| Course | D568 Health Equity and Social Determinants of Health |
|---|---|
| Task | Task 3 |
| Paper type | Health equity strategy analysis |
| Length | About 1,100 words, 3 pages |
| Format | APA 7 |
| School | Western Governors University (WGU) |
| Program | BS Health Science |
| Updated | September 2026 |
Free sample paper for D568 Task 3
Finishing Treatment Is Where the Gap Opens: Analyzing the ACCURE Strategy and Adapting It to Close a Black-White Disparity in Breast Cancer Treatment Completion at a Composite Health System
Student Name
Leavitt School of Health, Western Governors University
D568: Health Equity and Social Determinants of Health, Task 3
Course Instructor
Month Day, Year
Finishing Treatment Is Where the Gap Opens: Analyzing the ACCURE Strategy and Adapting It to Close a Black-White Disparity in Breast Cancer Treatment Completion at a Composite Health System
The Disparity
Black women in the United States are slightly less likely than White women to be diagnosed with breast cancer, yet more likely to die of it. From 2016 to 2020, the breast cancer death rate was 40% higher among Black women, 27.6 versus 19.7 deaths per 100,000, and twice as high among women younger than 50; Black women had the lowest five-year survival of any racial or ethnic group for nearly every subtype and stage (Giaquinto et al., 2022). Part of that gap arises after diagnosis, when patients start but do not complete recommended surgery, radiation or chemotherapy.
Lakeview Health, a composite regional health system with two cancer centers, found the same pattern in its own records. Over three years, 91% of White patients with early-stage breast cancer completed all recommended treatment, compared with 81% of Black patients. The system has asked which strategy could close that gap.
The Determinants Behind the Gap
Chart reviews and interviews with patients pointed to several social determinants. Economic stability: Black patients were more likely to work hourly jobs without paid leave, so daily radiation for six weeks meant lost income. Neighborhood and built environment: many lived farther from the radiation center, and some relied on rides from family members who also worked. Health care access and quality: missed appointments were recorded but not acted on, so a patient who stopped coming could go weeks without contact. Social and community context: some patients described feeling dismissed when they reported side effects, and several said no one had explained why every treatment mattered. Underlying these was a system that did not track outcomes by race, so clinicians did not know the gap existed.
The ACCURE Strategy
Accountability for Cancer Care through Undoing Racism and Equity, known as ACCURE, was developed by a partnership of community members, clinicians and researchers in Greensboro, North Carolina. It was designed on the premise that treatment disparities arise from how care systems work, not from patients' choices. Its intervention had three parts: a real-time registry drawn from the electronic health record that signaled missed appointments or unmet care milestones, a nurse navigator specially trained to respond to those signals, and feedback to clinical teams on treatment completion reported by race (Cykert et al., 2020).
Several elements were innovative. First, the registry turned the health record into a warning system; instead of waiting for a patient to return, the system noticed within days when someone missed a step. Second, reporting completion by race to clinicians made an invisible disparity visible and created accountability. Third, the navigators were trained in antiracism principles, so they approached missed appointments as problems for the system to solve rather than as evidence of patient noncompliance. An analysis of 3,251 navigator notes found six themes, including advocating for patients, addressing system barriers, connecting patients to resources, re-engaging patients after lapsed treatment, managing symptoms and side effects and giving emotional support (Griesemer et al., 2023).
The Evidence
ACCURE enrolled 302 patients with early-stage breast or lung cancer at two cancer centers from 2013 to 2015 and compared them with historical and concurrent patients who did not receive the intervention. In the comparison groups, Black patients completed treatment less often than White patients; among Black patients in the historical group, completion was 79.8%. Within the intervention, completion rose for everyone and the gap nearly disappeared, 88.4% for Black patients and 89.5% for White patients, and adjusted analyses confirmed the reduction in disparity (Cykert et al., 2020).
The evidence has limits. ACCURE was a pragmatic quality improvement trial, not a randomized trial, so secular trends could explain some of the improvement, although the concurrent control group helps address that. It took place in two cancer centers in one region with strong community partnerships, which may not exist elsewhere. Even so, the size of the effect and its focus on the gap itself make it one of the strongest examples of a strategy that narrowed a racial disparity in cancer treatment.
Adapting the Strategy to Lakeview Health
Lakeview would adapt ACCURE in four steps. First, build the registry: the informatics team would create a report from the electronic health record listing every patient with early-stage breast cancer, their planned treatment and each appointment, and flag any missed visit or delay of more than seven days between steps. Second, hire and train two nurse navigators, one per cancer center, with training in antiracism, trauma-informed communication and community resources. Navigators would contact flagged patients within two business days to learn what went wrong and solve it, arranging rides, helping with paid leave paperwork, connecting patients with financial counseling or bringing side effects to the oncologist's attention. Third, report completion rates by race to each oncology team every quarter, reviewed at a meeting where clinicians discuss what the data show. Fourth, form a community advisory group, including Black breast cancer survivors and leaders from local churches, to review the data and guide the program, as ACCURE's community partners did.
The adaptation also addresses determinants the registry cannot. Lakeview would use its community benefit funds for transportation vouchers and would offer radiation appointments in the early morning and evening so patients could keep working.
Measuring Equity
Success would be measured by the gap, not only by overall completion. The primary measure is the difference in treatment completion between Black and White patients, reported quarterly, with a goal of reducing it from ten percentage points to under two within two years. Secondary measures include the time between missed appointments and navigator contact, the number of patients re-engaged after a lapse, patient-reported experience of respect in care, and, over the longer term, five-year survival by race. If overall completion improved but the gap remained, the program would not be meeting its purpose.
Conclusion
The gap in breast cancer treatment completion at Lakeview reflects determinants that the system itself can change: how it notices missed care, how it responds and whether it looks at its own results by race. ACCURE shows that a real-time registry, trained navigators and transparent feedback can nearly eliminate such a gap. Adapted with the same attention to community partnership and measured by the disparity itself, it offers Lakeview a strategy with evidence behind it rather than a general call for more education.
References
Cykert, S., Eng, E., Manning, M. A., Robertson, L. B., Heron, D. E., Jones, N. S., Schaal, J. C., Lightfoot, A., Zhou, H., Yongue, C., & Gizlice, Z. (2020). A multi-faceted intervention aimed at Black-White disparities in the treatment of early stage cancers: The ACCURE pragmatic quality improvement trial. Journal of the National Medical Association, 112(5), 468-477. https://doi.org/10.1016/j.jnma.2019.03.001
Giaquinto, A. N., Sung, H., Miller, K. D., Kramer, J. L., Newman, L. A., Minihan, A., Jemal, A., & Siegel, R. L. (2022). Breast cancer statistics, 2022. CA: A Cancer Journal for Clinicians, 72(6), 524-541. https://doi.org/10.3322/caac.21754
Griesemer, I., Lightfoot, A. F., Eng, E., Bosire, C., Guerrab, F., Kotey, A., Alexander, K. M., Baker, S., Black, K. Z., Dixon, C., Ellis, K. R., Foley, K., Goettsch, C., Moore, A., Ryals, C. A., Smith, B., Yongue, C., Cykert, S., & Robertson, L. B. (2023). Examining ACCURE's nurse navigation through an antiracist lens: Transparency and accountability in cancer care. Health Promotion Practice, 24(3), 415-425. https://doi.org/10.1177/15248399221136534
What the D568 Task 3 instructions ask
The third D568 task asks you to evaluate an evidence-based strategy for reducing a health disparity and plan how it could be used elsewhere. You will usually need to describe the disparity, identify the determinants behind it, explain the strategy and its evidence, adapt it to a specific setting and describe how equity would be measured. The strategy should be published and tested, so its results can be judged. Evaluators look for determinants that the strategy actually addresses, evidence reported with its design and limits, adaptation steps that fit the new organization's resources and a measure of the gap between groups rather than overall improvement alone. Many versions ask how the strategy respects community voices.
How this D568 Task 3 example is built
The analysis opens with national data on the disparity and then the local picture at the composite health system. The determinants section draws on chart reviews and interviews, grouping findings by domain. The strategy section explains ACCURE's three parts and why each targets a determinant the organization can change. The evidence section reports the study's design, enrollment and results, including its reliance on historical comparison groups. The adaptation section sets out four steps, from building a registry to training navigators. The measurement section makes the difference in completion rates between Black and White patients the primary outcome, with process measures alongside. Each adaptation step names who at the health system would carry it out.
Where the D568 Task 3 rubric puts the marks
D568 Task 3 aspects are rated competent, approaching competence or not evident. A disparity aspect checks for a clear description with data. A determinants aspect rewards causes identified through evidence. A strategy aspect looks for an accurate description of the chosen approach. An evidence aspect asks for results and limitations reported fairly. An adaptation aspect wants specific steps suited to the new setting. A measurement aspect looks for equity measured as a gap between groups. Evaluators notice when adaptation respects the original model's core parts while changing what the new setting requires, and they expect the published study to be cited accurately.
D568 Task 3 help: what sends it back
Equity strategy analyses come back most often when success is measured only overall. A program can raise completion for everyone while the gap stays the same, so measure the difference. Second, the strategy is described from its title rather than its study. Read the methods and report what was actually done. Third, adaptation copies the original without regard to the new setting's staff or systems. Name what must change and what must stay. Fourth, determinants are general. Tie them to what patients and records at your setting show. Finally, report limitations honestly, such as historical controls, since evaluators credit balanced judgment over enthusiasm. Report the original study's population so readers can judge how well it transfers.
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D568 Task 3 questions, answered
What is the ACCURE strategy in D568?
A community-developed approach that combines a real-time registry of missed care, race-specific feedback to clinicians and trained navigators to reduce racial gaps in cancer treatment completion.
How should equity be measured in D568 Task 3?
By the gap between groups, not only overall rates. The sample makes the difference in treatment completion between Black and White patients the primary measure.
Can D568 Task 3 use a different strategy?
Yes, if it is published and tested and your instructions allow it. Choose one whose evidence you can report and whose parts address the determinants behind your disparity.
Is the D568 health system in the sample real?
No. Lakeview Health and its patient data are hypothetical, while the ACCURE trial and the national breast cancer statistics cited come from published sources. Readers should treat its figures as illustrative only.
Where can I find a free D568 Task 3 sample paper?
The ACCURE analysis and adaptation plan are reproduced above with a note on each section. Tell us your disparity in the D568 instructions and the first tailored paper is free.