Table 1.

Question wording, response categories, and coding for analysis of Organizational Structure and Process measures.

Measure	Source	Question Wording							Coding for analysis
Primary Care Leadership support	Primary Care Survey	Please rate each of the following potential barriers to providing timely follow-up for positive FOBTs, where 1 is not a barrier and 5 is a key barrier to providing timely follow-up for positive FOBTs.							1=”key barrier” (category 5) 0=all other responses
			Not a barrier				Key barrier	Don’t Know
			1	2	3	4	5
		Not a priority to leadership	□	□	□	□	□	□
Gastroenterology Leadership support	Gastroenterology Survey	Please rate each of the following potential barriers to providing timely follow-up for positive FOBTs, where 1 is not a barrier and 5 is a key barrier to providing timely follow-up for positive FOBTs.							1=”key barrier” (category 5) 0=all other responses
			Not a barrier				Key barrier	Don’t Know
			1	2	3	4	5
		Not a priority to leadership	□	□	□	□	□	□
Resource alignment: Tracking	Primary Care Survey	Has your PRIMARY CARE PROGRAM assigned anyone the responsibility of tracking what happens to patients with positive FOBT results? (Select One) □ Yes  Approximately how frequently does this person/s check these outcomes? (Select One)  □ As needed on an ongoing basis  □ Weekly  □ Monthly  □ Quarterly  □ Don’t know □ No □ Don’t know							1=someone is assigned to track “weekly or more frequently” 0=all other responses
Resource alignment: Colonoscopy appointment availability	Gastroenterology Survey	Please rate each of the following potential barriers to providing timely follow-up for positive FOBTs.							1=”key barrier” (category 5) 0=all other responses
			Not a barrier				Key barrier	Don’t Know
			1	2	3	4	5
		Limited availability of colonoscopy appointments	□	□	□	□	□	□
Primary Care Feedback	Primary Care Survey	Do primary care providers receive feedback about the amount of time it takes them to refer patients with positive FOBT results for colonoscopy?  □ Yes  □ No  □ Don’t know How are primary care providers given this feedback? (Check all that apply)  □ Individualized information at provider level  □ Aggregate information at the team or clinic level  □ Aggregate information at the facility level  □ Other (specify):  □ Don’t know How frequently are primary care providers given this feedback? (Select One)  □ Weekly  □ Monthly  □ Quarterly  □ Annually  □ Other (specify):  □ Don’t know							0=no feedback 1=aggregate feedback at any frequency 2=individual infrequent feedback (less frequently than monthly) 3=individual frequent feedback (at least monthly)
Gastroenterology Feedback	Gastroenterology survey	How is feedback on the timeliness of follow-up for patients with positive FOBT results given to GI/Endoscopy staff? (Check all that apply)  □ Verbally in a staff meeting  □ In writing in the form of an aggregate team, clinic or facility report  □ Other (specify):  □ No feedback provided to GI/Endoscopy staff on this aspect of care  □ Don’t know Approximately how frequently are GI/Endoscopy staff given this feedback? (Select One)  □ Weekly  □ Monthly  □ Quarterly  □ Annually  □ Don’t know							0=written less than monthly 1=written feedback at least monthly 2=verbal feedback less than monthly 3=verbal feedback at least monthly (hypothesized as the optimal category, based on prior research)(43–44)
Primary Care Incentives	Primary Care Survey	Which of the following do providers in your primary care program receive from leadership for their performance on assuring TIMELY FOLLOW-UP OF POSITIVE FOBT RESULTS? (Check all that apply)  □ Recognition for good performance  □ Monetary rewards for good performance  □ Counseling or reprimands for poor performance  □ None of the above  □ Don’t know							0=no rewards or reprimands 1=Recognition only 2=Monetary rewards (alone or in combination with other incentives) 3=Reprimands (alone or in combination with recognition)
Gastroenterology Incentives	Gastroenterology Survey	Which of the following rewards or reprimands do staff in your GI/Endoscopy program receive for their performance on assuring timely follow-up of positive FOBT results? (Check all that apply)  □ Recognition from leadership for good performance  □ Monetary rewards for good performance  □ Counseling or reprimands for poor performance  □ Other (specify):  □ None of the above  □ Don’t know							0=no rewards or reprimands 1=Recognition only 2=Monetary rewards (alone or in combination with other incentives) 3=Reprimands (alone or in combination with recognition)
Demand Efficiency: Number of contraindications on screening reminder	Primary Care Survey	Does your facility’s colorectal cancer screening clinical reminder ask about contraindications?  □ Yes  □ No  □ Don’t know Which of the following contraindications are asked about in the reminder? (Check all that apply)  □ Life limiting comorbidities/limited life expectancy  □ Health issues that increase risk of complications of colonoscopy  □ Recent colonoscopy  □ Patient not willing to undergo colonoscopy if screen is positive  □ Other (specify)							0=none 1=1–2 2=3 3=4 or more
Demand Efficiency: Does colonoscopy consult template include contraindications?	Primary Care Survey	Does your Primary Care program use a consult template for referrals to Gastroenterology for follow-up of positive FOBT results?  □ Yes  □ No  □ Don’t know Which of the following items are included in the template? (Check all that apply)  □ Anticoagulant use  □ Anti-platelet use  □ Diabetic  □ Anemia/Iron deficiency  □ Life expectancy or comorbidities related to life expectancy  □ Previous colonoscopy results  □ Physical/cognitive impairments that would make difficult to follow prep instructions  □ Lab values  □ Other (specify):  □ None  □ Don’t know							0=some contraindications 1=indications only 2=neither
Demand Efficiency: Guideline-concordant surveillance	Gastroenterology Survey	How soon is a repeat colonoscopy typically scheduled at your facility for the following types of patients:  □ 1–2 small adenomas (<1cm) on last colonoscopy:________years							0=not guideline-concordant (<5 years) 1=5 years 2=7–10 years
Supply Efficiency: How Gastroenterology providers are notified of FOBT+	Gastroenterology Survey	How is the GI/Endoscopy clinic first notified of an FOBT positive result? (Check all that apply)  □ Lab sends notification directly to GI/Endoscopy  □ Primary care notifies using consult template/referral  □ Other(specify):(n=5 said Gastroenterology identifies FOBT+)  □ Don’t know							0=Primary care notifies 1=Lab notifies 2=Gastroenterology notifies
Supply Efficiency: Does prep instruction require a separate appointment?	Gastroenterology Survey	What is the most typical way that patients receive their colonoscopy preparation instructions at your facility? (Select One)  □ Written instructions provided with prep kit  □ Written instructions mailed separate from prep kit  □ Verbal instructions provided over the phone  □ Individual appointment  □ Group appointment  □ Other (specify):  □ Don’t know							0=individual or group appointment (including those indicated in specified “other” responses) 1=all other categories
Supply Efficiency: Pre-procedure appointment required?	Gastroenterology Survey	Do you require a pre-procedure clinic appointment prior to the colonoscopy appointment?  □ Yes  □ No  □ Don’t know							0=Yes 1=No
Supply Efficiency: Overbooking is used	Gastroenterology Survey	In the past six months, did your GI program implement any of the following processes to keep up with colonoscopy demand? (Check all that apply)  □ Added additional clinic hours  □ Implemented make up clinics  □ Added additional staff  □ Increased use of contract providers  □ Increased use of fee basis providers  □ Overbooked appointments  □ Other (specify):  □ No change implemented  □ Don’t know							1=Overbooking appointments is used 0=all other responses
Patient-Centered Process: Patient notification of FOBT+ includes phone contact	Primary Care Survey	How are patients seen in your primary care program typically first notified of a positive FOBT result? (Select One)  □ Letter from primary care clinic  □ Letter from GI clinic  □ Phone call from primary care or GI clerk  □ Phone call from primary care or GI nurse  □ Phone call from primary care or GI provider  □ Email or secure messaging  □ Other (specify):  □ Don’t know							0=notification does not include phone contact 1=notification includes some phone contact
Patient-Centered Process: Are colonoscopy appointment times negotiated with patients?	Gastroenterology Survey	Which of the following options best describes the most common way that patients are scheduled for the first appointment to follow-up on a positive FOBT at your facility? (Select One)  □ Patient is sent a letter instructing them to come to the clinic at a specific date/time  □ Patient is first sent a letter instructing them to call the clinic, and then an appointment date/time is negotiated over the phone  □ A scheduler calls the patient to arrange an appointment date/time  □ Other (specify):  □ Don’t know							1=Second and third response options, and other responses that include phone contact with patient 0=All other responses
Patient-Centered Process: Do prep instruction methods include opportunities for questions?	Gastroenterology Survey	What is the most typical way that patients receive their colonoscopy preparation instructions at your facility? (Select One)  □ Written instructions provided with prep kit  □ Written instructions mailed separate from prep kit  □ Verbal instructions provided over the phone  □ Individual appointment  □ Group appointment  □ Other (specify):  □ Don’t know							0=Written only 1=Verbal phone and individual appointment 2=Group appointment and “other” responses that included written and verbal combinations
Patient-Centered Process: Do appointment reminders review prep instruction?	Gastroenterology Survey	Are preparation procedures reviewed as part of the [colonoscopy appointment] reminder?  □ Yes  □ No  □ Don’t know							0=No reminders or reminders do not review prep 1=Reminders review prep