Table 4.
FQHCs use of implementation strategies (N = 56) overall and stratified by degree of implementation
| Strategy grouped by stage | All centers (N = 56) Yes n (%) | Stratified
|
|
|---|---|---|---|
| Centers fully implementing EBIs (N = 43) Yes n (%) | Centers not fully implementing (N = 13) Yes n (%) | ||
| Stage 1: Assess Barriers and Context | |||
| Identify barriers to implementing EBIs to increase CRC screening | 47 (83.9%) | 36 (83.7%) | 11 (84.6%) |
| Collect feedback data from patients and family members | 22 (39.3%) | 17 (39.5%) | 5 (38.5%) |
| Conduct community assessment of CRC screening rates in your service area | 16 (28.6%) | 13 (30.2%) | 3 (23.1%) |
| Stage 2: Activate and Engage People to Support and Execute Implementation | |||
| Implement incremental changes over time to improve CRC screening | 46 (82.1%) | 37 (86.0%) | 9 (69.2%) |
| Distribute CRC screening guideline materials to providers | 46 (82.1%) | 35 (81.4%) | 11 (84.6%) |
| Consistently monitor the implementation process and modify as appropriate | 46 (82.1%) | 36 (83.7%) | 10 (76.9%) |
| Have regular review sessions to learn from past experiences and improve future implementation efforts | 42 (75.0%) | 32 (74.4%) | 10 (76.9%) |
| Seek consensus about chosen CRC EBIs among providers | 37 (66.1%) | 29 (67.4%) | 8 (61.5%) |
| Conduct group educational meetings for providers about intent and benefit of complying with CRC screening guidelines | 35 (62.5%) | 29 (67.4%) | 6 (46.2%) |
| Identify and prepare CRC screening champions (who actively promote the screening practice at the center) | 26 (46.4%) | 21 (48.8%) | 5 (38.5%) |
| Create a CRC screening implementation staff team | 23 (41.1%) | 19 (44.2%) | 4 (30.8%) |
| Obtain formal commitments from providers to recommend CRC screening to eligible patients | 18 (32.1%) | 15 (34.9%) | 3 (23.1%) |
| Stage 3: Integrate Intervention Within Existing Systems | |||
| Make changes to the electronic health record system | 42 (75.0%) | 31 (72.1%) | 11 (84.6%) |
| Develop a formal implementation protocol | 37 (66.1%) | 32 (74.4%) | 5 (38.5%) |
| Provide clinical supervision to improve providers’ compliance with CRC screening guidelines | 29 (52.8%) | 24 (55.8%) | 5 (38.5%) |
| Change physical structures, facilities or equipment | 12 (21.4%) | 11 (25.6%) | 1 (7.7%) |
| Stage 4: Make Changes to Broader Context to Support Implementation | |||
| Secure grant funding | 25 (44.6%) | 21 (48.8%) | 4 (20.8%) |
| Develop incentive systems for the organization | 20 (35.7%) | 8 (18.6%) | 12 (92.3%) |
| Build a coalition | 13 (23.2%) | 12 (27.9%) | 1 (7.7%) |
| Develop incentive systems for providers | 11 (19.6%) | 9 (20.9%) | 2 (15.4%) |
| Develop penalty systems for providers | 1 (1.8%) | 1 (2.3%) | 0 (0%) |
| Develop penalty systems for the organization | 1 (1.8%) | 1 (2.3%) | 0 (0%) |