Table 2.

Successes of implementing the STOP CRC direct-mail fecal testing program a direct mail program

Theme/subtheme	Illustrative quote
Improved internal processes
Improved standardization of CRC screening process	“Once you get the hang of the process, just carrying on with it has been pretty straightforward … this project has prepared us for implementing at the larger clinic. We know what we can and can’t do and how much time things take and what we’re going to need to prepare for to get things going here. So I think that’s been beneficial.”
Refined workflow for future mail out, population-based screening efforts	“It’s opened up a whole new way of using the [EMR] for screening and as mentioned earlier it has helped guide how we do outreach for … different preventive measures.”
Improved EMR accuracy and standard use of screening tools within EMR	“… we’ve been working very hard over the last year to move our health maintenance Epic field to better capture where we are with CRC screening for all of our patients. So [STOP CRC] is a big part of that… that’s been a major change for us and a real positive.”
Program has positive attributes
Reached more patients for CRC screening	“More patients are being screened than were previously from … patients coming to us and getting it from their providers. And that sending it out in the mail based on the criteria that we are using is a much more effective way to get it to patients.”
Increased CRC screening rate	“I think that STOP CRC has actually helped us to be able to better meet the [CRC screening] measure, because we have been able to get tests out to more people. So it’s impacted our [screening] scores in a positive way.”
Saved resources	“I was actually surprised at the amount of negative [normal] results we had [from completed mailed out FITs]. So we didn’t have enough positive results to impact the [colonoscopy] resources at all—which is great.”
Aligned with organizational values and culture	“I think STOP CRC is a good fit. And it’s really good timing, because we are moving more to that type of approach. Earlier I was trying to describe this transition from the provider being the center of how the team functions to spreading … other staff within the clinical team and other processes outside of the exam room of being able to serve patients. We’re transitioning to that…so this matches that really nicely.”
Improved patients’ awareness, engagement and satisfaction
Increased patient engagement in prevention and screening	“It creates a channel or a door to have certain communications with patients that maybe we haven’t necessarily had before. Then we’re actually able to get patients back in that were staying away for one reason or another. So, I’m really optimistic about it, [as it] encourages patient care.”
Increased patient awareness, knowledge, and skills about CRC screening in general	“Just the fact that we’re getting the information out to the community and it’s becoming less and less of a negative thing to talk about, less taboo…if one family member gets one, they explain it to the other family members and so on and so forth—they’ve been introduced to it already so if someone approaches them [about CRC screening] they’re a little less likely to say no.”
Experienced patient satisfaction and gratitude	“I’ve actually had people thank me for educating them on it. And then they’re more willing to do it... I’ve had patients come say,’ oh, I got a FIT kit and got checked out’, and they’re very thankful.”
Providers/staff had positive reactions to/ benefited from program
Providers supportive and appreciative	“I think there is recognition from our providers that getting the kits to patients based off of a conversation in the exam room, that our rates of return were really low. And I think our physicians are realizing that that’s just something that they weren’t able to keep up with… so it is a successful approach, for sure, in terms of provider perspective—I’ve never heard a complaint from a provider about [STOP CRC] reminding patients.”
Increased staff awareness, knowledge, and skills	“I do think it’s [STOP CRC] is worth it. I think that when staff have been working on the project they have enjoyed that part of it and learned a lot.”