Integrated implementation of evidence-based interventions to increase colorectal cancer screening through public health-primary care partnerships

Abstract

Background In 2015, the Centers for Disease Control and Prevention funded the Colorectal Cancer Control Program (CRCCP), which partners with health systems and primary care clinics to increase CRC screening uptake. We interviewed CRCCP stakeholders to explore factors that support an integrated implementation of evidence-based interventions and supporting activities to promote CRC screening with other screening and chronic disease management activities in primary care clinics. Methods Using the Consolidated Framework for Implementation Research, we conducted a literature review and identified constructs to guide data collection and analysis. We purposively selected four CRCCP awardees that demonstrated ongoing engagement with clinic partner sites, willingness to collaborate with CDC and other stakeholders, and availability of high-quality data. We gathered background information on the selected program sites and conducted primary data collection interviews with program staff and partners. We used NVivo QSR 11.0 to systematically pilot-code interview data, achieving a Kappa coefficient of 0.8 or higher, and then implemented a stepwise process to identify site-specific and cross-cutting emergent themes. Results Programs reported that they support clinic partners’ integrated implementation by providing coordinated application processes and braided funding streams, and by funding partner organizations to provide technical assistance to support efficient implementation of evidence-based interventions and supporting activities into existing clinic workflows. These actions, in turn, support clinics in implementing evidence-based interventions and supporting activities that promote both CRC screening and other chronic disease screening and management. Discussion The selected CRCCP programs and their partners implement activities to support the integration of evidence-based interventions and supporting activities with other clinic efforts. These integrated efforts support increased efficiency of clinic workflow, improved coordination of patient care, increased uptake of screening and improved patient outcomes. Conclusions The findings provide insights into how public health programs can support primary care clinics in integrating interventions and activities into existing workflows to support efficient, coordinated delivery of quality patient-centered care.

Integrated interventions and supporting activities to increase uptake of multiple cancer screenings: conceptual framework, determinants of implementation success, measurement challenges, and research priorities

“…For example, we learned through conversations with CRCCP programs that health systems issued joint patient reminders for multiple cancer screenings or provider assessment and feedback reports for all cancer screenings, driven by an overall desire to identify synergies and efficiencies to enable them to sustain the interventions and supporting activities (Tangka FKL, Hoover S, Cariou C, Creighton B, Hobbs L, Marzano A, et al: Improving the efficiency of integrated cancer screening delivery across multiple cancers: case studies from Idaho, Rhode Island, and Nebraska, in preparation). This need for a more integrated approach was further amplified by the COVID-19 pandemic, as in-person patient contact was limited and offering one-stop-shop screening approach for preventive care could be a more efficient approach [27]. The effectiveness and cost-effectiveness of these approaches, though, have not been systematically assessed, and this lack of focused evaluation of integration highlights missed opportunities to optimize the promotion and delivery of cancer screening.…”