Table 2.

Content-based adaptations implemented in the second-year mailed FIT program for Health Plan Oregon and Health Plan Washington

Program component*	O/W	Goal(s) for adaptation							Reason(s) for adaptation						Health plan-initiated adaptations	Content modification level*					Nature of content modifications*
		Reach, engagement	Feasibility/implementation	Fit with recipients	Effectiveness, outcomes	Implementation efficiency	Reduce costs	Satisfaction	Funding policies (incentives)	Service structure	Available resources	Time constraints	Billing constraints	Provider perception of intervention		Organizational (health plan)	Unit (health centers)	Provider	Population (enrollees)	Network systems (e.g., vendor) Community	Tailoring/tweaking/refining**	Adding elements	Removing elements	Re-ordering elements	Condensing timeline	Substituting elements
Identify eligible adults and obtain accurate contact information	W	●								●					- Vendor obtained updated contact and enrollment information from member, if needed				●	●		●		●
	O	●									●				- Increased patient address review in health record and mailing list - Improved capture of prior colorectal screening	●			●		●
Select FIT type	W			●	●			●		●					- Selected vendor that offered a 1-sample FIT kit (previous vendor used 2-sample kit)	●			●	●	●					●
Deliver program components (letters, phone calls, FIT kits)	W	●		●	●	●	●			●	●	●			- Vendor mailed introductory letter and attempted up to 3 live calls to obtain patient permission to mail kit				●	●		●		●
															- Vendor mailed FITs only to interested members, reached through live call				●	●			●
															- Health plan mailed invitation letter to members having no phone number, asking them to contact the plan to participate	●			●				●
	O	●			●	●					●			●	- Sent introductory letters (no FIT kit) to patients with no assigned provider or no clinic visits in last 12 months	●	●		●		●				●	●
	O	●			●				●		●	●			- Increased delivery of FIT reminders by health center staff (sometimes prioritized to Medicare enrollees)		●		●		●	●
Communicate test results	W			●	●	●		●		●	●			●	- Vendor mailed result letter to member (normal and abnormal)				●	●		●			●
															- Vendor concurrently informed PCP of abnormal result so PCP could order follow-up colonoscopy			●		●		●			●
															- Vendor called enrollees with abnormal FIT results				●	●	●					●
Streamline implementation	O					●	●	●			●	●	●		- Directly obtained kits from lab on behalf of clinics - Improved vendor billing process	●	●			●	●				●
	O	●			●	●					●	●			- Conducted a one-time (rather than split) mailing per health center	●	●		●		●				●	●

*Rows with “W” indicate Health Plan Washington; rows with “O” indicate Health Plan Oregon