In 1980, Chicago had no difference in outcomes between Black and White women for breast cancer – both groups had the same death rate. But as imaging in the form of mammography and treatment improved a disparity in outcomes took hold and grew. At the same time, several other racially diverse cities in the United States did not have a large difference in the death rate from breast cancer between Black and White women. This suggests that in Chicago, Black women were not accessing the same care as White women and not benefiting from improvements in detection and screening.

There are many ways that one can arrive at this outcome – higher death rates from breast cancer for Black women compared to White women. It could be that Black women were not accessing mammograms as often as White women. It could be that they were not accessing high quality mammograms. The barriers could be at the diagnostics and/or treatment stage. Or it could be all of the above. To design effective interventions, Equal Care set out to understand the breast health landscape across Metro Chicago. We developed a very specific model that would systematically look at breast health resources, measure the quality of breast cancer care at all or most facilities and look at how women were accessing care and whether women of color were accessing the same quality of care as White women.

Equal Care collects mammography screening and treatment data from area institutions to determine if they are meeting national standards of care for finding and treating breast cancer. Through Equal Care, we have shown that quality of care, especially mammography, varies widely across Metro Chicago.

University of Illinois research shows that poor women and publicly insured women are far more likely to have their breast cancers missed by poor quality mammography. This variation and the fragmentation of care – in particular, on Chicago’s south side – affects stage of diagnosis, whether a woman gets high quality care (guideline concordant care) and this can in turn affect survival.

Equal Care also collects data on how women navigate the system known as care process data and we map out the barriers and facilitators to getting all the care a patient needs for the best outcome.

Recently we have started a new project that is going a step further and looking at the latest technologies and precision medicine to see if women of color and women who are less affluent are suffering from barriers to today’s medicines. Based on the results of this work, we will design improvements to help women access the care they need.

Equal Care identifies areas of deficit where the organization then focuses its interventions.

Medical education in the forms of:

• Quality Feedback to Providers
• Mammography Technologist Training,
• Breast Imaging Team Education,
• Provider workshops
• Rapid Cycle Improvement projects

Patient support in the form of:

• Specialized navigation programs,
• Outreach and education