What impacts how open a clinic is to consider a range of possible EBIs?
This part of the CLD focuses on the factors that impact a clinic’s willingness to fully consider all EBIs. The more effort and resources required from the clinic to successfully implement an EBI, the less likely the clinic is to be open to considering that EBI.[[139]] Considering how well a given EBI or set of EBIs aligns with the clinic’s culture and priorities is important.[[113, 416]]
If clinic champion(s) support specific EBIs, the clinic is more likely to be open to selecting and implementing them. The presence of team-based care structures likely increases a clinic’s openness to EBIs because the importance of CRC screening is valued by all members of the care team. The more partner effort required for successful EBI implementation decreases the clinic’s openness to that EBI[[233]] and increases the clinic’s perception that the EBI is complex.[[124, 129]] Clinics are much less likely to consider implementing EBIs that are perceived as complex.[[83, 108, 110, 113, 179, 180, 231, 232, 346, 415, 416, 436, 437]]
Finally, if successful EBI implementation requires changes to the clinic system that feel complex, the clinic’s perception that the EBI is complex increases.[[103, 115, 129, 248]] Updating or adapting the EHR system and working with providers to change their practice patterns are examples of system-level changes that can feel complex.
Cited references for this diagram
A large proportion of CRCCP grantees expressed the need for training with regards to specific EBIs, especially system-level EBIs and provider-directed EBIs to promote CRC screening. Grantees rated these EBIs as more difficult to implement than client-oriented EBIs and fewer grantees reported use of these EBIs.
Escoffery C, Hannon P, Maxwell AE, Vu T, Leeman J, Dwyer A, Mason C, Sowles S, Rice K, Gressard L. Assessment of training and technical assistance needs of Colorectal Cancer Control Program Grantees in the U.S. BMC Public Health. 2015 Jan 31;15:49. doi: 10.1186/s12889-015-1386-1. PMID: 25636329; PMCID: PMC4318175.
Many grantees also noted that working with providers was difficult given challenges in changing their systems or practice patterns and that they are often overburdened and have limited time.
Hannon PA, Maxwell AE, Escoffery C, Vu T, Kohn M, Leeman J, Carvalho ML, Pfeiffer DJ, Dwyer A, Fernandez ME, Vernon SW, Liang L, DeGroff A. Colorectal Cancer Control Program grantees' use of evidence-based interventions. Am J Prev Med. 2013 Nov;45(5):644-8. doi: 10.1016/j.amepre.2013.06.010. PMID: 24139779; PMCID: PMC4618374.
Overall, more grantees used small media and client reminders, and rated these EBIs easier to implement than interventions to reduce structural barriers, provider reminders, or provider assessment and feedback, which have been shown to have greater impact on improving screening rates than either small media or client reminders.[[13]]
Hannon PA, Maxwell AE, Escoffery C, Vu T, Kohn M, Leeman J, Carvalho ML, Pfeiffer DJ, Dwyer A, Fernandez ME, Vernon SW, Liang L, DeGroff A. Colorectal Cancer Control Program grantees' use of evidence-based interventions. Am J Prev Med. 2013 Nov;45(5):644-8. doi: 10.1016/j.amepre.2013.06.010. PMID: 24139779; PMCID: PMC4618374.
Grantees were most likely to implement small media (96%) and client reminders (75%) and also rated these as easier to implement than the other strategies (Table 2).
Hannon PA, Maxwell AE, Escoffery C, Vu T, Kohn M, Leeman J, Carvalho ML, Pfeiffer DJ, Dwyer A, Fernandez ME, Vernon SW, Liang L, DeGroff A. Colorectal Cancer Control Program grantees' use of evidence-based interventions. Am J Prev Med. 2013 Nov;45(5):644-8. doi: 10.1016/j.amepre.2013.06.010. PMID: 24139779; PMCID: PMC4618374.
Adoption and implementation of the provider-oriented EBIs (provider reminders, provider assessment and feedback) and reduction of structural barriers was more gradual, with a few new grantees adopting these EBIs each year. There was also more turbulence in terms of implementation for these EBIs, with several grantees discontinuing them before 2015. Notable reasons for discontinuing EBIs were lack of resources, partners’ priorities, and ending of funding. These less-frequently implemented and sustained EBIs may have more potential to affect screening rates.[[15,16,21)]] However, provider-oriented EBIs are more complex, which can reduce implementation.[[22]]
Hannon PA, Maxwell AE, Escoffery C, Vu T, Kohn MJ, Gressard L, Dillon-Sumner L, Mason C, DeGroff A. Adoption and Implementation of Evidence-Based Colorectal Cancer Screening Interventions Among Cancer Control Program Grantees, 2009-2015. Prev Chronic Dis. 2019 Oct 10;16:E139. doi: 10.5888/pcd16.180682. PMID: 31603404; PMCID: PMC6795067.
We found that grantees’ reasons for discontinuing an EBI most often related to capacity issues. Context also may be an important factor. For instance, electronic health records systems were identified as a barrier to EBI implementation. This suggests that sustainability in clinic settings may be challenged when electronic health records systems cannot support integration of client and provider reminder systems as well as provider assessment and feedback reports.
Hannon PA, Maxwell AE, Escoffery C, Vu T, Kohn MJ, Gressard L, Dillon-Sumner L, Mason C, DeGroff A. Adoption and Implementation of Evidence-Based Colorectal Cancer Screening Interventions Among Cancer Control Program Grantees, 2009-2015. Prev Chronic Dis. 2019 Oct 10;16:E139. doi: 10.5888/pcd16.180682. PMID: 31603404; PMCID: PMC6795067.
We found that most grantees adopted and implemented small media and client reminders early in the study period; most grantees also maintained these 2 EBIs through 2015. These client-oriented EBIs are often considered simpler to implement than the provider-oriented EBIs because they do not necessarily require partnerships with health systems or modifications to electronic health records.
Hannon PA, Maxwell AE, Escoffery C, Vu T, Kohn MJ, Gressard L, Dillon-Sumner L, Mason C, DeGroff A. Adoption and Implementation of Evidence-Based Colorectal Cancer Screening Interventions Among Cancer Control Program Grantees, 2009-2015. Prev Chronic Dis. 2019 Oct 10;16:E139. doi: 10.5888/pcd16.180682. PMID: 31603404; PMCID: PMC6795067.
The EBIs listed above vary in terms of complexity and partnerships required. The client-oriented EBIs could be implemented directly by grantees or by their clinical or community partners. The provider-oriented EBIs may be more complex from the perspective of a typical grantee organization because they require 1 or more clinic or health system partners. In addition, implementing provider reminders or provider assessment and feedback may require working with or adapting electronic health records.
Hannon PA, Maxwell AE, Escoffery C, Vu T, Kohn MJ, Gressard L, Dillon-Sumner L, Mason C, DeGroff A. Adoption and Implementation of Evidence-Based Colorectal Cancer Screening Interventions Among Cancer Control Program Grantees, 2009-2015. Prev Chronic Dis. 2019 Oct 10;16:E139. doi: 10.5888/pcd16.180682. PMID: 31603404; PMCID: PMC6795067.
Implementation readiness — an organization’s combined capacity, commitment, and willingness to implement a new program, policy, or practice — facilitates implementation success.[[16–18]] Because public health resources are limited, identifying a clinic’s readiness to successfully implement and sustain interventions, as well as gaps in clinic resources or practices that need to be addressed before implementation, is critical. Such assessment practices can guide clinics to select interventions with the greatest potential for long-term sustainability, and in turn help maximize the impact of public health spending, optimize clinic success, reduce cancer disparities, and improve population health.
Hohl SD, Melillo S, Vu TT, Escoffery C, DeGroff A, Schlueter D, Ross LW, Maxwell AE, Sharma KP, Boehm J, Joseph D, Hannon PA. Development of a Field Guide for Assessing Readiness to Implement Evidence-Based Cancer Screening Interventions in Primary Care Clinics. Prev Chronic Dis. 2022 May 12;19:E25. doi: 10.5888/pcd19.210395. PMID: 35550244; PMCID: PMC9109642.
The authors found that most grantees implemented and maintained client-oriented EBIs such as client reminders and small media. Grantees considered these EBIs easier to implement than provider-oriented EBIs or reduction of structural barriers.
Joseph DA, DeGroff A. The CDC Colorectal Cancer Control Program, 2009-2015. Prev Chronic Dis. 2019 Dec 5;16:E159. doi: 10.5888/pcd16.190336. PMID: 31808418; PMCID: PMC6896829.
Third, we found that grantees allocated a disproportionate amount of their awards toward interventions with limited evidence for their effectiveness (eg, mass media), and grantees found client-oriented interventions, such as client reminders and small media, easier to implement.
Joseph DA, DeGroff A. The CDC Colorectal Cancer Control Program, 2009-2015. Prev Chronic Dis. 2019 Dec 5;16:E159. doi: 10.5888/pcd16.190336. PMID: 31808418; PMCID: PMC6896829.
Specifically, CRCCP grantees were twice as likely as nongrantees to use small media and 3 to 4 times more likely to use client reminders to increase community awareness of CRC screening guidelines and to increase community demand for CRC screening. The frequent use of small media and client reminders may be due to their ease of implementation and the fact that the CRCCP grantees are able to take the lead on the implementation of these activities.
Maxwell AE, Hannon PA, Escoffery C, Vu T, Kohn M, Vernon SW, DeGroff A. Promotion and provision of colorectal cancer screening: a comparison of colorectal cancer control program grantees and nongrantees, 2011-2012. Prev Chronic Dis. 2014 Oct 2;11:E170. doi: 10.5888/pcd11.140183. PMID: 25275807; PMCID: PMC4184085.
CRCCP grantees and nongrantees similarly rated the ease or difficulty of implementing Community Guide-recommended interventions. On a 5-point scale (1= very difficult, 2 = somewhat difficult, 3 = neutral, 4 = somewhat easy, 5 = very easy), patient-directed interventions were rated from 3.2 (reducing structural barriers) to 3.8 (small media), and provider-directed interventions were rated from 3.1 (provider assessment and feedback) to 3.5 (provider reminders) for all organizations combined.
Maxwell AE, Hannon PA, Escoffery C, Vu T, Kohn M, Vernon SW, DeGroff A. Promotion and provision of colorectal cancer screening: a comparison of colorectal cancer control program grantees and nongrantees, 2011-2012. Prev Chronic Dis. 2014 Oct 2;11:E170. doi: 10.5888/pcd11.140183. PMID: 25275807; PMCID: PMC4184085.
Fewer grantees used interventions directed at health care providers, such as provider assessment and feedback and provider reminders, which usually require collaboration with a partner organization.
Maxwell AE, Hannon PA, Escoffery C, Vu T, Kohn M, Vernon SW, DeGroff A. Promotion and provision of colorectal cancer screening: a comparison of colorectal cancer control program grantees and nongrantees, 2011-2012. Prev Chronic Dis. 2014 Oct 2;11:E170. doi: 10.5888/pcd11.140183. PMID: 25275807; PMCID: PMC4184085.
Awardees also provided ongoing support to overcome the complexity of many EHR systems, a challenge among FQHCs that stalled their ability to optimize data management and reporting features.
Schlueter D, DeGroff A, Soloe C, Arena L, Melillo S, Tangka F, Hoover S, Subramanian S. Factors That Support Sustainability of Health Systems Change to Increase Colorectal Cancer Screening in Primary Care Clinics: A Longitudinal Qualitative Study. Health Promot Pract. 2023 Jul;24(4):755-763. doi: 10.1177/15248399221091999. Epub 2022 May 18. PMID: 35582930; PMCID: PMC9672135.
A study of the first CRCCP from 2009 to 2015 found that many clinics were more likely to put in place EBIs that were easier to implement, and thus opportunities may exist to further increase screening uptake by facilitating implementation of other EBIs. (Hannon et al., 2013)
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.
The key determinants of successful implementation [of integrating EBIs across cancer screening] that were deemed to have the most impact (average score of 3.0) were complexity of the intervention, implementation cost, overall implementation climate, and ensuring appropriate individuals were involved in the implementation process. Higher levels of complexity and cost were negatively related to implementation success.
Subramanian S, Tangka FKL, Hoover S, DeGroff A. Integrated interventions and supporting activities to increase uptake of multiple cancer screenings: conceptual framework, determinants of implementation success, measurement challenges, and research priorities. Implement Sci Commun. 2022 Oct 5;3(1):105. doi: 10.1186/s43058-022-00353-8. PMID: 36199098; PMCID: PMC9532830.
We found that the complexity of the intervention, cost of delivering the intervention and supporting activities, implementation climate at the clinic, and engaging appropriate team members in the implementation process were key determinants of implementation success.
Subramanian S, Tangka FKL, Hoover S, DeGroff A. Integrated interventions and supporting activities to increase uptake of multiple cancer screenings: conceptual framework, determinants of implementation success, measurement challenges, and research priorities. Implement Sci Commun. 2022 Oct 5;3(1):105. doi: 10.1186/s43058-022-00353-8. PMID: 36199098; PMCID: PMC9532830.
Small media was often used at the initiation of the program, and this could be due to the availability of small media materials[[20]] and tools that grantees could easily tailor.
Tangka FKL, Subramanian S, Hoover S, Cole-Beebe M, DeGroff A, Joseph D, Chattopadhyay S. Expenditures on Screening Promotion Activities in CDC's Colorectal Cancer Control Program, 2009-2014. Prev Chronic Dis. 2019 Jun 6;16:E72. doi: 10.5888/pcd16.180337. PMID: 31172915; PMCID: PMC6583814.
Across the 5 years, grantees allocated more resources to small media in the first year of the program. Small media might be easier to implement while other interventions might require more planning; CDC and other organizations provide small media materials that grantees can easily tailor to implement targeted campaigns.
Tangka FKL, Subramanian S, Hoover S, Cole-Beebe M, DeGroff A, Joseph D, Chattopadhyay S. Expenditures on Screening Promotion Activities in CDC's Colorectal Cancer Control Program, 2009-2014. Prev Chronic Dis. 2019 Jun 6;16:E72. doi: 10.5888/pcd16.180337. PMID: 31172915; PMCID: PMC6583814.
Oops! It seems we couldn't find any results for your search. Please try different filters.
