Factors that support readiness to implement integrated evidence-based practice to increase cancer screening

Abstract

Background In 2015, the Centers for Disease Control and Prevention (CDC) funded the Colorectal Cancer Control Program (CRCCP), which partners with health care systems and primary care clinics to increase colorectal cancer (CRC) screening uptake. We interviewed CRCCP stakeholders to explore the factors that support readiness for integrated implementation of evidence-based interventions (EBIs) 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 (CFIR), 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 site staff and partners. We used NVivo QSR 11.0 to systematically pilot-code interview data, achieving a kappa coefficient of 0.8 or higher, then implemented a step-wise process to identify site-specific and cross-cutting emergent themes. We also included screening outcome data in our analysis to examine the impact of integrated cancer screening efforts on screening uptake. Results We identified four overarching factors that contribute to clinic readiness to implement integrated EBIs and supporting activities: the funding environment, clinic governance structure, information sharing within clinics, and clinic leadership support. Sites reported supporting clinic partners’ readiness for integrated implementation by providing coordinated funding application processes and braided funding streams and by funding partner organizations to provide technical assistance to support efficient incorporation of EBIs and supporting activities into existing clinic workflows. These actions, in turn, support clinic readiness to integrate the implementation of EBIs and supporting activities that promote CRC screening along with other screening and chronic disease management activities. Discussion The selected CRCCP program sites supported clinics’ readiness to integrate CRC EBIs and supporting activities with other screening and chronic disease management activities increasing uptake of CRC screening and improving coordination of patient care. Conclusions We identified the factors that support clinic readiness to implement integrated EBIs and supporting activities including flexible funding mechanisms, effective data sharing systems, coordination across clinical staff, and supportive leadership. The findings provide insights into how public health programs and their clinic partners can collectively support integrated implementation to promote efficient, coordinated patient-centered care.

Barriers to and facilitators of implementing colorectal cancer screening evidence-based interventions in federally qualified health centers: a qualitative study

“…This study used CFIR to identify the factors that support readiness to implement EBIs to promote CRCS. They identified information sharing (accessing and sharing patient and EHR data) as supportive of integrated implementation [ 23 ]. This finding is consistent with ours, as the information technology infrastructure (i.e., systems used for data communication) that rolls out provider and patient reminders can influence implementation success.…”

“…Although some research has focused on determinants of CRCS [ 20 – 23 ], no known studies use the updated CFIR to explore barriers to and facilitators of CRCS EBIs within FQHCs. Using CFIR to analyze semi-structured interviews can help to determine the barriers to and facilitators of the implementation of CRCS EBIs in the FQHC setting.…”

Examining the availability and readiness of health facilities to provide cervical cancer screening services in Nepal: a cross-sectional study using data from the Nepal Health Facility Survey

“… 43 Second, the integration of cervical cancer screening services with chronic disease management has promoted health facility readiness by implementing a team-based approach. 44 To ensure the implementation and adherence to service guidelines, a standard operating procedure needs to be developed by health facilities to achieve the set target of providing services. 45 Additionally, continuous monitoring of readiness and availability of quality services and the actual delivery of the services is pertinent.…”

Consensus-based framework for evaluating data modernization initiatives: the case of cancer registration and electronic reporting

“…The target sample size for the interviews and the focus groups was about 9 respondents based on the numbers required to reach saturation in our previous research with CDC programs and confirmed by others. 21–23 Table 1 provides details on the constructs and themes explored; Figure 1 presents the registries that participated. Registries were selected using a purposive sampling approach to ensure broad representation across NPCR.…”