This presentation was supported by Cooperative Agreement Numbers U48-DP001909, U48-DP001946, U48-DP001924, U48-DP001934, U48-DP001938(03), U48-DP001944, U48-DP001936, U48-DP001949-02, U48–DP001911, & U48-DP001903 from the Centers for Disease Control and Prevention. The findings and conclusions in this presentation are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Shin-Ping Tu, MD, MPH; Maria Fernandez, PhD, Vicki Young, PhDon behalf of the CPCRN FQHC Workgroup Investigators

Emory University University of California Los AngelesUniversity of Colorado University of South Carolina

University of Texas Houston University of WashingtonWashington University at St. Louis

Denver, COOct 3rd, 2013

The CPCRN FQHC WorkgroupSurvey Results: Implementation of Evidence-Based Approaches

(EBAs) for Promoting CRC Screening  

EBAs for Promoting CRC Screening in the FQHC Survey

CHC Main Survey:• Provider Reminders• Patient Reminders• One-on-one Education• Provider Assessment &

Feedback

Clinic Characteristics Survey:• One-on-one Education• Reducing Structural Barriers• Patient Reminders• Provider Assessment &

Feedback• Patient Navigators• Provider Reminders

Assessment of EBA implementation

• Level 1: Yes, we have implemented this strategy fully and systematically across the clinic.

• Level 2: Yes, we have implemented this strategy, but it is inconsistently implemented across the clinic.

• Level 3: Yes, we are at an early stage of implementing this strategy at the clinic.

• Planning: No, but we are planning to implement this strategy in the future.

• No plan: No, and we have no plans to do so.

Levels of Implementation of EBAs for Promoting CRC Screening—Main Survey

Provider Reminders

Patient Reminders

One-on-one Education

Provider Assessment & Feedback

0%10%20%30%40%50%60%70%80%90%

100%

29.9720.52

30.62 25.08

20.20

13.36

27.0418.89

18.89

16.61

17.26

20.52

22.15

32.57

11.419.22

8.79 16.94 13.68 16.29

No planPlanningLevel 3Level 2Level 1

Missing Frequencies: 20

One-on

-one E

duca

tion

Reduc

ing S

tructu

ral B

arrier

s

Patien

t Rem

inders

Provide

r Ass

essm

ent &

Fee

dbac

k

Small M

edia

Patien

t Nav

igator

s

Provide

r Rem

inders

0%

20%

40%

60%

80%

100%

10.20 14.29 14.29 6.12 12.2426.53

8.16

20.4130.61

42.86

30.6132.65

32.65

28.57

20.41

20.41

24.49

28.57 20.41

22.45

34.69

32.6518.37

14.29

18.3732.65 6.12

14.29

16.33 16.334.08

16.332.04

12.24 14.29

No planPlanningLevel 3Level 2Level 1

Levels of Implementation of EBAs for Promoting CRC Screening—Clinic Survey

Organizational Factors Assessed in CHC Main Survey

General Factors• Practice Adaptive Reserve• Inner Setting:

– Structural Characteristics—Resources– Culture- innovation, flexibility, & reflexivity,– Culture- stress & effort– Network & Communication (using PAR items)– Leadership (using PAR items)

• Outer Setting:– Patient needs & resources (Patient-centeredness)

• Process:– Executing– Reflecting & Evaluating– Engagement

• Individual Characteristics: – Knowledge & Beliefs—Openness

EBA-specific Factors• EBA Characteristics:

– Relative advantage– Complexity

• Inner Setting: – Compatibility – Implementation climate– Goals and feedback– Learning climate (using PAR items)– Structural characteristics—resources

• Process:– Engaging Champions

• Individual Characteristics– Knowledge and Beliefs—Appeal

Organizational Factors Assessed in Clinic Characteristics Survey

• EBA-Specific Factors– Tension for change– Organizational Incentives and Rewards– Goals and Feedback

• Outer Setting: External policies and incentives

Preliminary Results from Multi-level Analysis (Main Survey)

Provider Reminders: Predictors of Implementation

Predictors of Provider Reminders Implementation

Odds Ratio*

P-value

Practice Adaptive Reserve 2.23 0.0286Patient-centeredness 2.34 0.0348

Structural Characteristics--Resources 3.63 0.0001

Communication 1.98 0.0109

Culture--Innovation & Flexibility 3.59 0.0227

Leadership 1.81 0.027

Reflection & Evaluation 2.28 0.0047

• *Associated with higher levels of provider reminder implementation• Adjusted for education, which is significantly correlated to the outcome• Number of respondents =296

Provider Reminders: EBI-Specific Predictors of Implementation

EBI (Provider Reminders) -Specific Factors Odds Ratio*

P-value

Compatibility (between EBA & clinic) 2.18 0.0478

Relative advantage 1.95 0.0393

• *Associated with higher levels of provider reminder implementation• Adjusted for education• Number of respondents =296

Patient Reminder: Predictors of ImplementationPredictors of Patient Reminders Implementation Odds Ratio* P-value

Knowledge & Beliefs 0.26 0.0042

Patient-centeredness 2.83 0.0046

Organizational Resources 2.15 0.0156

Communication 1.95 0.0101

Reflection & Evaluation 2.09 0.0096

• *Aassociated with higher levels of provider reminder implementation• Adjusted for education• Number of respondents =296

One-on-One Education: Predictors of ImplementationPredictors of One-on-one Education Implementation

Odds Ratio*

P-value

Practice Adaptive Reserve 5.17 <.0001

Patient-centeredness 8.22 <.0001

Structural Characteristics--Resources 2.76 0.0035

Communication 3.78 <.0001

Culture--Reflexivity 3.96 0.0004

Culture--Effort 3.97 0.0002

Culture--Stress 0.22 <.0001

Leadership 3.29 <.0001

Reflection & Evaluation 4.32 <.0001• *Odds ratio over 1 means associated with higher levels of provider reminder implementation• Adjusted for education• Number of respondents =296

Provider Assessment & Feedback: General PredictorsPredictors of One-on-one Education Implementation

Odds Ratio*

P-value

Practice Adaptive Reserve 3.05 0.0004

Patient-centeredness 3.23 0.0001Structural Characteristics--Resources 3.95 <.0001Communication 2.54 <.0001Culture--Reflexivity 2.39 0.0043Culture--Effort 1.93 0.0287Leadership 2.45 <.0001Reflection & Evaluation 3.14 <.0001

• *Odds ratio over 1 means associated with higher levels of provider reminder implementation• Adjusted for education• Number of respondents =296

Significance

• This study is among the first to examine determinants from the Consolidated Framework for Implementation Research (CFIR) on implementation of evidence based cancer control interventions.