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Diagram 1.1

What impacts a clinic's ability to effectively address barriers to CRC screening using EBIs?

The goal of implementing evidence-based interventions (EBIs) for CRC screening is to increase population-level screening. A clinic’s ability to effectively address gaps and barriers to screening using EBIs depends on:

  1. The clinic’s ability to select and adapt EBIs to fit their specific contexts.
  2. The clinic’s ability to implement the selected EBIs as intended.

Selecting EBIs that meet specific clinic and population needs relies on the clinic’s willingness to consider all EBI options.

Diagram 1.0 Overview
System Dynamics of Selecting & Implementing EBIs
Diagram 1.1
Addressing CRC Screening Barriers
Diagram 1.2
Factors Influencing Clinic Openness to EBIs
Diagram 1.3
Factors for Selecting & Adapting EBIs
Diagram 1.4
Strengthening EBI Impact
Diagram 1.5
Factors Impacting EBI Implementation
Diagram 1.6 Conclusion
Recommendations for Effective EBI Implementation
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Variables move in the same direction
Research evidence supports relationship
Research team hypothesizes relationship
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What impacts a clinic's ability to effectively address barriers to CRC screening using EBIs?

The goal of implementing evidence-based interventions (EBIs) for CRC screening is to increase population-level screening. A clinic’s ability to effectively address gaps and barriers to screening using EBIs depends on:

  1. The clinic’s ability to select and adapt EBIs to fit their specific contexts.
  2. The clinic’s ability to implement the selected EBIs as intended.

Selecting EBIs that meet specific clinic and population needs relies on the clinic’s willingness to consider all EBI options.

Cited references for this diagram

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75

Early results from our PY1 evaluation, including changes in screening rates, suggest the CRCCP is working; program reach was measurable and substantial, clinics enhanced EBIs in place or implemented new ones in clinics, and we observed an increase in the overall average screening rate.

DeGroff A, Sharma K, Satsangi A, Kenney K, Joseph D, Ross K, Leadbetter S, Helsel W, Kammerer W, Firth R, Rockwell T, Short W, Tangka F, Wong F, Richardson L. Increasing Colorectal Cancer Screening in Health Care Systems Using Evidence-Based Interventions. Prev Chronic Dis. 2018 Aug 9;15:E100. doi: 10.5888/pcd15.180029. PMID: 30095405; PMCID: PMC6093266.

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201

Third, the effectiveness of these EBIs on CRC order and screening uptake was significant across all populations served and independent of insurance status.

Kim KE, Tangka FKL, Jayaprakash M, Randal FT, Lam H, Freedman D, Carrier LA, Sargant C, Maene C, Hoover S, Joseph D, French C, Subramanian S. Effectiveness and Cost of Implementing Evidence-Based Interventions to Increase Colorectal Cancer Screening Among an Underserved Population in Chicago. Health Promot Pract. 2020 Nov;21(6):884-890. doi: 10.1177/1524839920954162. Epub 2020 Sep 29. PMID: 32990041; PMCID: PMC7894065.

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305

All four priority EBIs were positively associated with clinic screening rates with statistical significance (Table 3).

Sharma KP, DeGroff A, Scott L, Shrestha S, Melillo S, Sabatino SA. Correlates of colorectal cancer screening rates in primary care clinics serving low income, medically underserved populations. Prev Med. 2019 Sep;126:105774. doi: 10.1016/j.ypmed.2019.105774. Epub 2019 Jul 15. PMID: 31319118; PMCID: PMC6904949.

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332

Overall, the average clinic-level screening rate increased by 11.7 percentage points from baseline (33.5%) to PY2 (45.2%).

Sharma KP, DeGroff A, Maxwell AE, Cole AM, Escoffery NC, Hannon PA. Evidence-Based Interventions and Colorectal Cancer Screening Rates: The Colorectal Cancer Screening Program, 2015-2017. Am J Prev Med. 2021 Sep;61(3):402-409. doi: 10.1016/j.amepre.2021.03.002. Epub 2021 May 14. PMID: 33994253; PMCID: PMC11008572.

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354

Average clinic CRC screening rates generally increased when clinics implemented or enhanced any number EBIs or SAs compared to clinics that did not newly implement or enhance any EBIs/SAs.

Sharma KP, DeGroff A, Hohl SD, Maxwell AE, Escoffery NC, Sabatino SA, Joseph DA. Multi-component interventions and change in screening rates in primary care clinics in the Colorectal Cancer Control Program. Prev Med Rep. 2022 Jul 9;29:101904. doi: 10.1016/j.pmedr.2022.101904. PMID: 35864930; PMCID: PMC9294188.

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407

Across all interventions and multicomponent interventions, increases in the overall FQHC screening uptake ranged from 4.9 to 26.7 percentage points. Each FQHC implemented interventions that increased CRC screening among its low-income population.

Subramanian S, Tangka FKL, Hoover S. Role of an Implementation Economics Analysis in Providing the Evidence Base for Increasing Colorectal Cancer Screening. Prev Chronic Dis. 2020 Jun 25;17:E46. doi: 10.5888/pcd17.190407. PMID: 32584756; PMCID: PMC7316416.

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445

Screening uptake increased across all the sites during the implementation period, ranging from 7.1 to 18.9 % points.

Tangka FKL, Subramanian S, Hoover S, Lara C, Eastman C, Glaze B, Conn ME, DeGroff A, Wong FL, Richardson LC. Identifying optimal approaches to scale up colorectal cancer screening: an overview of the centers for disease control and prevention (CDC)'s learning laboratory. Cancer Causes Control. 2019 Feb;30(2):169-175. doi: 10.1007/s10552-018-1109-x. Epub 2018 Dec 14. PMID: 30552592; PMCID: PMC6382575.

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