Factors Influencing Implementation of a Colorectal Cancer Screening Improvement Program in Community Health Centers: an
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Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA; 2Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA; 3Regenstrief Institute, Indianapolis, IN, USA; 4Oregon Health & Sciences University, Portland, OR, USA; 5CareOregon Inc., Portland, OR, USA.
BACKGROUND: Evidence-based programs such as mailed fecal immunochemical test (FIT) outreach can only affect health outcomes if they can be successfully implemented. However, attempts to implement programs are often limited by organizational-level factors. OBJECTIVES: As part of the Strategies and Opportunities to Stop Colon Cancer in Priority Populations (STOP CRC) pragmatic trial, we evaluated how organizational factors impacted the extent to which health centers implemented a mailed FIT outreach program. DESIGN: Eight health centers participated in STOP CRC. The intervention consisted of customized electronic health record tools and clinical staff training to facilitate mailing of an introduction letter, FIT kit, and reminder letter. Health centers had flexibility in how they delivered the program. MAIN MEASURES: We categorized the health centers’ level of implementation based on the proportion of eligible patients who were mailed a FIT kit, and applied configurational comparative methods to identify combinations of relevant organizational-level and program-level factors that distinguished among high, medium, and low implementing health centers. The factors were categorized according to the Consolidated Framework for Implementation Research model. KEY RESULTS: FIT tests were mailed to 21.0–81.7% of eligible participants at each health center. We identified a two-factor solution that distinguished among levels of Contributions to the Literature • This study identifies what clinical setting factors lead to different levels of implementation of an evidence-based colorectal cancer screening program. High levels of implementation were directly linked to having centralized staff devoted to implementation and the ability to carry out the program as designed. • Configurational comparative methods are well-suited to assess combinations of conditions linked to successful implementation. Understanding how combinations of conditions lead to successful implementation can inform efforts to optimize the delivery of evidence-based interventions in practice. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11606-020-06186-2) contains supplementary material, which is available to authorized users. Received August 30, 2019 Accepted August 25, 2020
implementation with 100% consistency and 100% coverage. The factors were having a centralized implementation team (inner setting) and mailing the introduction letter in advance of the FIT kit (intervention characteristics). Health centers with high levels of implementation had the joint presence of both factors. In health centers with medium levels of implementation, only one factor was present. Health centers with low levels of implementation had neithe
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