispanic (2009–2013)* 3.7% 5.2% 3.4% 3.3%Cervical Cancer Mortality Rate – White Non-Hispanic (2009–2013)* 3.0% 2.6% 1.7% 2.3%Cervical Cancer Incidence Rate – Hispanic (2009–2013)** 13.8% 13.3% 11.1% 11.2%Cervical Cancer Incidence Rate –  White Non-Hispanic (2009–2013)** 9.1% 8.1% 8.4% 8.3%Source: National Cancer Institute, State Cancer Profiles https://statecancerprofiles.cancer.gov/index.html*Mortality Rates are Age-Adjusted, Annual per 100,000**Incidence Rates are Age-Adjusted, Annual Cases per 100,000RESULTSWithin three counties in Texas, variability exists in the cervical cancer survivorship care delivery and coordination. Community Assessment Profiles (CAP) of these differences were created for each county using different mapping tools. CAPs then serve to guide the qualitative Phase II of the methods utilizing on the ground participant observation and key informant interviews in Dallas, Fort Worth, and Bexar counties. Development of this method has included learning throughout the quantitative phase regarding how best to utilize the GIS maps to pinpoint targets of interest (i.e. hot spots, cold spots, ZCTA, county level queries) with a low incidence disease like invasive cervical cancer. NEW METHODSfRAPSequential mixed methods design using quantitative GIS and qualitative participant observation and key informant interviews to investigate cervical cancer disparities among cervical cancer survivors. Data used to create GIS maps for Phase I are drawn from large open-access census level repositories, as well as from the Texas level repositories.Outcomes Measures: We seek to identify barriers and facilitators of high quality cancer survivorship care at three levels: 1) community 2)  care delivery (medical) 3) policyCONCLUSIONSGIS can help to showcase differences at county and ZCTA-level data related to cervical cancer care delivery. Quantitative CAPs can help focus qualitative research to best understand cervical cancer mortality disparities seen in Hispanic women. Quantitative GIS mapping and descriptive statistical analysisRegion Selection for studyRegion selection for the study determined by the public health issue under investigationGIS Mapping to county level for both social determinants of health and access points for medical careQualitative Data AnalysisQualitative Data CollectionCommunity explorationKey informant interviews• neighborhood • medical• community • policyParticipant observation time in each communityImmersion/crystallizationThematic developmentCross-level and cross-region comparisonsBexar County All Cervical Cancer Cases Dallas County All Cervical Cancer Cases Tarrant County All Cervical Cancer CasesExamples of Quantitative Phase to Identify County and ZCTA level differences through GIS Mapping:Age-Adjusted Invasive Cancer Incidence Rates in TexasCervix Uteri, NH White, 2010–2014By County, Age-adjusted to  2000 U.S. Standard PopulationTexas Rate: 8.5/per 100,000 0.0–7.0 7.1–9.4 9.5–13.5 13.6–52.8 Unstable  Risk population  < 1,000

A novel mixed method using Geographic Information Systems (GIS) and ethnographic methods to study disparities in cervical cancer mortality in Hispanic women

https://scholarlyworks.lvhn.org/cgi/viewcontent.cgi?article=1566&context=family-medicine

A novel mixed method using Geographic Information Systems (GIS) and ethnographic methods to study disparities in cervical cancer mortality in Hispanic women

Abstract

Similar works

Full text

Available Versions

Lehigh Valley Health Network: LVHN Scholarly Works