Evaluating Uptake of Evidence-Based Interventions in 355 Clinics Partnering With the Colorectal Cancer Control Program, 2015–2018

Abstract

Purpose and Objectives Colorectal cancer screening rates remain suboptimal in the US. The Colorectal Cancer Control Program (CRCCP) of the Centers for Disease Control and Prevention (CDC) seeks to increase screening in health system clinics through implementation of evidence-based interventions (EBIs) and supporting activities (SAs). This program provided an opportunity to assess the uptake of EBIs and SAs in 355 clinics that participated from 2015 to 2018. Intervention Approach The 30 funded awardees of CRCCP partnered with clinics to implement at least 2 of 4 EBIs that CDC prioritized (patient reminders, provider reminders, reducing structural barriers, provider assessment and feedback) and 4 optional strategies that CDC identified as SAs (small media, professional development and provider education, patient navigation, and community health workers). Evaluation Methods Clinics completed 3 annual surveys to report uptake, implementation, and integration and perceived sustainability of the priority EBIs and SAs. Results In our sample of 355 clinics, uptake of 4 EBIs and 2 SAs significantly increased over time. By year 3, 82% of clinics implemented patient reminder systems, 88% implemented provider reminder systems, 82% implemented provider assessment and feedback, 76% implemented activities to reduce structural barriers, 51% implemented provider education, and 84% used small media. Most clinics that implemented these strategies (>90%) considered them fully integrated into the health system or clinic operations and sustainable by year 3. Fewer clinics used patient navigation (30%) and community health workers (19%), with no increase over the years of the study. Implications for Public Health Clinics participating in the CRCCP reported high uptake and perceived sustainability of EBIs that can be integrated into electronic medical record systems but limited uptake of patient navigation and community health workers, which are uniquely suited to reduce cancer disparities. Future research should determine how to promote uptake and assess cost-effectiveness of CRCCP interventions.

Factors That Support Sustainability of Health Systems Change to Increase Colorectal Cancer Screening in Primary Care Clinics: A Longitudinal Qualitative Study

“…Whether champions served in leadership or other FQHC staff roles, their ongoing promotion of EBIs and SAs, and clear and consistent leadership support, was paramount to prioritize these efforts. CRC screening champions have been associated with increased CRC screening rates and higher overall clinic performance (DeGroff et al, 2018; Maxwell et al, 2020). Given the clear benefits of having a screening champion, awardees can prioritize working with clinics to develop concrete plans to establish, support, and maintain champions despite staff turnover or funding changes.…”

“…Integrating EBIs and SAs into existing FQHC processes proved essential to CRCCP sustainability. Previous research identified an increase in the proportion of CRCCP partner clinics with sustainable EBIs and SAs in place over time, from 24 to 34 percentage points over a 2-year period (Maxwell et al, 2020). Understanding the extent to which EBI and SA implementation continues in CRCCP partner clinics following termination of CRCCP funding and TA could address long-term sustainability.…”

“…The purpose of this paper is to describe factors that facilitated early program implementation and supported sustainability among four CRCCP awardees and their partner clinics. We define sustainability as full integration of EBIs/SAs into health system and/or clinic operations, with high-quality implementation in place and the supporting infrastructure needed to maintain the EBI/SA (Maxwell et al, 2020). We captured lived experiences of CRCCP implementers through qualitative case studies in early and late phases of program implementation.…”

Twenty years of capacity building across the cancer prevention and control research network

“…CDC now requires all CRCCP awardees to partner with healthcare systems to implement EBIs; many of these partners are FQHCs serving populations experiencing health disparities and low screening rates. The CPCRN workgroup continues to partner with CDC to evaluate various aspects of CRCCP, such as implementation quality of mailed CRC fecal testing programs [ 45 ] and the uptake of EBIs and their association with change in CRC screening rates among participating primary care clinics [ 46 , 47 ]. Over time, the scope of the partnership has grown to include other types of capacity-building activities.…”

The Contribution of Implementation Evaluation to the Field of Public Health

“…Finally, the article by Maxwell et al ( 22 ) is a good example of the differences in uptake, implementation, integration, and sustainability of interventions proven effective in increasing colorectal cancer screening (CCS). The authors looked at implementation across 355 clinics partnering with the Colorectal Cancer Control Program and suggested that both technical and financial support, and the ability to integrate 6 of 8 strategies into electronic health records, may be key to implementation.…”