What additional factors impact EBI sustainability early in the implementation process?
This section of the CLD also focuses on how to incorporate sustainability early in the EBI implementation process. One way to prioritize sustainability right away is to use CRCCP funding to pay for training and TA support for clinics. Increasing the amount of training and support clinics receive helps them fully understand EBI activities and resource requirements. A complete understanding of EBIs helps clinics embed EBI activities and requirements into job descriptions and standard operating procedures (SOPs), which increases the extent to which clinics can integrate them into their existing practices.[[443]] Using CRCCP funding to support embedding EBI activities into SOPs directly also supports EBI sustainability.[[251]]
Another key aspect of sustainability is the extent to which clinics evaluate their readiness for EBI implementation. Providing training and TA support[[457]] as well as developing a clear understanding of EBI activities and resource requirements are two ways to facilitate clinic completion of readiness assessments. These assessments allow clinics to identify opportunities to integrate EBIs into existing practices[[270]] and subsequently do the integration.[[140]]
Increasing leadership support for CRC screening helps prioritize getting EBI requirements into SOPs[[258]] and prioritizing ongoing staff education and training. Providing ongoing staff education and training also supports embedding EBI activities into SOPs.[[254]]
Cited references for this diagram
Key informants who represented current and previous recipients generally said that mixed-methods assessments conducted before implementation prepared them to use results to inform development of tailored action plans for EBI implementation and technical assistance with partners.
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.
Respondents noted the importance of planning for sustainability from initiation of CRCCP implementation by allocating funding to integrate EBIs into FQHC practices. Respondents reported that FQHCs were encouraged to apply funding in ways that directly supported sustainability, such as building infrastructure and long-term FQHC practices (e.g., EHR assessments, quality improvement [QI] efforts, and workflow adaptations) versus funding staff positions (e.g., patient navigators) requiring new funding sources once CRCCP funding ends.
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.
Ongoing staff education and training were critical for sustaining EBIs/SAs embedded in clinic workflows and standard operation procedures (SOPs).
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.
Clear, visible leadership support helped facilitate sustainability by enabling institutionalization of EBIs and SAs within FQHCs. Champions leveraged external policies/reporting requirements (e.g., Health Resources and Services Administration Uniform Data System CRC screening performance measure) to make the case for sustained implementation of EBIs/SAs to upper levels of clinic administration.
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.
Our findings highlight the essential role of awardees in using readiness assessment findings to “meet clinics where they are” and mobilize strength-based partnerships—a critical tenet of public health service—to identify opportunities to integrate EBIs and SAs into existing clinic protocols.
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.
Integrating CRC interventions into the standard operating procedures and work flow processes of health systems, when possible, will contribute to sustainability (e.g., incorporating client reminders into the electronic health record system so that reminders are automated).
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.
The patient navigator indicated it was simpler to discuss numerous screening tests and preventive measures during one call, as it was easier for the patient navigator to go through and discuss any and all testing a patient may need. Nonetheless, the patient navigator indicated that it was sometimes challenging for a patient to hear the list. It could be overwhelming if a patient was not prepared or did not initially understand the purpose of the tests or screenings.
Tangka FKL, Subramanian S, Hoover S, Cariou C, Creighton B, Hobbs L, Marzano A, Marcotte A, Norton DD, Kelly-Flis P, Leypoldt M, Larkins T, Poole M, Boehm J. Improving the efficiency of integrated cancer screening delivery across multiple cancers: case studies from Idaho, Rhode Island, and Nebraska. Implement Sci Commun. 2022 Dec 16;3(1):133. doi: 10.1186/s43058-022-00381-4. PMID: 36527147; PMCID: PMC9756516.
Oops! It seems we couldn't find any results for your search. Please try different filters.
