This presentation was supported by Cooperative Agreement Numbers U48-DP001909, U48-DP001946, U48-DP001924, U48-DP001934, U48-DP001938(03), U48-DP001944, U48-DP001936, U48-DP , U48–DP001911, & U48-DP from the Centers for Disease Control and Prevention. The findings and conclusions in this presentation are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Shin-Ping Tu, MD, MPH; Maria Fernandez, PhD, Vicki Young, PhD on behalf of the CPCRN FQHC Workgroup Investigators Emory UniversityUniversity of California Los Angeles University of ColoradoUniversity of South Carolina University of Texas HoustonUniversity of Washington Washington University at St. Louis Denver, CO Oct 3 rd, 2013 The CPCRN FQHC Workgroup Survey Results: Implementation of Evidence-Based Approaches (EBAs) for Promoting CRC Screening

EBAs for Promoting CRC Screening in the FQHC Survey CHC Main Survey: Provider Reminders Patient Reminders One-on-one Education Provider Assessment & Feedback Clinic Characteristics Survey: One-on-one Education Reducing Structural Barriers Patient Reminders Provider Assessment & Feedback Patient Navigators Provider Reminders

Assessment of EBA implementation Level 1: Yes, we have implemented this strategy fully and systematically across the clinic. Level 2: Yes, we have implemented this strategy, but it is inconsistently implemented across the clinic. Level 3: Yes, we are at an early stage of implementing this strategy at the clinic. Planning: No, but we are planning to implement this strategy in the future. No plan: No, and we have no plans to do so.

Levels of Implementation of EBAs for Promoting CRC Screening—Main Survey Missing Frequencies: 20

Levels of Implementation of EBAs for Promoting CRC Screening—Clinic Survey

Organizational Factors Assessed in CHC Main Survey General Factors Practice Adaptive Reserve Inner Setting: –Structural Characteristics—Resources –Culture- innovation, flexibility, & reflexivity, –Culture- stress & effort –Network & Communication (using PAR items) –Leadership (using PAR items) Outer Setting: –Patient needs & resources (Patient- centeredness) Process: –Executing –Reflecting & Evaluating –Engagement Individual Characteristics: –Knowledge & Beliefs—Openness EBA-specific Factors EBA Characteristics : –Relative advantage –Complexity Inner Setting: –Compatibility –Implementation climate –Goals and feedback –Learning climate (using PAR items) –Structural characteristics—resources Process: –Engaging Champions Individual Characteristics –Knowledge and Beliefs—Appeal

Organizational Factors Assessed in Clinic Characteristics Survey EBA-Specific Factors –Tension for change –Organizational Incentives and Rewards –Goals and Feedback Outer Setting: External policies and incentives

Preliminary Results from Multi-level Analysis (Main Survey)

Provider Reminders: Predictors of Implementation Predictors of Provider Reminders Implementation Odds Ratio* P-value Practice Adaptive Reserve Patient-centeredness Structural Characteristics--Resources Communication Culture--Innovation & Flexibility Leadership Reflection & Evaluation *Associated with higher levels of provider reminder implementation Adjusted for education, which is significantly correlated to the outcome Number of respondents =296

Provider Reminders: EBI-Specific Predictors of Implementation EBI (Provider Reminders) -Specific FactorsOdds Ratio* P-value Compatibility (between EBA & clinic) Relative advantage *Associated with higher levels of provider reminder implementation Adjusted for education Number of respondents =296

Patient Reminder: Predictors of Implementation Predictors of Patient Reminders ImplementationOdds Ratio*P-value Knowledge & Beliefs Patient-centeredness Organizational Resources Communication Reflection & Evaluation *Aassociated with higher levels of provider reminder implementation Adjusted for education Number of respondents =296

One-on-One Education: Predictors of Implementation Predictors of One-on-one Education Implementation Odds Ratio* P-value Practice Adaptive Reserve5.17<.0001 Patient-centeredness8.22<.0001 Structural Characteristics--Resources Communication3.78<.0001 Culture--Reflexivity Culture--Effort Culture--Stress0.22<.0001 Leadership3.29<.0001 Reflection & Evaluation4.32<.0001 *Odds ratio over 1 means associated with higher levels of provider reminder implementation Adjusted for education Number of respondents =296

Provider Assessment & Feedback: General Predictors Predictors of One-on-one Education Implementation Odds Ratio* P-value Practice Adaptive Reserve Patient-centeredness Structural Characteristics--Resources 3.95<.0001 Communication 2.54<.0001 Culture--Reflexivity Culture--Effort Leadership 2.45<.0001 Reflection & Evaluation 3.14<.0001 *Odds ratio over 1 means associated with higher levels of provider reminder implementation Adjusted for education Number of respondents =296

Significance This study is among the first to examine determinants from the Consolidated Framework for Implementation Research (CFIR) on implementation of evidence based cancer control interventions.