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

• Type of Material: Article
• Authors: Annette E Maxwell, University of California Los Angeles; Amy DeGroff, Centers for Disease Control and Prevention, Atlanta; Sarah D Hohl, University of Washington; Krishna P Sharma, Centers for Disease Control and Prevention, Atlanta; Juzhong Sun, Centers for Disease Control and Prevention, Atlanta; Ngoc-Cam Escoffery, Emory University; Peggy A Hannon, University of Washington
• Language: English
• Date: 2022-05-01
• Publisher: CENTERS DISEASE CONTROL & PREVENTION
• Publication Version: Final Published Version
• Copyright Statement: This publication is in the public domain and is therefore without copyright. All text from this work may be reprinted freely. Use of these materials should be properly cited.
• Final Published Version (URL): http://dx.doi.org/10.5888/pcd19.210258
• Title of Journal or Parent Work: PREVENTING CHRONIC DISEASE
• Volume: 19
• Start Page: 1
• End Page: 12
• Grant/Funding Information: This work was supported by a contract from the National Association of Chronic Disease Directors with the University of Washington. Additional support was provided by CDC and the National Cancer Institute through the Cancer Prevention and Control Research Network, a network within CDC’s Prevention Research Centers program at Emory University, U48DP006377, and the University of Washington, U48DP005013 and U48DP006398.; The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of CDC. Data are not publicly available.
• Keywords: ADHERENCE; PRINCIPLES; SCREENING COLONOSCOPY; PATIENT NAVIGATION; Public, Environmental & Occupational Health; COST-EFFECTIVENESS; Science & Technology; Life Sciences & Biomedicine; STRATEGIES

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.