THE METROPOLITAN CHICAGO NAVIGATION INITIATIVE
Portes Foundation-Institute of Medicine Chicago
Grant Application
Anne Marie Murphy, PhD
David Ansell, MD, MPH
The Metropolitan Chicago Navigation Initiative Proposal to Portes Foundation-Institute of Medicine Chicago
CONTENTS
Executive Summary .......................................................................................................................................................3
Grant Narrative ..............................................................................................................................................................5
Background and Rationale .........................................................................................................................................5
Purpose of the Study ...............................................................................................................................................10
Metropolitan Chicago Navigation Initiative .............................................................................................................11
Research Design .......................................................................................................................................................12
Outcomes and Outputs............................................................................................................................................13
Evaluation Methodology .........................................................................................................................................14
Data collection .........................................................................................................................................................17
Work Plan ................................................................................................................................................................18
Pre-funding Preparation ..........................................................................................................................................18
Budget .........................................................................................................................................................................18
Biographical Sketches ..................................................................................................................................................21
Task Force Advisory Boards and Committees ..............................................................................................................30
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The Metropolitan Chicago Navigation Initiative Proposal to Portes Foundation-Institute of Medicine Chicago
EXECUTIVE SUMMARY
We propose to conduct a study whose primary purpose is to evaluate the efficacy of the
Metropolitan Chicago Navigation Initiative in improving health care resource utilization;
improving access to quality breast health services; and addressing cultural beliefs contributing
to the disparity in breast cancer mortality for Black and underserved women in Chicago.
Secondary aims of this study include development of policy recommendations to improve
access to and quality of breast health care; development of replicable evaluation methodology
for navigation programs; and development of an evidence-based model for navigation that may
be replicated for other health disparities whose causes include system barriers, uneven
geographic resource allocation and cultural beliefs that act as barriers to care utilization among
adversely affected patient populations. Lastly, we seek to identify further areas of improvement
for this initiative.
Across the United States, black women have a lower incidence rate of breast cancer but poorer
survival compared to white women.1 In 2007, published research demonstrated that breast
cancer mortality in black women was 62% higher than white women in Chicago.2 Local studies
have highlighted the complexity and multifaceted nature of this problem in Chicago.3 Access to
quality breast health care and timely intervention has proven to increase early detection and
survival from breast cancer. In Chicago, studies have demonstrated that Black and uninsured
women are less likely to access quality breast health care in a timely manner provided by
specialized practitioners.4
Since its inception in 2008, the Metropolitan Chicago Breast Cancer Task Force (Task Force) has
conducted rigorous analyses that have evidenced numerous policy and health system barriers
that contribute to disparate outcomes for Black and underserved women. The Task Force has
established best practice guidelines in breast cancer mortality prevention efforts. Recently, two
client navigation programs were piloted to address access to care and health system
fragmentation for minority and underserved women. These programs significantly increased
mammography utilization for uninsured and publicly insured women, and identified
opportunities for quality improvement for health care facilities. Evaluation and further
development of this work will advance scientific knowledge of the benefits of a comprehensive
navigation approach that includes targeted outreach and education in addressing interpersonal
barriers. This work is particularly timely with the roll out of the Affordable Care Act and the
1
Smigal C, Jemal A, Ward E, et al: Trends in breast cancer by race and ethnicity: Update 2006. CA Cancer J Clin 56:
168-183, 2006
2
Metropolitan Chicago Breast Cancer Task Force Annual Report Back to the Community, 2010.
3
Ansell D, Grabler P, Whitman S, Ferrans C, Burgess-Bishop J, Murray LR, Rao R, Marcus E. A community effort to
reduce the black/white breast cancer mortality disparity in Chicago. Cancer Causes Control. 2009; 20(9): 16811688.
4
Allgood K, Rauscher G, Whitman S. Screening Mammography Need, Utilization and Capacity in Chicago: Can We
Fulfill Our Mission and Our Promises? In N. Uchiyama & M. Zanchetta do Nascimento (Eds.), Mammography Recent Advances. Rijeka, Croatia: InTech. 2012
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The Metropolitan Chicago Navigation Initiative Proposal to Portes Foundation-Institute of Medicine Chicago
increase in enrollment in Illinois Medicaid, which historically has had the lowest screening rates
for mammography among insured populations.5
We are requesting $35,000 to conduct a formal evaluation of the two pilot navigation programs
that will be managed internally as a single Navigation Initiative. The Task Force has additional
resources to support implementation of the Initiative. To date, sixteen facilities have
committed to donating over 2500 mammograms to increase access to quality screening for
uninsured and under-insured women. In addition, the Task Force has expert leadership in
developing successful interventions for underserved communities (see expert advisory board
members page 20).
Overall, we expect that the Navigation Initiative will reach the women who are most impacted
by the disparity; change health seeking behavior (get screened and become routine screeners);
and improve breast health knowledge, ultimately leading to improved mammography
utilization, earlier detection of disease, and timely follow-up and treatment when necessary at
a comprehensive breast center where a multidisciplinary team coordinates care.
5
Data presented at an Illinois Breast Cancer Screening and Treatment Quality Initiative Board meeting.
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The Metropolitan Chicago Navigation Initiative Proposal to Portes Foundation-Institute of Medicine Chicago
GRANT NARRATIVE
BACKGROUND AND RATIONALE
Despite all of the technological advances in breast cancer screening, diagnosis and treatment,
mortality rates for Black women in Chicago have remained relatively constant over the past
twenty-five years. This stands in stark contrast to the significant decline in breast cancer
mortality rates for non-Hispanic White women.6 In 2007, the breast cancer mortality rate for
Black women was 62% higher than the rate for their white counterparts, as shown in Figure 1.7
Annually in Chicago, there are 70 excess deaths in Black women due this disparity. This
inequality represents one of the highest racial disparities in breast cancer mortality in the
United States. 8 A recent study of the twenty-five largest metropolitan cities in the US
demonstrates that Chicago has the fifth highest racial disparity in breast cancer mortality – 61%
– compared to New York at 24% and San Francisco with no disparity.9 This extreme geographic
variability in breast cancer mortality between numerous racially/ethnically diverse cities across
the United States suggests that differential biology is not the driving force behind this problem.
Though one study identified a small subset of African women to have a predisposition for more
aggressive tumors, this still does not explain the current Black:White breast cancer disparity in
the United States. The difference in mortality rates far between New York, Baltimore, and San
Francisco as compared to Chicago suggests that the health system in these cities supports
better health outcomes.10
6
Hirschman J, Whitman S, Ansell D. The black:white disparity in breast cancer mortality: the example of Chicago.
Cancer Causes Control 2007;18(3):323–333
7
Metropolitan Chicago Breast Cancer Task Force, Op Cit.
8
Whitman S, Orsi J, Hurlbert M. The racial disparity in breast cancer mortality in the 25 largest cities in the United
States Cancer Epidemiology 36 (2012) e147–e151.
9
Ibid.
10
Dezheng Huo, Francis Ikpatt, Andrey Khramtsov, Jean-Marie Dangou, Rita Nanda, James Dignam, Bifeng Zhang,
Tatyana Grushko, Chunling Zhang, Olayiwola Oluwasola, David Malaka, Sani Malami, Abayomi Odetunde, Adewumi
O. Adeoye, Festus Iyare, Adeyinka Falusi, Charles M. Perou, Olifunmi Olopade. Population Differences in Breast
Cancer: Survey in Indigenous African Women Reveals Over-Representation of Triple-Negative Breast Cancer.
Journal of Cancer Oncology (2009) 27, No. 27, 4515-4521.
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The Metropolitan Chicago Navigation Initiative Proposal to Portes Foundation-Institute of Medicine Chicago
62%
Figure 1. Black:White Aggregate Age Adjusted Mortality, Chicago 1981-2007
Although the debate is ongoing, a number of factors contributing to this disparity have been
identified including health system and intrapersonal barriers. Specifically, differences in access
to care, quality of mammography, and utilization of breast health services have been identified
as significant contributing factors to this problem.11, 12
In Chicago, access to and quality of care are functions of capacity and geography. A local study
of mammography capacity in Chicago demonstrated a considerable unmet need in screening
mammography services.13 The city does not have adequate screening mammography capacity
defined by the number of machines to adequately screen every age-eligible resident annually.
In addition, there is a shortage in fellowship-trained radiologists and specialized radiology
technologists. These specialized providers equate to quality care, which is concentrated in high
volume and/or academic facilities in the Chicago metro area. The study also found that high
volume facilities were less likely to serve patient populations who were majority Black or
Hispanic.14 To further exacerbate the problem of access, Chicago’s only public hospital stopped
providing screening mammograms, eliminating 10,000 screening exams that were previously
provided annually to predominately underserved women.15 The Chicago Department of Public
Health clinics have also decreased in the volume of mammograms they provide and have
recently lost state funding for mammography services due to alleged poor quality. In addition,
the statewide screening program for uninsured women is underfunded. In the last two years,
the statewide program has run out of funds for screening mammograms within the first 3 or 4
11
Ansell et al., Op Cit.
Rauscher G., Murphy A.M., Orsi J.M., Dupuy D.M., Grabler P.M, Weldon, C.B. “Beyond MQSA: Measuring the
quality of breast cancer screening programs” American Journal of Roentology – in press.
13
Allgood K, Rauscher G, Whitman S. Screening Mammography Need, Utilization and Capacity in Chicago: Can We
Fulfill Our Mission and Our Promises? In N. Uchiyama & M. Zanchetta do Nascimento (Eds.), Mammography Recent Advances. Rijeka, Croatia: InTech. 2012
14
Ibid.
15
Ibid.
12
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months of the state fiscal year. Insufficient capacity and uneven geographic distribution of
mammography screening resources are among the major contributing factors to these
disparities. As a result, Black women in Chicago are less likely to have breast cancer detected
through screening mammography.16 In addition, Black women are less likely to have their
mammograms read by breast imaging specialists; more likely to present with later stage breast
cancer; and more likely to experience delays in diagnosis and treatment compared to White
women.17,18,19
A report by the Dartmouth Institute for Health Policy and Clinical Practice in September 2010
showed that among all Medicare recipients, Chicago has the lowest mammogram screening
rates in the nation, with even lower rates for Black women served by Medicare.20. A recent
study by the University of Illinois at Chicago showed that more Black women held cultural
beliefs about breast cancer that caused them to delay seeking care for suspicious breast
symptoms. No such relationship was found for Caucasian women.21,22,23 These studies suggest
that the disparity in mortality may be exacerbated by lack of effective breast cancer education,
in addition to systemic barriers to access timely, quality mammography screening and
treatment.
Since its inception in 2008, the Metropolitan Chicago Breast Cancer Task Force (Task Force) has
initiated projects that have established best practice guidelines in breast cancer mortality
prevention efforts. In particular, the Task Force established a healthcare collaborative project
known as the Chicago Breast Cancer Quality Consortium (Consortium) – the nation’s first
federally designated Patient Safety Organization dedicated exclusively to breast health and the
elimination of racial breast health disparities. Through the Consortium, the Task Force has
created a mammography and a breast cancer treatment quality surveillance system. With
passage of Public Laws 95-1045 and 97-0638, the mammography component has been
incorporated into the Illinois Medicaid program and this year has gone statewide. Under this
new initiative, Illinois becomes the first state in the nation to have a mammography quality
surveillance system that is more rigorous than the federal Mammography Quality Standards
16
Ansell, Op Cit.
Ibid
18
Rauscher GH, Allgood KL, Whitman S, Conant E. Disparities in Screening Mammography Services by
Race/Ethnicity and Health Insurance Journal of Women's Health, 2012; 21(2): 154-160
19
Rauscher GH, Ferrans CE, Kaiser KK, Campbell RT, Calhoun E, Warnecke RB. Misconceptions about breast lumps
and delayed medical presentation in urban breast cancer patients. Cancer Epidemiology, Biomarkers and
Prevention 2010;19(3):640-7. PMCID: PMC3625394.
20
Fisher ES, Goodman DC, Chandra A. Disparities in Health and Health Care among Medicare Beneficiaries. A Brief
Report of the Dartmouth Atlas Project. By Dartmouth Institute for Health Policy and Clinical Practice in September
2010
21
Rauscher et al., Misconceptions about breast lumps and delayed medical presentation in urban breast cancer
patients. Op Cit.
22
Peek ME, Sayad JV, Markwardt R. Fear, Fatalism and Breast Cancer Screening in Low-income African American
Women: The Role of Clinicians and the Health Care System. Journal of General Internal Medicine. 2008
23(11):184753
23 Kaiser K, Cameron KA, Curry G, Stolley M. Black Women’s Awareness of Breast Cancer Disparity and Perceptions
of the Causes of Disparity. Journal of Community Health. 2013 38:766-772.
17
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Act. We currently have participation by 160 academic and community institutions in the
mammography surveillance system statewide and have 28 hospitals participating in our
treatment quality project. In addition, the Task Force has engaged in care process analysis at 26
institutions across Metropolitan Chicago to better understand the pathway that women follow
when accessing breast health services. Findings from the care process analysis indicated
considerable variation in processes of care across mammography facilities. It was identified that
many lower resource facilities did not have sufficient capacity to track patients, resulting in a
higher rate of women not obtaining their mammogram results or, more importantly, not
returning for additional imaging after an abnormality was found.24
In the literature, patient navigation interventions have demonstrated considerable success in
mitigating some of the barriers to breast health care identified above.25, 26 The National Cancer
Institute Patient Navigation Research Program was found to reduce time to diagnostic
resolution, time to treatment initiation and patient satisfaction. 27 While promising, the
literature notes several limitations to existing navigation programs and community based
interventions. Specifically, there is considerable variation in the defined roles and
responsibilities of the navigator. While there is a breadth of navigation programs, few of these
programs intervene at the point of screening initiation. Perplexingly, there are a number of
community-based and clinic/hospital based programs involved in breast cancer screening and
navigation across Metropolitan Chicago. However, the organizations use widely diverse
methods in their work with varying levels of success. Notably, these disparate approaches have
had limited impact on reducing the disparity in breast cancer mortality rates for Black women in
the city.
One of the factors contributing to the limited impact for most health promotion initiatives is
the lack of resources allocated to program evaluation. The need for sound if not rigorous
evaluation remains essential to all public health programs, especially those at the community
level. 28 , 29 Without sufficient evaluation, the effectiveness of an intervention cannot be
assessed. Currently, community based interventions are typically not included in systematic
24
Weldon C., Trosman J., Dupuy D., Roggenkamp B., Schink J., Orsi J., Murphy A.M. “Do patient tracking, followup, and referral practices contribute to breast cancer disparities in a large urban area?” abstract accepted for
presentation ASCO 2012
25
Nguyen TUN, Kagawa-Singer M. Overcoming Barriers to Cancer Care through Health Navigation Programs.
Seminars in Oncology Nursing 2008. 24(4). 270-8.
26
Carroll JK, Humiston SG, Meldrum SC, Salamone CM, Jean-Pierre P, Epstein RM, Fiscella K. Patient Experiences
with Patient Navigation for Cancer Care. Patient Education and Counseling. 2010 80. 241-7
27
Freund KM, Battaglia TA, Calhoun E, Dudley DJ, Fiscella K, Pasket E, Raich PC, Roetzheim RG. National Cancer
Institute Patient Navigation Research Program Methods, Protocol and Measures. Cancer. 2008, 113(12), 33913399.
28
Pettman TL, Armstrong R, Doyle J, Burford B, Anderson LM, Hillgrove T, Honey N, Waters E. Strengthening
Evaluation to Capture the Breadth of Public Health Practice: Ideal vs. Real. Journal of Public Health. 2012. 34(1),
151-5.
29
Whitney W, Duthcer GA, Keselman A. Evaluation of Health Information Outreach: Theory, Practice, and Future
Direction. Journal of Medical Library Association. 2013. 101(2). 138-46.
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The Metropolitan Chicago Navigation Initiative Proposal to Portes Foundation-Institute of Medicine Chicago
reviews as are experimental studies. Improving the quality of evaluation of non-experimental
and/or community based interventions will lead to inclusion of such interventions in the
broader conversation in the literature, which will in turn promote a culture of practice-based
evidence informing future public health practice30.
Informed by our previous efforts including quality data collection and care process analysis, the
Task Force piloted two breast cancer prevention initiatives over the past year. Screen to Live
(STL) is a community-based outreach and navigation program for uninsured and publicly
insured women who live in Englewood and West Englewood. These are predominately Black
community areas with two of the highest breast cancer mortality rates in the city. To date the
women navigated through STL have been 70% uninsured, 23% publicly insured and 7% privately
insured. The second program, Beyond October (BYO), is a Metro wide navigation program for
self-referring uninsured women. BYO was promoted via the media and community partners all
across Metro Chicago and generally women initiated contact with the Task Force themselves to
request a mammogram. Several collaborating health facilities including academic and safety net
hospitals donated free mammograms to benefit underserved women. As a result of
partnerships developed by the Task Force, these pilot programs increased mammography
capacity and access to quality care for uninsured and under-insured women. In the last year,
over 1,100 women received navigation services, and 906 women completed a mammogram
and obtained their results through these two programs. These pilot programs highlighted
successful strategies to reach marginalized women and increase mammography utilization.
These programs patch a fragmented system and help identify gaps in care processes that
increase the time between screening and diagnostic care and the number of women who are
lost to follow up.
The Task Force plans to continue work piloted in STL and BYO. Moving forward and for the
purposes of this study, internally the pilot programs Screen to Live and Beyond October will be
consolidated into the Metropolitan Chicago Navigation Initiative (Navigation Initiative). The
novelty of the Navigation Initiative lies in that the Task Force has created a comprehensive
navigation program responding to the individual needs of the women serviced. Task Force staff
members navigate women across the breast cancer care spectrum utilizing in-kind resources
from a wide variety of facilities across the city, each with their own policies and procedures.
Our initiatives address many of the areas of concern raised by the studies cited above.
30
Ibid.
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In summary, the racial disparity in breast cancer mortality is a complex ecological phenomenon,
illustrated in Figure 2. To eliminate this disparity, a multifaceted approach is imperative to
address all the contributing factors. Interventions also need to include a comprehensive
evaluation component to measure efficacy and impact.
Public Policy
•Insufficient funding for
state screening
programs for
underserved women
Health system Barriers
•Variation in access to &
quality of breast health
resources
Community Barriers
•Social Norms Mistrust
of health care system
Intrapersonal
Barriers
•Insufficient Health
Seeking Behavior
•Fear and mistrust
•Lack of knowledge
Figure 2. Ecological Model of the complexity of the factors contributing to racial disparity in breast cancer mortality
in Chicago.
PURPOSE OF THE STUDY
The primary purpose of this study is to evaluate the efficacy of the Metropolitan Chicago
Navigation Initiative in improving health care resource utilization; access to quality breast
health services; health seeking behavior and addressing cultural beliefs contributing to the
disparity in breast cancer mortality for Black and underserved women in Chicago. Secondary
aims of this study include the development of policy recommendations to improve access to
and quality of breast health care; the development of a replicable evaluation methodology for
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The Metropolitan Chicago Navigation Initiative Proposal to Portes Foundation-Institute of Medicine Chicago
other navigation programs; and the development of an evidence-based model for navigation
that may be replicated for disparities impacting other health outcomes. Lastly, we seek to
identify further areas of improvement for this initiative.
METROPOLITAN CHICAGO NAVIGATION INITIATIVE
Since 2012, eighteen medical facilities have donated over 2500 free mammograms to support
our efforts to increase access to quality care for underserved women. Over the past year, the
efforts of the pilot programs were enhanced. The intervention strategies of the Navigation
Initiative consist of outreach, education and navigation efforts to address community and
interpersonal barriers contributing to the disparate breast outcomes for minority and
underserved women. Typical methods (i.e. medical facilities mailings or phone calls) to reach
most marginalized populations are insufficient. Use of peer educators or community navigators
working in the community; as well as use of outreach strategies in unconventional locations
such as on the street, bus, or laundromats has been successful in reaching marginalized
populations. In the Navigation Initiative, navigators will attend community events such health
fairs and community meetings. Specialized strategies such as street outreach will be conducted
in communities with the highest breast cancer mortality rates. In addition, the initiative will be
promoted via media and community partners throughout Metro Chicago.
Following outreach, the second component of this intervention is education. Increased
knowledge and improved attitude regarding breast health have been shown to improve
interpersonal barriers to mammography utilization. However, health behavior change is as
complex as the problem to be addressed. Two health behavior models facilitate understanding
the factors impacting healthcare decision-making.
 According to the Theory of Planned Behavior, behavior is a function of one’s intent,
which is determined by a person’s attitude toward the behavior, social norms (what do
other people believe the person should do) and lastly, the individual’s perception of
their ability to perform the behavior (self-efficacy).31,32,33
 The Transtheoretical (Stages of Change) Model explains behavior change as a process of
six stages: Pre-contemplation, Contemplation, Preparation, Action, Maintenance and
Termination.34 The Pre-contemplative stage typically represents women who lack health
seeking behavior and who do not intend to get a mammogram. Breast health awareness
is critical to encourage women to begin contemplating getting screened and
transitioning to the next stage. Once in the contemplative stage, an individual intends to
make the behavior change within six months. Women who self-refer into our program
31
Ajzen, I. (1991). The Theory of Planned Behavior. Organizational Behavior and Human Decision Processes, 50,
179–211.
32
Armitage, C., & Conner, M. (2001). Efficacy of the theory of planned behavior: A meta-analytic review. British
Journal of Social
Psychology, 40, 471–499.
33
Grizzell, J. (2007, 1/27/2007). Behavior Change Theories and Models. Retrieved January 28, 2007, from
http://www.csupomona.edu/~jvgrizzell/best_practices/bctheory.html.
34
Prochaska, J., Johnson, S., & Lee, P. (1998). The transtheoretical model of behavior change. In S. Schumaker, E.
Schron, J. Ockene & W. McBee (Eds.), The Handbook of Health Behavior Change, 2nd ed. New York, NY: Springer.
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and request a mammogram represent individuals in the preparation stage; they are in
the process of developing an action plan to get screened. Once a woman has completed
her mammogram, she has transitioned to the Action stage. Non routine screeners
represent women in the maintenance stage; while individuals who reach the
termination stage are routine screeners who are fully aware and empowered to
maintain their breast health. The Model posits that an individual will cycle through the
early stages repeatedly, unless there is a targeted intervention. Financial barriers and
lapses in insurance are possible factors contributing to relapses in the later stage
between routine and non-routine screening.
These two models provide a foundation to conceptualize barriers to mammography utilization
as well as strategies to facilitate behavior change based on the individual stage of the client. To
successfully meet the individual needs of each client in the Navigation Initiative, an educational
curriculum has been developed based on these theoretical models. Messages will be tailored
for each client based on their current stage of change to facilitate progression to the final stage
of desired behavior.
Once a client has decided to get a mammogram, navigation services will be provided to her
throughout the breast health continuum. Our navigation services include assisting clients in
obtaining an order for a screening, scheduling the exam, completion of the exam, obtaining
exam results and prior films for comparison, and, if needed, scheduling and completion of
diagnostics. Navigators act as a liaison between the patient and the medical facility and contact
both parties throughout the process to ensure that the client has successfully completed the
breast health process, accessed all necessary services, and is knowledgeable of the next step of
care (i.e. annual screening or short-term follow up).
RESEARCH DESIGN
A non-experimental pretest–posttest design will be used to assess the efficacy of the
intervention strategies employed by the Navigation Initiative. The targeted population for this
intervention is women 40 and older who are uninsured, underinsured or publicly insured
through Medicaid. However, assistance will be provided to any woman seeking information
and/or support in obtaining breast health care. Outreach efforts will be focused in the
following Chicago Southside communities who have the highest breast cancer mortality rates in
the city Englewood, West Englewood, Roseland, Chatham, and Auburn Gresham. Attendance at
other community events such as health fairs and church events will be provided upon request
from a community stakeholder.
All participants will be assessed using a pretest questionnaire to establish a baseline level of
knowledge, attitudes and behaviors related to breast cancer and health resource utilization,.
The client will choose which level of services she wishes to receive. Women seeking breast
health education only will represent the comparison group, and those choosing to receive
education and navigation services will comprise the intervention group. This is discussed
further in the Evaluation section of this proposal.
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We anticipate that women who receive education and navigation will show an increase in
breast health knowledge, decrease in fears and fatalistic attitudes related to breast cancer and
mammography and improvement in their stage of behavior change when compared to women
who receive education only. This project will be submitted for approval to the Rush University
Medical Center Institutional Review Board.
OUTCOMES AND OUTPUTS
The targeted outcomes and expected deliverables for the Navigation Initiative are presented
below in Table 1 respective to the specific intervention strategy.
Table 1. Program deliverables and evaluation outcomes respective to related intervention strategy
Intervention
Strategy
Outputs
Outreach
Outreach Form
Community
Navigator Training
Curriculum
Process

Outcomes
Impact
 Reach 2000 women through
outreach and self-referral
Train 7 Navigators

Education
Breast Health
Education Curriculum


Educate 1,000 women
Increase intensity/dose
of services provided




Assess integrity of
service to planned
design

Increase intensity/
dose of services
provided and
received
Navigation Protocol
Client Tracking Tool
Navigation
Community Resource
Guide
Increase patient knowledge
of the benefits of
mammography and early
detection
Decrease fatalistic attitudes
regarding breast cancer
Decrease fear of screening
Increase mammography
utilization

Increase mammography
utilization

Increase access to quality
breast health services

Increase number of women
who become routine
screeners
Increase timely follow up for
diagnostic imaging
Decrease the rate of patients
who are lost to follow up


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EVALUATION METHODOLOGY
Currently, the local and national landscape of health care is changing dramatically. In Chicago,
breast health services can be described as non-existent, inaccessible and under-utilized. It is
this context that necessitates the Navigation Initiative and the rigorous evaluation of this work.
The Navigation Initiative is in the implementation stage of development. After one year of
piloting, barriers and facilitators to the process and impact outcomes have been identified.
These findings have informed the enhancement of the Task Force’s navigation efforts, and have
led to the development of theory-based interventions for the Navigation Initiative. The current
study will evaluate the efficacy the Navigation Initiative in increasing mammography utilization
and improve knowledge, attitudes and behaviors related to breast cancer awareness. Expected
process and impact outcomes have been established and, in tandem to implementation, an
evaluative study will be conducted to assess the fidelity of implementation and success of
accomplishing expected outcomes. The Evaluation Framework developed by the Centers for
Disease Control and Prevention has been utilized to develop the evaluation plan of the
Navigation Initiative.
As stated previously, a non-experimental pretest–posttest design will be used to assess the
efficacy of the intervention strategies employed by the Navigation Initiative. The target
population for this intervention is minority women, particularly African American age 40 and
older who are uninsured or under-insured. Outreach activities will be accessible to all women in
this target group. Women recruited and or contacted through outreach will have an option to
receive education only, or education and navigation. For purposes of the evaluation, receipt of
education-only refers to the comparison group; while receipt of both education and navigation
refers to the intervention group. Those in the intervention group will receive more intensive
support and education that we anticipate will favorably impact the clients’ attitudes toward
mammography utilization and their self-efficacy to become routine screeners. The more
intervention and navigation services a woman obtains, the more likely that individual woman
will acquire sustainable favorable health behavior change which, if taken collectively, may
improve breast health outcomes for Chicago’s most vulnerable women. This concept can also
be explained as behaving in a dose response manner, an increase in services provided leading
to an increase in desired study outcomes.
Outcomes will be stratified by point of entry into the program (outreach vs. self-referral);
services received; services completed; and pre and post stage of change. A navigation index will
be created based on the volume and duration of each point of contact with a given client. The
following navigation actions will serve as critical points of navigator-client contact during the
study:
 Completion of intake process
 Appointment reminder call and preparation
 Notification of results
 If diagnostic services are required, scheduling and follow-up as needed
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The index will assess the dose/response within the intervention group based on the intensity of
the navigation process. One hypothesis is that, women who self-refer may be at a higher stage
of change and therefore will require less intense navigation to complete their mammogram.
Throughout the navigation process, identification of critical personal/social barriers that
undermine positive health behaviors will be documented using the navigation tool and pre-post
questionnaires. Overall, we hope to identify which strategies are most successful to reach
underserved women; which education messages are best to promote women becoming routine
screeners; which navigation strategies increase mammogram completion and reduce delays in
the care process. The indicators that will be measured in the evaluation are listed in Table 2.
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Table 2. Expected Outcomes, shown with respective indicators and data collection method.
Outcomes
Integrity of service to
planned design
Indicators
Were the outreach, education
and navigation activities
implemented as planned? Y/N
If, N description of the variance.
Number, type and duration of
outreach events, educational
sessions and navigation services
provided
Impact
Process
Intensity/dose of
services provided and
Number, type and duration for
received
services received
Reach into the target
population
Increase patient
knowledge of the
benefits of
mammography and
early detection
Decrease fatalistic
attitudes regarding
breast cancer
Decrease fear of
screening
Increase
mammography
utilization
Increase number of
women who become
routine screeners
Increase timely
follow up for
diagnostic imaging
Decrease the rate of
women who are lost
to follow up
Time to complete the navigation
process
Number and type of
recruitment strategies
Number and type of women
receiving services
Knowledge of breast health
facts before and after receipt of
education
Data Collection Forms
Outreach Tracking Form
Navigation Tool
Outreach Tracking Form
Pre/post questionnaire
Intake Form
Navigation Tool
Outreach Tracking Form
Pre/post questionnaire
Intake Form
Navigation Tool
Navigation Tool
Outreach Tracking Form
Pre/post questionnaire
Intake Form
Pre/post questionnaire
Patient knowledge, attitude and
behavior regarding use of breast Pre/post questionnaire
care services
Patient knowledge, attitude and
Pre/post questionnaire
behavior regarding screening
Number of completed
mammograms
Navigation Tool
Number of women who indicate
last mammogram was within
the last 2 years on intake.
Pre/post questionnaire
Intake Form
Percent of women with abnormal
screening who get diagnostic
follow-up within 30 days
Navigation Tool
Number of women who
complete navigation process
from screening to receipt of
results
Navigation Tool
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The Metropolitan Chicago Navigation Initiative Proposal to Portes Foundation-Institute of Medicine Chicago
DATA COLLECTION
A mixed methodology will be utilized to collect data for this evaluation. Secondary data will
come from the mammography quality surveillance and care process analyses described above
and vital statistics.
A variety of tools will be used to collect primary data for the project.
 An intake form is used to collect client demographic and mammography utilization
information.
 A pre/post questionnaire will be created to assess changes in clients’ knowledge and
attitudes related to screening and breast cancer. At the point of contact, all women will
complete a pre-test questionnaire related to current breast health knowledge, attitudes
and beliefs regarding breast cancer and stage of intent related to health seeking
behavior. A follow up post-test questionnaire related to the aforementioned items will
be administered at 5 months and 10 months. Women in the comparison group will also
be asked to complete a brief education survey at 5 and 10 months to assess the
information retained from the education session.
 An outreach tracking tool has been created to document the type, frequency of use and
number of women reached at each venue. The form is completed by each staff person
who performs any outreach and/or education activity.
 A navigation form is used to document the details of the navigation process for each
client. Specifically, the number of contacts made with the client and health care
provider throughout the screening process is documented, counted and categorized.
 Bi-weekly staff meetings will be held to discuss facilitators and barriers to implementing
project activities. The meeting minutes will provide qualitative data for process
outcome.
A Microsoft Access database was created to maintain project data and facilitate client tracking.
Individual level data collected from the outreach tracking form, intake, and navigation forms
will be linked to the outreach event where the client was recruited. Each data source will
provide an integral piece of information that will be used collectively to document the women’s
breast health journey through this project. Statistical analysis will be conducted using SAS and
GIS.
The process evaluation will run concurrently with implementation of the project activities. The
process measures will be assessed monthly, and the findings will be used to assess the fidelity
of implementation and reach into the target population, as well as identify areas for
improvement. At six and twelve months of implementation, the data representing participants
who have completed navigation and/or education services will be analyzed to evaluate
achievement of projected outcomes specified above. If additional mammograms are still
available after 12 months, the intervention will continue until all screenings are used and every
participant has received navigation and/or education. The complete process and impact
evaluation will conclude at the time all data has been received. Following each phase of the
evaluation, the findings will be synthesized and assessed for appropriate next steps. After the
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The Metropolitan Chicago Navigation Initiative Proposal to Portes Foundation-Institute of Medicine Chicago
completion of this study, refinements to the intervention and outputs will be completed as
needed. The outputs will be finalized and staff will be developing related manuscripts to
document the scientific contribution of the work. Support from the IOMC-Portes Foundation
will be referred to in publications and presentations related to this study. The Task Force will
also seek resources to support sustainability for the evaluation component of this initiative.
WORK PLAN
PRE-FUNDING PREPARATION
The Task Force currently has funding for the general operations of its navigation program and is
seeking funding from IOMC-Portes Foundation to add a rigorous evaluation and analysis
component to the work so as to improve its efficacy and broaden its utility to other
organizations and other disease states. The following activities will be completed using existing
funding prior to the commencement of IOMC-Portes Foundation funding. This project is on
track to obtain approval from the Rush University Medical Center Institutional Review Board
(RUMC IRB) by December 1, 2014.
First Quarter (January – March)
 Initiate Study – Pre/post data collection
Second Quarter (April – June)
 Full Implementation
 Process Evaluation
 5 month Post-test implementation – May 2015
 6 month Impact Evaluation – June 2015
Third Quarter (July – September)
 Full Implementation
 Program updates per process evaluation outcomes.
 Process Evaluation
 Begin planning for program and evaluation sustainability
Fourth Quarter (October – December)
 Full Implementation
 Process Evaluation
 10 month Post-test implementation – October 2015
 12 month Impact Evaluation – December 2015
Conclusion of Study
 Data Analysis
 Interpretation of Findings
 Revisions to Intervention and outputs
 Dissemination of Findings
BUDGET
The Task Force is requesting $35,000 in funding to support this project.
Salary Support Requested: $22989
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The Metropolitan Chicago Navigation Initiative Proposal to Portes Foundation-Institute of Medicine Chicago
This would consist of funding for 5% effort by Dr. Anne Marie Murphy (Annual salary $139,790
over term of grant) who is the Executive Director of the Metropolitan Chicago Breast Cancer
Task Force and Director of the Chicago Breast Cancer Quality Consortium and a faculty member
at the Department of Health Systems Management at Rush University Medical Center (RUMC).
Dr. Murphy is the state’s former Medicaid Director (2003-2007) and has been with the Task
Force since 2009. Dr. Murphy has over 15 years of health policy experience and has extensive
relationships with healthcare providers and knowledge of the overall Illinois and Chicago health
care systems. Her career has spanned health policy practice, healthcare operations and
research with a particular emphasis on improving the healthcare delivery system for vulnerable
populations. Biosketch is provided. Dr. Murphy will supervise this project and will be
responsible for the scientific content, review, abstract and publication generation.
The other principal investigator, Dr. David Ansell will contribute 5% effort and his time will be
donated by Rush University Medical Center. Dr. Ansell has an extensive history of involvement
in disparities research generally and in breast cancer disparities research more specifically over
the past decade. Details of his publications in this area are available on his accompanying
biosketch. Dr. Ansell was an original founder of the Task Force and is a key member of the
Chicago Breast Cancer Quality Consortium steering committee. He is also the Vice President for
Clinical Affairs for Rush University Medical Center where he oversees many aspects of clinical
care including patient safety and quality improvement.
This grant will also support 20% effort by Ms. Teena L. Francois, MPH, who is the Associate
Director of Community Health Initiatives and Research (Annual salary $80,310 over term of
grant). Ms. Francois will be responsible for the day to day work of this project. She received
her Masters of Public Health in Epidemiology and Health Education from Tulane University in
2003. Her career focus has been on maternal and child health (MCH) related issues particularly
for vulnerable populations including underserved communities and children with special needs
(CSN). She comes to the Task Force with extensive experience and knowledge in breast cancer
epidemiology, disparities research and evaluation of breast and cervical cancer prevention,
screening, diagnostic and treatment initiatives. Prior to joining the Task Force, Teena was an
epidemiologist with the Sinai Urban Health Institute (SUHI) from 2005 to 2010. During that time
she was a Breast Health Supervisor for the Helping Her Live Breast Cancer Prevention program
and Evaluator for the Stand Against Cancer program. She was also a member of the
coordinating committee for the Task Force.
In addition to her work in breast cancer epidemiology, Teena was a contracted evaluator for the
National Center of Immunization and Respiratory Diseases Assessment Branch in improving the
national assessment of kindergarten vaccination coverage. She also supported the Georgia
Department of Public Health MCH program, the Early Intervention Institute and the Louisiana
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The Metropolitan Chicago Navigation Initiative Proposal to Portes Foundation-Institute of Medicine Chicago
Department of Public Health in the development, implementation and evaluation of state
initiatives for children and youth with special health care needs.
Fringe Benefits: $6897
Task Force employees are leased RUMC employees and as such enjoy RUMC employee benefits
at a charge to the Task Force of 30% of salary.
Occupancy: $4800
The salary support requested in this grant represents 6% of Task Force total salary and
contractual salaries for the term of the grant. The Task Force employs a uniform cost allocation
methodology across all grants. Total occupancy costs for Task Force over this time period is
expected to be $80,000 (rent, utilities and phone for staff working on the project). Therefore,
6% of this total is $4,800.
Travel: $300
Travel for staff to present this work at any of the relevant national scientific meetings will be
considerably more than the $1,000 allowable in this grant. The Task Force will therefore cross
subsidize this grant with an additional $1,000-$1,500 to allow either Dr. Murphy or Ms. Teena
Francois MPH to present this work nationally.
Indirects: $7,000 – cross subsidized by Task Force from other funds.
Task Force indirects for administration of grants, audits, accounting, supplies and other costs
associated with overseeing its various projects run at approximately 12-14%. The Task Force
will utilize public support through fundraising to support this aspect of this grant.
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The Metropolitan Chicago Navigation Initiative Proposal to Portes Foundation-Institute of Medicine Chicago
BIOGRAPHICAL SKETCHES
NAME
POSITION TITLE
Anne Marie Murphy
Director Chicago Breast Cancer Quality Consortium,
Assistant Professor Department of Health
Management Systems, RUMC
eRA COMMONS USER NAME
AnneMurphy
EDUCATION/TRAINING
DEGREE
(if applicable)
YEAR(s)
Trinity College Dublin, Ireland
B.A.
1988
The Johns Hopkins University, Baltimore
Ph.D.
1996
INSTITUTION AND LOCATION
FIELD OF STUDY
Natural Science (Genetics)
Biology (Molecular
Genetics)
Personal Statement
I am the founding Director of the Chicago Breast Cancer Quality Consortium, the nation’s first
federally designated Patient Safety Organization dedicated exclusively to breast health and
elimination of racial health disparities. As such, I have a proven track record of bringing
healthcare institutions and providers together to build consensus on how to voluntarily
improve our healthcare system. A testament to the success of this effort is the fact that over
80% of hospital based mammography in Metropolitan Chicago now participate in and
contribute data to our Breast Cancer Quality Consortium project. With the passage of Public
Law 95-1045 and Public Law 97-638, our mammography quality surveillance project is now
going statewide for Medicaid providers. In addition, we receive treatment quality data from
institutions that treat more than half of breast cancer patients across Metropolitan Chicago
(Cook and the collar counties).
Last year, in response to a crisis in funding for uninsured women’s mammography due to state
budget cuts, the Metropolitan Chicago Breast Cancer Task Force launched our Beyond October
program, with a successful appeal to area hospitals to donate free mammograms. 800 free
mammograms were secured and we successfully navigated close to 700 women to these free
mammograms. This navigation project took place on the heels of our launch of Screen to Live
Englewood, a community based breast care navigation project that was launched in June of
2012. Therefore, within 12 months of our initiation of navigation, we had navigated close to
1000 women to breast cancer screens and had navigated those in need of follow up onward.
As the state’s former Medicaid Director, the former State Director of Health Programs at the
Illinois Department of Public Health, the Governors health policy advisor, and a congressional
health policy advisor for Senators Kennedy, Simon and Durbin, I have a deep understanding of
Illinois’ health delivery system and have a long history of health system reform and quality
improvement. As the Governor’s health policy advisor, I was responsible for operationalizing
the expansion of the Illinois Breast and Cervical Cancer Program to cover all uninsured women.
Illinois is the only state in the nation to cover all uninsured women in this program and does so
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The Metropolitan Chicago Navigation Initiative Proposal to Portes Foundation-Institute of Medicine Chicago
with both federal and state funds. In 2009, I transitioned from my role as a health policy
practitioner to a new role as a health researcher focusing on breast cancer disparities at the
Chicago Breast Cancer Quality Consortium. Under my leadership, the Chicago Breast Cancer
Quality Consortium became the first federally designated Patient Safety Organization dedicated
exclusively to breast health and has developed a data collection system for breast cancer
quality metrics. Our publication on the inadequacies of the current federal Mammography
Quality Standards Act will be published in the American Journal of Roentology in the next few
months. I have presented our research extensively over the past 3 years at academic
conferences with the abstracts listed below. Thus, my expertise in the health delivery system in
Illinois, relationship and experience with the State’s Medicaid program, experience with racial
disparities in breast cancer care, and leadership skills within the Task Force will facilitate the
collaborations necessary to successfully implement this research project on the eve of
launching of the Affordable Care Act, which will have significant effects on the nation’s
healthcare delivery system.
Positions and Employment
1995-1996
Committee Staff Member for the Health, Education, Labor and Pension
Committee, U.S. Senate (Senator Edward M Kennedy)
1996-1997
American Association for the Advancement of Science Congressional
Fellowship Spent in the offices of Senator Paul Simon and Richard J.
Durbin, U.S. Senate
1997-2003
Senior Healthcare Policy Advisor, Senator Richard J. Durbin, U.S. Senate
2003-2006
Illinois Medicaid Director, Department of Healthcare and Family Services
2007-March 2009
Illinois Director of State Healthcare Programs
April 2009-present
Director, Chicago Breast Cancer Quality Consortium
April 2010-present
Executive Director Metropolitan Chicago Breast Cancer Task Force
2011 – present
Assistant Professor Department of Health Systems Management, RUMC
Honors
American Association for the Advancement of Science Congressional Fellowship 1996
Loretta Lacey Award, 2005 – Illinois Maternal and Child Health Coalition
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The Metropolitan Chicago Navigation Initiative Proposal to Portes Foundation-Institute of Medicine Chicago
Excellence in Government Administration, 2005 – Illinois Primary Health Care Association
Richard J. Phelan Profile in Courage Award, 2007 – Planned Parenthood Illinois
State Award for Excellence, 2007 – American Academy of Nurse Practitioners
White House Champion for Change in the Fight Against Breast Cancer 2010 – nominated by
Susan G. Komen for the Cure
Publications and Abstracts
1. Rauscher G., Murphy A.M., Orsi J.M., Dupuy D.M., Grabler P.M, Weldon, C.B. “Beyond
MQSA: Measuring the quality of breast cancer screening programs” American Journal of
Roentology – in press
2. Murphy A. M, Dupuy D. M, Ferrans C., Ansell D.A. “Creation of a Statewide
Mammography Program to Improve Mammography Quality” Oncology Nurses Society
book on Cancer Health Policy – in press
3. Trosman J., Weldon C., Dupuy D., Roggenkamp B., Ganschow P., Schink J., Murphy A.M.
4. “Why do breast cancer programs fail to refer patients to genetic counseling upon
obtaining family history?” abstract accepted for presentation ASCO (2012)
5. Weldon C., Trosman J., Dupuy D., Roggenkamp B., Schink J., Orsi J., Murphy A.M.
6. “Do patient tracking, follow-up, and referral practices contribute to breast cancer
disparities in a large urban area?” abstract accepted for presentation ASCO 2012
7. Knightly E., Weldon C., Trosman J., Dupuy D., Murphy A.M. “Breast cancer care
improvement – overcoming common barriers” abstract accepted for presentation at
NCBC (2012)
8. Dupuy D., Knightly E., Weldon C., Trosman J., Murphy A.M “Examining Variation in
Mammography Quality: the case of Chicago, Illinois” abstract accepted for presentation
at NCBC (2012)
9. Murphy AM., Dupuy D., et al. “Quality Improvement as a tool to reduce disparities”.
American Association for Cancer Research (AACR)- Cancer Disparities Conference –
2011
10. Gardner A.J., Miller S.C., Dupuy D., Murphy A.M., “Evaluation and Outcomes of a CMECertified Symposium Addressing the Breast Cancer Mortality in Chicago” CE Measure
(2011) Vol 5, #1
11. Murphy A.M., Rauscher G., Dupuy D., Alvarez R., Macarol T., Knightly E., Ansell D.,
Grabler P., Robinson P., Marcus E. “Are Breast Cancer Quality Metrics being Met?” J Clin
Oncol 29: 2011 (abstract 6051) ASCO 2011
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The Metropolitan Chicago Navigation Initiative Proposal to Portes Foundation-Institute of Medicine Chicago
12. Weldon C., Trosman J., Dupuy D., Alvarez R., Murphy A.M. “Breast Cancer Care
Improvements in an Urban Environment” Abstract accepted for Academy Health 2011
13. Weldon C., Trosman J., Dupuy D., Alvarez R., Marcus E., Schink J., Murphy A.M.
“Facilitators of Quality Breast Cancer Screening and Diagnosis in an Urban Environment”
. J Clin Oncol 29: 2011 (suppl; abstr e16584)
14. Murphy A.M., Dupuy D., Rauscher G., Alvarez R. “Lifting all Boats: Quality Improvement
as a means to Reducing Racial Health Disparities” Poster presented at APHA Annual
Meeting, Nov 2010
15. Murphy, AM and Montell, DJ “Cell Type specific roles for Cdc42, Rac, and RhoL in
Drosophila Oogenesis, J. Cell Biol. (1996) vol 133, 617-630
16. Murphy, A.M., T. Lee, C.M Andrews, B.Z. Shilo, and D.J. Montell “The Breathless FGF
receptor homolog, a downstream target of Drosophila C/EBP in the developmental
control of cell migration (1995) Development (1995) 121: 2255-2263
17. Wojcik, E., Murphy A. M., Fares H., Dang-Vu Khoi, and Tsubota, S “Enhancer of
rudimentaryp1, e(r)p1, a highly conserved enhancer of the rudimentary gene (1994)
Genetics 138:1163-1170
Ongoing Research and Community Education Support
September 2011- August 2016
NIH grant to Breast Cancer Surveillance Consortium – Group Health Seattle to support “Risk
Based breast cancer screening in community settings.” We have a subcontract through the
University of Illinois on this grant to assist in creating a Chicago mammography registry for this
project so as to expand participation in the project of African American women.
Role: Site PI on the subcontract
July 2013 – June 2015
Avon Foundation for Women - $400,000 to support the general operations of the Metropolitan
Chicago Breast Cancer Task Force and its project the Chicago Breast Cancer Quality Consortium.
Role: Principal Investigator Anne Marie Murphy, Ph.D.
February 2013 – January 2014
Chicago Community Trust - $150,000 to support research into facilitators and barriers to
mammography receipt within the primary care environment.
Role: Principal Investigator
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The Metropolitan Chicago Navigation Initiative Proposal to Portes Foundation-Institute of Medicine Chicago
October 2011- March 2014
Susan G. Komen for the Cure Foundation - $600,000 to staff the projects in grant below and to
pilot a mammography and treatment quality surveillance system so as to better understand
Chicago’s racial health disparities
Role: Principal Investigator Anne Marie Murphy, Ph.D.
July 2010 – November 2013
Susan G. Komen for the Cure Foundation - $500k to build high quality breast cancer care
capacity in Chicago through piloting quality improvement interventions.
Goals:
Perform a comprehensive environmental scan at 20 Chicago area institutions so as to better
understand variation in business practice across the continuum of care with a view to
identifying best practices and areas for improvement
Creation of 3 Rapid Cycle Improvement teams in the areas of Mammography Quality
Improvement, Treatment Adherence Improvement and Business Processes Improvement
Role: Principal Investigator Anne Marie Murphy, Ph.D.
April 2012 - 2014
State of Illinois, Dept. of Healthcare and Family Services
Grant to assist the state in establishing a mammography quality surveillance system statewide.
Under this grant, the Chicago Breast Cancer Quality Consortium will outreach to providers to let
them know about the project, assist them in enrolling with the Department of Healthcare and
Family Services, train providers statewide on how to collect data for the project, will provide
technical assistance on data collection, analyze the data and provide each facility/radiologist
with an annual report comparing their metrics to those collected for the state as a whole.
Role: Principal Investigator Anne Marie Murphy, Ph.D.
Completed Support
March 2008 – June 2013
Avon Foundation for Women - $1.5 million to support the establishment of the Metropolitan
Chicago Breast Cancer Task Force and its project the Chicago Breast Cancer Quality Consortium
and to fund community based programs in breast cancer outreach and navigation.
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The Metropolitan Chicago Navigation Initiative Proposal to Portes Foundation-Institute of Medicine Chicago
NAME
POSITION TITLE
David A. Ansell
Senior Vice President for Clinical Affairs, Chief
Medical Officer, Professor, Department of Internal
Medicine
eRA COMMONS USER NAME
EDUCATION/TRAINING
INSTITUTION AND LOCATION
Franklin and Marshall College, Lancaster, PA
Health Science Center at Syracuse, Syracuse, NY
University of Illinois, School of Public Health, Chicago, IL
DEGREE
(if applicable)
YEAR(s)
B.A.
M.D.
MPH
1974
1978
1991
FIELD OF STUDY
Biology
Medicine
Epidemiology
Positions and Employment
1989-1993
Director, Ambulatory Screening Clinic, Division of General Medicine/Primary
Care, Cook County Hospital, Chicago, IL
1993-1995
Chairman, Division of General Medicine/Primary Care, Cook County Hospital,
Chicago, IL
1995-2005
Chairman, Department of Medicine, Mount Sinai Hospital Medical Center,
Chicago, IL
2001-2005
Executive Vice Chairman, Department of Internal Medicine, Chicago Medical
School, North Chicago, IL
2005-present Professor, Department of Internal Medicine, Rush University Medical Center,
Chicago, IL
2005-present Chief Medical Officer, Associate Dean for Hospital Affairs and Vice President,
Hospital Affairs Rush University Medical Center, Chicago, IL
Other Experience and Professional Memberships
1995-2005
Member, Resident Recruitment Committee, Mount Sinai Hospital Medical
Center, Chicago, IL
Honors
Selected Peer-Reviewed Publications
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The Metropolitan Chicago Navigation Initiative Proposal to Portes Foundation-Institute of Medicine Chicago
1.
Grabler P., Dupuy D., Rai J., Bernstein S., Ansell D. “Regular screening mammography
before the diagnosis of breast cancer reduces black: white breast cancer differences and
modifies negative biological prognostic factors”. Breast Cancer Research and Treatment. (2012).
(DOI) 10.1007/s10549-012-2193
2. Ansell, D, Grabler, P, Whitman S, Ferrans C, Burgess-Bishop J, Murray LR, Rao, R, Marcus, E.
A community effort to reduce the Black:White breast cancer mortality disparity in Chicago.
Cancer Causes and Control, Vol pp, 2009
3. Hirschman, J, Whitman, S, Ansell, D. The black:white disparity in breast cancer mortality:
the example of Chicago. Cancer Causes and Control, Vol. 18, pp. 323-333, 2007.
4. Whitman, S, Shah, A. Silva, A, Ansell D. Mammography screening in six diverse communities
in Chicago – a population study. Cancer Detection and Prevention, 31:2, 2007.
5. Levine M, Iliescu M, Margellos H, Estarziau M, Ansell D. The effects of cocaine and heroin
use on intubation rates and hospital utilization in patients with acute asthma exacerbations.
Chest, Oct. 2005, 128: 1951-1957.
6. Dell J, Whitman S, Shah A, Silva A, Ansell D. The Smoking Experience in Six Diverse Chicago
Communities - A Population Study. American Journal of Public Health. June 2005, Vol. 95:6, pp.
1036-1042.
7. Whitman S, Silva A, Shah A, Ansell D. Diversity and Disparity: GIS and Small-Area Analysis in
Six Chicago Neighborhoods. Journal of Medical Systems 2004;28(4):397-411.
8. Whitman S, Ansell D, Lacey L, Chen EH, Ebie N, Dell J, Phillips CW. Patterns of breast and
cervical cancer screening at three public health centers in an inner-city urban area. Am J Public
Health 1991; 81(12):1651-3.
9. Whitman S, Lacey L, Ansell D, Chen EH, Dell J, Phillips CW. Do chart reviews and interviews
provide the same information about breast and cervical cancer screening? Int J Epidemiol
1993; 22(3):393-7.
10. Lacey L, Whitfield J, DeWhite W, Ansell D, Whitman S, Chen E, Phillips C. Referral adherence
in an inner city breast and cervical cancer screening program. Cancer 1993; 72(3):950-5.
11. Ansell D, Whitman S, Lipton R, Cooper R. Race, income, and survival from breast cancer at
two public hospitals. Cancer 1993; 72(10):2974-8.
12. Bressler J, Ansell D, Parker J, Dillard J, Whitman S. Breast cancer screening in an urban
public hospital. Five-year results. Cancer 1993; 72(12):3636-40.
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The Metropolitan Chicago Navigation Initiative Proposal to Portes Foundation-Institute of Medicine Chicago
13. Whitman S, Lacey L, Ansell D, et al. An intervention to increase breast and cervical cancer
screening in low income, African - American women. Fam Community Health 1994; 12:56-63.
14. Ansell D, Lacey L, Whitman S, Chen E, Phillips C. A nurse-delivered intervention to reduce
barriers to breast and cervical cancer screening in Chicago inner city clinics. Public Health Rep
1994; 1 09(1):104-11.
15. Ansell DA, Hu TC, Straus M, Cohen M, Sherer R. HIV and syphilis seroprevalence among
clients with sexually transmitted diseases attending a walk-in clinic at Cook County Hospital.
Sex Transm Dis 1994; 21(2):93-6. Review.
16. Schiff RL, Ansell D. Federal anti-patient-dumping provisions: the first decade. Ann Emerg
Med 1996; 28(1):77-9.
17. Ansell D, Schiff G, Dick S, Cwiak C, Wright K. Voting with their feet: public hospitals, health
reform, and patient choices. Am J Public Health 1998; 88(3):439-41.
18. Schiff RL, Ansell D, Goldberg D, Dick S, Peterson C. Access to primary care for patients with
diabetes at an urban public hospital walk-in clinic. J Health Care Poor Underserved 1998;
9(2):170-83.
19. Silva A, Whitman S, Margellos H, Ansell D. Evaluating Chicago's success in reaching the
Healthy People 2000 goal of reducing health disparities. Public Health Rep 2001; 116(5):48494.
20. Ansell D, Schiff R, Goldberg D, Furumoto-Dawson A, Dick S, Peterson C. Primary care access
decreases nonurgent hospital visits for indigent diabetics. J Health Care Poor Underserved
2002; 13(2):171-83.
Completed Research Support
January 1999 - July 2005
Susan Komen Foundation
Free Mammography Program
Goals: The Komen Foundation’s Woman to Woman (WtoW) grant provides community
education and screening mammograms to uninsured women in low-income areas of the city.
WtoW particularly serves the communities of East and West Garfield Park, North and South
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The Metropolitan Chicago Navigation Initiative Proposal to Portes Foundation-Institute of Medicine Chicago
Lawndale, and the Pilsen area, though it offers services to low-income women throughout
Chicago.
Role: Principal Investigator: David Ansell, MD, MPH
Grant #1D58HP00373-01
July 2003 – June 2006
HRSA
Residency Training in General Internal Medicine
Goals: To train residents to become good physicians in the urban environment. To this end,
they are being educated in four activities to learn about:
Evidence Based Medicine
Social Epidemiology and Research
Geriatric Care
Cultural Competency
Role: Principal Investigator: David Ansell, MD, MPH
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The Metropolitan Chicago Navigation Initiative Proposal to Portes Foundation-Institute of Medicine Chicago
TASK FORCE ADVISORY BOARDS AND COMMITTEES
Chicago Breast Cancer Consortium Full Steering Committee
Name
Robert Maganini
Terry Macarol , RT, (R) (M) (QM) CBPN-I
Eileen Knightly, RN, BSN, MHA
Barbara Akpan, RN, MS
David Ansell, MD
Barbara Fisher
Pat Merryweather
Patricia Robinson, MD
Elizabeth Marcus, MD
Pam Ganschow, MD
Clarissa Moholick, MHSA, CCRP, CTR
Babs Waldman, MD
Garth Rauscher, Ph.D.
Affiliation
Alexian Brothers Medical Center
Advocate Healthcare System
Mercy Hospital and Medical Center
Black Nurses Association/Community
Rush University Medical Center
IDPH
Telligen
Loyola University Medical Center
John H. Stroger Hospital
John H. Stroger Hospital
Adventist Healthcare System
Community Health
University of Illinois at Chicago
Mammography Advisory Board
Name
Charlene Sennet, MD
Terry Macarol , RT, (R) (M) (QM) CBPN-I
Eileen Knightly, RN, BSN, MHA
Barbara Akpan, RN, MS
Kristi Allgood, MPH
Gregory Moss, MD
Gene Solmos, MD
Elizabeth Holland, MD
Affiliation
University of Chicago
Advocate
Mercy
Black Nurses Association/Community
Mt. Sinai
Resurrection Health Care
Rush University Medical Center
Advocate Christ Breast Center
Treatment Advisory Board
Name
Elizabeth Marcus, MD
Pamela Ganschow, MD
Patricia Robinson, MD
Clarissa Moholick, MHSA, CCRP, CTR
Nina Bickell, MD, MPH
Funmi Olopade, MD
Tricia Moo-Young, MD
Karen Snitchler
Seema Khan
Ruta Rao
Affiliation
John H. Stroger Hospital
John H. Stroger Hospital
Loyola University Medical Center
Adventist Health System
Mount Sinai (NYC)
University of Chicago
North Shore University Health System
Northwestern Memorial
Mercy Hospital and Medical Center
Northwestern Memorial
Rush University Medical Center
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Primary Care Advisory Board
Name
Pamela Ganschow, MD
Patricia Robinson, MD
Zakiya Moton, MPH
Susan Hong, MD
Melissa Simon, MD, MPH
Norm Ryan, MD
Erin Kaleba, MPH
Ashlesha Patel, MD
Tanu Pandey, MD, MPH
Wendy Conners (RN), (BSN), (CCM)
Susan B. Cahn, MA, MHS
Julie Darnell , PhD, MHSA
Thomas O’Connell
Kathleen Guerro
Affiliation
John H. Stroger
Loyola University Medical Center
University of Chicago
University of Chicago
Northwestern Memorial Hospital
Rush University Medical Center
Alliance
John H. Stroger
John H. Stroger
Resurrection Health Care
University of Illinois at Chicago
University of Illinois at Chicago
Lawndale Christian Health Center
Access Community Health Network
Outreach and Education Task Force Committee
Name
Barbara Akpan, RN, MS
Zakiya Moton, MPH
Angela Walker
Babs Waldman, MD
Monica Peek, MD
Carol Ferrans, PhD, RN, FAAN
Latehesha Fitch
Janis Sayer, MSW
Pamela Guzman
Affiliation
Black Nurses Association – Chicago Chapter
/Community
University of Chicago
Loretto Hospital
Community Health
Sisters Working it Out
University of Illinois at Chicago
advocate
Chicago Department of Public Health
Access Community Health Network
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