Fact Sheet: QIO Faith-Based Initiatives

QIOs Work With Religious Institutions To Reduce Health Care Disparities Medicare Quality Improvement Organizations are increasingly forging partnerships with faith-based institutions to reduce racial and ethnic disparities in the quality of health care. Trusted in their communities, religious organizations help QIOs reach seniors with vital information on breast cancer, diabetes, and other health conditions that disproportionately affect minority groups. Some examples: Bells for Remembrance Program QIOs in Georgia, Massachusetts, North Carolina, Oklahoma, Puerto Rico, South Carolina, South Dakota, Tennessee, and Virginia are leading community coalitions participating in the Bells program—a faith-based initiative promoting the awareness of breast and cervical health during religious services. The Georgia Medical Care Foundation, for example, has recruited more than 500 partner organizations since 1997 to join the initiative, which seeks to increase awareness of the importance of early detection and to encourage older women to get annual mammograms. These efforts have increased the state’s breast cancer screening rate from 52.4% to 57.4%. The project helps participating churches enhance their relationships with local health care providers and breast cancer support services as well as improve their knowledge of breast cancer so they can serve as a resource for their congregation. QSource, the Tennessee QIO, has recruited more than 500 churches and community organizations to participate in its Bells program. In Oklahoma, more than 68 churches have joined the effort sponsored by the Oklahoma Foundation for Medical Quality; in North Carolina, more than 200 churches work with Carolinas Center for Medical Education; in Massachusetts 75 religious congregations are working with MassPRO; and in Puerto Rico, more than 1,180 churches participated in the island-wide event sponsored by QIPRO in Oct. 2000. FMQAIof Tampa has made significant progress reducing disparities in the care of diabetes by educating providers and working with church congregations. Between July 1999-June 2001, FMQAI reduced the gap between older whites and African Americans in HbA1c (long-term blood sugar level) testing for proper care of diabetes from 9.8% to 7.3%. During this period, FMQAI also closed the gaps for biennial eye exams, from 7.9% to 5.5%, and for biennial lipid profiles, from 19.2% to 14.1%. FMQAI analyzed claims data to determine disparities in diabetes care for Medicare populations in each Florida zip code, then briefed hundreds of providers throughout the state. FMQAI also developed educational materials to train ministers on how parishioners can recognize and manage the condition; attended community health fairs; and contacted church leaders working with the elderly African American population. TMF Health Quality Institute created a peer advisor program called Natural Health Partners that trains networks of highly respected church members who engage African-American beneficiaries in east Texas by distributing flu immunization materials in churches. The program relies on informal local networks of caring individuals willing to help improve the health of others in their community. During the most recent flu season, TMF and Natural Health Partners organized 10 influenza immunization clinics in east Texas. TMF plans to work with Helpers this fall to educate the community on the importance of breast cancer early detection and other QIO projects. Quality Insights of Delaware is educating church leaders to raise mammography awareness through a coalition of African-American leaders called Mature African Americans for Mammography (MAAM). Working with MAAM, the QIO has invited community members to educational meetings and asked them to share information with family, friends, and others. Interim data shows the MAAM Coalition has reached as many as 3,000 women, resulting in about 350 new mammography screenings. Quality Insights’ work has helped increase the number of Delaware’s African American women receiving mammograms from 40% to 45% between 1998-2000. MetaStar, Inc., the Wisconsin QIO, has helped coordinate the local effort of the national Diabetes Sundays educational program, which raises awareness about diabetes among African Americans through church services. The Wisconsin program delivers structured presentations during church services that focus on diabetes care topics and disseminate culturally appropriate brochures on diabetes. Participating churches receive four, 5-minute presentations from partner organizations, including the American Diabetes Association and the local health department. MetaStar developed an evaluation plan that shows 92% of respondents said they knew more about diabetes following the presentations, and 96% said they wanted to hear further presentations on additional health issues at their church. Virginia Health Quality Center has organized a number of initiatives that capitalize on the ability of faith-based organizations to reach the local Medicare population. As part of its Partners in Quality Wellness initiative, which involves about 1,100 churches, VHQC works closely with parish nurse programs to disseminate information about mammography, diabetes, and immunizations. VHQC provides kits for awareness campaigns to parish nurses, develops copy-ready church bulletin inserts; and provides training at parish nurse meetings. In the state’s Tidewater region, VHQC participates in the Sisters for Mammograms project, designed to increase the use of mammograms among older African-American women by working through churches. The project has helped cut the difference in mammography rates between African-American and Caucasian women for the Tidewater region from 10.8% to 7% and help increase mammography rates for African-American women in Tidewater from 49.5% in 1998 to 58.8% in 2001. New Mexico Medical Review Association has worked with Hispanic priests and Promotoras (community health advisors) to reduce health disparities in influenza immunization rates among Hispanic Medicare beneficiaries. Promotoras, who live in the communities where they work as health educators, helped disseminate NMMRA immunization materials by making home visits stressing that health promotion and prevention are consistent with religious beliefs in Hispanic culture. NMMRA also partnered with the American Cancer Society and seven local churches in the "Take-A-Moment and Tell-A-Friend" program, in which volunteer coordinators at churches worked with their clergy to identify appropriate messages for breast cancer early detection. The Arkansas Foundation for Medical Care has held health fairs in counties with the lowest rates of mammography among African American women. The fairs are held in partnership with the Witness Project, a church-based education program that enhances awareness and knowledge of breast and cervical cancer, and increases mammography screening among low-income, rural, African American women. The project supports a team of African-American breast and cervical cancer survivors who bear "witness" to their friends and neighbors in small group sessions, ranging in size from two to 25 women. Women who participated in the baseline Witness program demonstrated significant increases in mammography compared to a control group. Primaris works with St. Louis churches that sponsor support groups for African-American women with breast cancer. The QIO helps churches produce a brochure to encourage women to get mammograms and helps support groups conduct campaigns using the brochure. Options include using mammography vans, placing health education information in church bulletins, and pastor remarks to parishioners from the pulpit. To reduce disparities in flu immunization, the Missouri QIO also began a project in St. Louis for the 2001 flu season focusing on the zip codes with the highest concentrations of African-American Medicare beneficiaries. The QIO helped form an advisory committee of local organizations, health providers, and faith-based organizations. All the faith-based organizations in the targeted zip codes received the educational materials for use with their parishioners. For the 2002 flu season, the QIO also will provide materials to faith-based groups to help them conduct presentations with their audiences. Alabama Quality Assurance Foundation, the Alabama QIO, recently entered into a partnership with the Tuscaloosa Ministerial Alliance to reduce the state’s 11% disparity rate between African American and white women who receive mammographies. The partners have recruited 20 local pastors to participate in the American Cancer Society’s Tell-a-Friend program—in which volunteers call other congregation members to urge them to get a mammogram and document their progress. AQAF provided the pastors with packets containing brochures on why African American women should receive breast cancer screenings and how to get them. Pastors then enlisted coordinators, who AQAF trained. MPRO, the Michigan QIO, has distributed culturally appropriate breast cancer information to about 25,000 churches across the state and trained lay health advisors from 200 congregations in the Detroit area. Through its African-American Women Advocating, Reaching and Educating (AWARE) program, MPRO works with churches to address barriers that prevent African-American women from receiving regular breast cancer screenings and diabetes testing. Pastors identify influential people among their congregations who are interested in receiving training from MPRO. MPRO then provides selected congregation members with information on breast health and a tool kit containing ads for church newsletters, posters for church bulletin boards, and a quarterly newsletter written in a culturally appropriate manner for African American women. Lumetra, the California QIO, works with faith-based organizations to promote flu and pneumococcal vaccinations among African-Americans in Alameda and Los Angeles Counties. Through telephone calls and discussion groups with African-American Medicare beneficiaries, Lumetra identified causes for disparities in vaccination rates and communication preferences. Lumetra incorporated these findings into its Adult Immunization Project, which has reached more than 900 faith- and community-based organizations through a newsletter that includes tips and tools needed to launch a vaccination campaign. In addition, Lumetra has visited or contacted 180 churches and community centers that have hosted education meetings or onsite health fairs. Lumetra also supports a peer-education program for churches to encourage church-based county vaccination clinics. The Colorado Foundation for Medical Care has created a project to overcome social barriers about mammography in the Hispanic community by bringing the message into a socially sanctioned environment. CFMC is working with leaders in the Hispanic community to speak in Hispanic Roman Catholic Churches, and has partnered with Hispanic clinics to improve perceptions and services. Health Services Advisory Group (the Arizona QIO), Qualidigm (the Connecticut QIO), MassPRO (the Massachusetts QIO), Mountain-Pacific Quality Health Foundation (the Montana QIO), Acumentra, (the Oregon QIO), and MetaStar (the Wisconsin QIO) all work intensively with local networks of parish nurses, who serve their congregations as health counselors, educators and advocates. The Wisconsin QIO conducted a Parish Nurse Seminar in late March, with more than 75 people in attendance. The seminar provided parish nurses advocacy and referral resources on diabetes care, mammography and immunization for the elderly. Based on the seminar’s success, MetaStar is considering a conference for parish nurses, public health offices, home health agencies and beneficiary representatives. The Montana QIO worked with 200 nurses through the state’s Parish Nurse Ministry. The QIO has developed packets that nurses have used to design programs in their churches that promote healthy behaviors related to breast cancer, immunizations, diabetes, and heart health. The QIO recently extended its effort through the state’s ministerial association to reach congregations not served by parish nurses.

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