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| Kelly Shaw, MPH, says that when members of the Swedish Health team designed the Breast Care Express, they took special care to help each patient forget she was on a truck. |
Ten years ago, a mobile mammography van in northwest Washington State was a welcome site for women who, in many cases, had nowhere else to turn. Those women, who neither had the ability to travel nor the means to pay for an exam, were left with a critical choice: Do I roll the dice and wait another year? It was a gamble that Swedish Health Services (Seattle) wasn’t about to let patients take.
The concept of mobile mammography was nothing new to the area. As early as 1994, Providence Hospital?which Swedish Health purchased in 2000?operated a mobile mammography program that featured a mobile unit pulled inside a horse trailer. Kelly Shaw, MPH, manager of the Swedish Providence Campus Comprehensive Breast Center, admits, “While the operation was first-rate and revolutionary for the area, the folding screens did not make for a very intimate setting. It wasn’t private, and some women were uncomfortable with that.”
When Swedish Health purchased the hospital, it continued its mission of outreach and community service to Washington’s underserved population. Still, Swedish Health searched for a way to reach women constrained by severe travel or financial roadblocks. The solution: Since patients weren’t able to go to the mountain, Swedish Health rolled the mountain to them.
Going the Distance
Unveiled in May 2004 with a price tag of $550,000?nearly all of which was paid for through philanthropic donations?the aptly named 18-wheel “Swedish Breast Care Express” coach was put into service. This state-of-the-art mobile mammography coach measures 64 feet in length (cab included), features 13 gears, comes with a professional driver, and delivers mammogram results in 12 minutes or less via a satellite link that connects the coach to the Comprehensive Breast Center on Swedish’s Providence Campus.
The Breast Care Express performs mammograms at corporations to supplement the cost of providing care to rural and underserved communities that don’t have adequate medical resources. For example, the entire month of October is dedicated to providing mammograms to the female employees at Microsoft Corp (Redmond, Wash). Other major corporate entities also are being served.
The coach is outfitted with two dressing rooms, one mammography suite, and one multipurpose exam room for other women’s health services?such as breast ultrasound, clinical breast exams, and PAP tests. (In fact, an ultrasound unit is already in place and will become part of the program once a technologist is hired to operate the system?hopefully by the end of 2005.) The Breast Care Express is equipped with a Selenia full-field digital mammography unit from Hologic Inc (Bedford, Mass).
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| The Breast Care Express houses the latest mammography equipment, including this Selenia full-field digital mammography unit from Hologic. |
Performing roughly 5,000 mammograms per year in the mobile unit necessitated adding one technologist and one assistant to handle the increased load. More staff will be needed to meet scheduling, billing, and support services as patient volumes continue to grow.
“These are all the things you would need to add if you added 5,000 more patients per year in the Breast Center,” admits Shaw, who says that Swedish Health continues to operate two mobile mammography vans in addition to the truck. The vans generally travel around the greater Seattle area and service the same types of accounts as the coach. However, Swedish Health is somewhat limited in where the vans can go because staff must set up a makeshift clinic at each site.
True Patient Care
Public reaction to the new mobile coach has been nothing short of amazing, not to mention deeply satisfying. “The response has been tremendous,” says Shaw, who notes that the coach handles between 20 and 25 mammograms per day. “They love the coach, and they love the idea of coming on board to have their mammogram.
“When women come on board the Express, it’s warm, inviting, and comfortable,” she continues. “We took care in designing the coach so that once inside, patients would forget they were on a truck. It’s basically like a rolling clinic. The equipment’s not mobile, the facility is.”
Here’s how it works: A patient comes on board and has a digital mammogram. The file size of the digital image is compressed and then transferred via satellite, which relays those images to Providence?one of four campuses in the Swedish Health system. Total time is 3 minutes per image, and about 12 minutes from start to finish.
Once the Providence campus receives the images, a board-certified radiologist dedicated to interpreting mammograms reviews the images and determines whether the exam is normal or if further imaging is necessary. Cost for using the satellite: an additional $12 per exam. Cost for giving a patient immediate feedback: priceless.
“If the radiologist sees something, he or she can ask for an additional diagnostic workup. They notify the coach, and the workup is done right then,” Shaw explains. “It’s really amazing for women living in rural areas or underserved communities, because if they don’t have access to a mammography facility for screening, they’re also lacking the same ability to go for a diagnostic workup.”
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| According to its full graphics display, the Swedish Breast Care Express is “Going the Distance for Women’s Health,” in the greater Seattle area. |
Shaw says that patients who use the services of the Breast Care Express receive the same level of care that they would receive at the Comprehensive Breast Center.
“We’re bringing to patients the resources of board-certified radiologists who read only mammograms,” Shaw says. “Our technologists are well-trained and well-experienced. We’re also bringing digital mammography to the patients, and we use CAD and the best that technology can offer. We can have an entire workup?to the point of some type of invasive procedure, like a biopsy?right there on the coach.”
Shaw pauses for a moment, then adds, “There’s nothing that would stop us in the future from bringing the physician out and doing biopsies.”
All the Pluses
Swedish Health links up with local businesses to coordinate screening events throughout the area. Whether it’s a tribal health clinic, community-based health clinic, church, or book club, Swedish Health will roll its Breast Care Express to any location where 20 or more women need a mammogram.
The benefits of taking the rolling mammography coach on the road are twofold, according to Shaw, who joined Swedish Health 3 years ago after her time as director of cancer control for the state of Washington. First, and most importantly, is that services are being offered to women who might not otherwise have access to care. Second, the program gives Swedish Health more visibility in the greater Puget Sound region.
“It’s a way for Swedish to have a presence in communities that we wouldn’t have been able to otherwise,” Shaw says. “The true issue, though, is being able to provide services to women who have no access to care.”
Paula Hallam, MD, is a shareholder and partner in Radia Medical Imaging (Everett, Wash), an outside radiology group that interprets all images at the Providence Campus. According to Hallam, who oversees the radiologist portion of the mobile mammography program, “The mobile mammography coach has helped our ability to provide excellent care to those outlying areas that don’t have access to local medical facilities. It’s about demographics and peoples’ economic level.”
Hallam explains that the almost-instantaneous turnaround in results eliminates patients’ concerns about waiting by the phone for results. (What’s worse, some women have no phone.)
“Nobody wants to wait, especially if something’s going on,” notes Hallam, a graduate of the Northwestern University School of Medicine (Chicago). “People want to be put on the right track, and I think that’s where we help the anxiety level that often exists with waiting for a call. [At our Providence Campus Comprehensive Breast Center,] patient follow-up visits usually occur within a week, but that’s for people who are locally established. For people at distant sites, it can take months. It’s not just about accessibility; some don’t have phone numbers they can be reached at. They may be a transient population in many ways.” With the coach providing almost instantaneous results, however, patients leave with the information necessary to proceed.
A once-forgotten, once-neglected segment of western Washington’s female population is now receiving the medical services it needs. Reaction has been so positive, Shaw says, that Swedish Health hopes to add a second Breast Care Express to the fleet.
“It’s become so popular, communities where we used to take the mammography van to are now wanting us to bring the coach,” she notes. “We’re slammed full, yet there’s more need. In fact, some clinics are upset because we can’t come out for more days. There’s definitely a need, and for hospitals that have an interest in community outreach, this is totally the way to go. It’s the right thing to do.”
Dave Cater is a contributing writer for Medical Imaging.
