Proposed Cross-center Project Survey of Federally Qualified Health Centers Vicky Taylor & Vicki Young

Overview We are proposing a survey of Federally Qualified Health Centers (in Network states) that belong to their state primary health care association. This survey would focus on organizational factors that influence implementation of evidence- based breast, cervical, and colorectal cancer screening interventions in primary care practice. The project would provide information about translation processes in health center settings. We would be able to include multiple geographic areas and health centers serving diverse patient populations.

Community Guide Recommendations Provider assessment and feedback Provider reminders and recall Client reminders Small media One-on-one education Reducing structural barriers Reducing out-of-pocket expenses

Primary Health Care Associations California Primary Care Association Colorado Community Health Network Georgia Association for Primary Health Care Massachusetts League of Community Health Centers Missouri Primary Care Association North Carolina Community Health Center Association South Carolina Primary Health Care Association Texas Association of Community Health Centers Washington Association of Community and Migrant Health Centers Most (but not all) health centers belong to their state primary health care association.

Health Centers (2007) California110 Colorado 14 Georgia 28 Massachusetts24 Missouri 21 North Carolina27 South Carolina 22 Texas58 Washington 25 Network members in states with smaller numbers of health centers could survey all of the health centers in their state, and Network members in states with larger numbers of health centers could randomly select a sample of health centers.

Conceptual Framework Interactive Systems Framework for Dissemination and Implementation Systems that are relevant to implementation processes: Prevention synthesis and translation Prevention support Prevention delivery Factors influencing the processes of implementation within prevention delivery systems: Individual Organizational Community General organizational functioning and innovation-specific organizational capacity are both important.

Research Questions Relationship between organizational capacity of health centers and their adoption of cancer control interventions Relative importance of general organizational functioning and innovation- specific organizational capacity Relative importance of various aspects of general organizational functioning

Survey Questions Use of evidence-based interventions Breast cancer Cervical cancer Colorectal cancer Patient characteristics Racial/ethnic groups served Proportion uninsured Proportion with limited English proficiency Staffing levels and patterns Numbers of physicians, physician assistants, and nurse practitioners Numbers of nurses and medical assistants Employs lay health workers

Survey Questions Clinic resources Computerized medical records system Community gastroenterologist who provides lower endoscopy Community radiologist who provides mammography Leadership styles Soliciting different perspectives on priorities Communication patterns Physicians and nurses function as a team

Survey Questions Decision-making processes Nursing staff are encouraged to suggest improvements Capacity to change Administrators facilitate new procedures Clinic priorities Preventive care Use of cancer control resources Community Guide PLANET website

Discussion Group Suggestions Qualitative data collection effort to inform survey instrument development Address primary prevention as well as secondary prevention Include community as well as organizational survey items Explore possibility of getting some information from primary health care association databases (to reduce participant burden) Include survey items developed by other discussion groups

Possible Methods We could use the same recruitment approach that was recently reported by Shields and colleagues. This research group conducted a survey addressing health center adoption of health information technology. Their approach resulted in a response rate of 80%. Each health center’s Executive Director or his/her designated staff member completed a survey. Initially, questionnaires were both mailed and ed to Executive Directors. Follow-up s and telephone calls were made. Respondents were given the option of completing a survey on paper or electronically. Clinics were offered a financial incentive for survey participation.

Possible Workgroups Involve primary health care associations as community partners South Carolina could facilitate this process. Develop survey implementation protocol Develop survey instrument We could consider having several workgroups that would focus on different sections of the survey instrument.

Resource Issues The proposed project could probably be completed by existing personnel at the Coordinating Center and Network sites: Collaboration with primary health care associations Development of survey protocols Development of survey instrument content Development of web-based survey Human subjects applications Survey implementation procedures Data analysis Some additional resources would be required: Printing of project materials Mailings and telephone calls Financial incentives for clinic participation