In late 2020, UNC Global Radiology addressed a health equity crisis in North Carolina using a model of community health partnership applied successfully in Kenya and Malawi. The COVID-19 pandemic has perpetuated a concerning trend of at-risk patients foregoing preventive healthcare across the U.S. In response, the UNC Department of Radiology is addressing local women’s health care imaging inequities through a global health lens.
Months into the groundbreaking “Local to Global” referral coordination partnership between UNC Breast Imaging, led by Dr. Cherie M. Kuzmiak and Piedmont Health, a North Carolina 501(c)(3) multi-site federally qualified community health center (FQHC), UNC Global Radiology looks ahead optimistically. The goal of this collaboration is to bridge a statewide equity gap in access to preventive care through enabling the State of North Carolina’s Level 1 academic medical center to facilitate timely delivery of breast cancer screening for all patients facing barriers to care, such as financial, language, transportation and appointment availability.
Melissa Culp M.Ed., RT(R)(MR), Director of UNC Global Radiology, has spear-headed the coordination and development of the partnership for this initiative. The collaboration focuses on breast cancer screening and diagnostic services delivery across regions where healthcare inequalities disproportionately impact underserved communities.
Mrs. Culp noted: “The community partnership between the UNC Department of Radiology and Piedmont Health is an example of UNC Health’s mission to ‘Lead the Way’ by providing Carolina Care for the people of North Carolina. Ensuring health equity and making systems-level changes so that all patients have access to care is foundational to the mission of UNC Radiology. This collaboration is one example of several ways in which we are taking ‘ownership of and accountability for doing the right thing’ as a department.”
Cherie M. Kuzmiak, DO, FACR, FSBI, Division Chief of UNC Breast Imaging, is a nationally renowned breast imager who has devoted her career to advancing women’s health care and breast imaging. Statewide, Dr. Kuzmiak is a highly regarded physician advocate of access to breast cancer screening for all North Carolinians. Rightfully, she is UNC Radiology’s most suited physician-lead to address socioeconomic barriers to mammography care within UNC Health’s patient population as a borderless global health imperative. In addition, Dr. Kuzmiak is UNC’s site principal investigator for a National Cancer Institute-funded, nationwide study (TMIST) of 3D versus 2D mammography efficacy to evolve tailored patient mammography built on genetics and individual risk factors in breast cancer development.
Prior to becoming UNC Global Radiology’s first domestic initiative, and with support from a Susan G. Komen community grant from the local NC Triangle to the Coast affiliate, the UNC Breast Imaging/Piedmont Health partnership facilitated by Dr. Kuzmiak supported a smaller-scale referrals program targeting barriers to accessing breast screening care.
With steps now in place to build upon earlier success and to grow the initiative, Dr. Kuzmiak stated: “I look forward to our continued collaboration with Piedmont Health to improve health care access for our fellow North Carolinians. We are actively working together as a team to eliminate barriers. Our goal is to continue ensuring that everyone has access to the best care available.”
Piedmont Health leadership is also essential to strengthening coordinated patient referrals and maintaining effective communications with UNC Breast Imaging. Piedmont Health’s Chief Operating Officer Misty Drake has built a 20-year career in community health center administration, addressing urban public health challenges over 14 years in Chicago. Her purview now includes addressing community health struggles in low-resource areas of North Carolina faced by at-risk patients.
Ms. Drake notes: “This referrals coordination program is yet another example of how the mission-driven partnership between Piedmont Health and UNC Health to address access and equity issues across our shared service area can help assure that no one falls through the cracks. I’m optimistic that this focused work on breast cancer screening access can lead to our future success in addressing other preventive screening and treatment needs.”
The UNC Radiology/Piedmont Health partnership goes beyond the singular goal of increasing access to breast cancer screening. To examine the pandemic-perpetuated, declining rates statewide of preventive screening cases, the team has also built an observational, longitudinal study into the initiative’s design. Through weighing Piedmont Health breast cancer screening referrals against UNC Breast Imaging’s overall, mammography case volume over time, program collaborators can evaluate systemic barriers to accessing breast cancer screening in under-served populations statewide. Data collection and analysis will enable UNC School of Medicine faculty leaders to initiate and oversee collaborative development of solutions for more equitable screening care for North Carolinians served by large hospital systems and community health networks alike.
While the U.S. continues to struggle with the highest rates of pandemic-induced morbidity and mortality worldwide, carrying out the UNC School of Medicine’s global health mission at home is clearer than ever. As the referral coordination partnership takes root, its promise of success illustrates converging patient care and community service missions at work of UNC Health, UNC School of Medicine and the University’s Carolina Next strategic plan.
Looking ahead, UNC Radiology will apply its successful community health-partnering model to other areas where care access needs improvement. Examples include: 1) ensuring at-risk pediatric North Carolinians have access to interventional radiology services; and 2) creating interventions with community partners to increase access to lung cancer screening for vulnerable populations. UNC Global Radiology will evaluate how its successes in optimizing access to education, equipment, and infrastructure worldwide can be duplicated by UNC Health and UNC School of Medicine leadership across North Carolina in low-resource areas.
Mrs. Culp concluded: “Our experiences teach us that relationships are the most important part of health equity initiatives. Real, authentic collaboration with community partners and local stakeholders is key for sustainable progress. With this framework, we seek to understand barriers to care and to create solutions that remove those barriers. Real change takes time and effort, and we are committed longitudinally to initiatives that increase access for all populations. Every patient – every person – deserves high-quality care.”