At a glance
In Phase 2, we provide a process and tools to help your assessment team design and administer your readiness assessment.
Why Phase 2 matters
As a recipient of CDC's Colorectal Cancer Control Program (CRCCP), you will work with partner clinics to implement evidence-based interventions (EBIs) to help increase colorectal cancer screening rates. A readiness assessment that is designed well and administered properly helps clinics leverage strengths, identify barriers, and plan for success.
Completing the activities in this phase of the Field Guide for Assessing Readiness to Implement Evidence-Based Cancer Screening Interventions will help you design and administer readiness assessments to determine each clinic's ability to implement EBIs.
Phase 2 activities
Complete these activities to design and administer your readiness assessment.
2.1 Determine relevance and feasibility of EBIs for the clinic settings
Evaluation of the 2015–2020 CRCCP found that colorectal cancer screening rates increased when the number of EBIs implemented increased.
As a CRCCP award recipient, you will work with your partner clinics to determine which interventions are best suited for each clinic based on their varying resources, patient and provider needs, and context. CDC requires clinics to implement at least two of the following four priority EBIs for colorectal cancer screening recommended by the Community Preventive Services Task Force:
- Provider assessment and feedback: In this context, interventions that evaluate provider performance in delivering or offering screening to patients are called provider assessments. The presentation of information to providers about their performance in recommending or providing screening services is called provider feedback.
- Provider reminders: Reminders inform health care providers that it is time for a patient's cancer screening test. A recall is another form of provider reminder that alerts providers that a patient is overdue for screening.
- Patient or client reminders: Written messages (letter, postcard, email, or text) or telephone messages (including recorded or automated messages) are used to alert patients that they are due for screening. Patient reminders can be general to reach a group of people or tailored to reach one person.
- Reducing structural barriers: Structural barriers, such as inconvenient clinic hours or lack of transit options, make it hard for people to access cancer screening services.
Clinics may implement additional supporting interventions, such as patient navigation and small media.
- Patient navigators: Patient navigators assess and remove patient barriers and support the completion of screening tests (such as returning completed home stool tests), follow-up diagnostic tests, and referral to cancer treatment, if needed. Patient navigators may also help implement EBIs in clinics.
- Small media: Small media include videos or printed materials (such as letters, brochures, and newsletters) that inform and motivate patients to be screened for cancer. These materials may be used to support patient navigation and implementation of patient reminder interventions.
2.2 Understand the readiness assessment domains CRCCP requires
CRCCP requires the following six readiness assessment domains for each participating clinic:
- Baseline CDC rate: The proportion of eligible clinic patients who are up to date with colorectal cancer screening.
- EBIs implemented: The strategies recommended by the Community Preventive Services Task Force that clinics are implementing or enhancing to increase screening. They must include at least two of the four priority EBIs for the CRCCP (provider assessment and feedback, provider reminders, patient reminders, and reducing structural barriers).
- EBI implementation quality: The degree to which the strategies recommended by the Community Preventive Services Task Force are in place at the clinic. This includes assessing quality, assessing whether EBIs are being implemented effectively (for example, how many patient reminders result in screening?), and determining if clinical activities are EBIs.
- Workflow and screening process: How the clinic team identifies patients who are due for screening, educates patients about cancer screening, recommends screening, schedules screening tests, records screening results, and follows up with patients.
- Electronic health record (EHR) capacity: If, how, and where patient screening test information is documented, screening rates are calculated and validated, and clinical workflows are integrated.
- Clinic resources and capacity: Ability and support from clinic staff to implement EBIs, leadership support for EBI implementation, and tangible resources (such as space and materials) to implement EBIs.
The CRCCP Manual (Part 1, including Appendix B) describes the assessment domains in more detail. The CRCCP Manual is available only to CRCCP award recipients.
2.3 Review existing readiness data collection tools
To develop the Field Guide, our team reviewed assessment tools designed and administered by multiple CRCCP award recipients. Recipients agreed to share their tools to inform others' readiness assessment efforts. The tools highlighted here may be adapted for use across diverse clinic settings.
These tools were selected for inclusion based on their:
- Ability to meet a required readiness assessment domain.
- Ease of understanding without additional explanation.
- Applicability across various clinic settings.
See the domains below for information about related data collection tools. An asterisk (*) next to the tool name indicates that it can be used to collect the minimum data required for that CDC readiness assessment domain.
EBIs implemented
EBIs implementation quality
Workflow and screening process
Electronic health record (EHR) capacity
Clinic resources and capacity
2.4 Determine data collection strategies
After your team has completed the activities above, we suggest you come together to:
- Identify and discuss what data are already being collected by the clinic and what additional new data may need to be collected to meet readiness assessment requirements.
- Decide where and how assessment data will be stored.
- Determine how the available data can be compiled for analysis and decide how new additional data can be collected (in person, online, on paper, or by phone or video) considering available expertise and resources.
- Design or adapt data collection tools.
- Establish a time frame for conducting the assessment and analyzing the information (data) you have gathered.
As you design your assessment and select your approach, consider the timeline for collecting data. CRCCP award recipients have used online, paper-based, and oral surveys; qualitative interviews and focus groups; and site or workflow observations. Below are questions that may help guide resources needed for each type of data collection tool.
Considerations for determining data collection strategies
All strategies:
- What is the estimated timeline for data collection?
- Who will respond to the survey and participate in the interviews?
- What is the clinic's capacity to respond using the proposed format? For example, do they have enough Internet bandwidth for online surveys?
- How many times will individuals be interviewed or surveyed?
- When will data be collected?
- How long will the survey or interview take to complete?
Interviews or focus groups:
- Will the interview or focus group be conducted in person or by phone or video?
- Will you conduct focus groups or one-on-one interviews?
- What are your recording capabilities and transcription needs?
Surveys:
- Will the survey be conducted online, on paper, or a combination of both?
- Will the survey be self-administered or interviewer-administered? By phone or in person?
Site or workflow observations:
- Which clinic and award recipient staff members need to be present?
Analyses:
- Will analysis software be needed?
- Who will analyze or interpret the results?
2.5 Gather data to assess the minimum required assessment domains
In this activity, you will work with your assessment team to apply the approach you defined in the previous activity. You will collect the information needed to assess the minimum required assessment domains for the readiness assessment.
Minimum required data elements for CRCCP readiness assessment
Routinely collected for CDC baseline clinic data:
- Clinic characteristics.
- Colorectal cancer screening tests that the clinic uses or is planning to use.
- Current colorectal cancer screening rate.
- How the clinic validates screening rates.
- EBIs implemented.
Specific to the readiness assessment:
- EBI implementation processes.
- Workflow processes for each colorectal cancer screening test.
- Evaluation practices for EBI implementation.
- Clinic resources and capacity
- Electronic health record processes and capacity.
2.6 Review data
The members of your assessment team should work together to make sure the data you collected are ready for evaluation. For example, you will want to check surveys to make sure responses are not missing or entered incorrectly. You should also check the notes from the site observations to make sure they are clear.
2.7 Resolve discrepancies
You may need to return to your clinic partners for clarification or to answer additional questions. This can be done informally through email or as part of a more formal team meeting. Your resources and situation should determine the format. Factors to consider include the number and type of questions you have, your relationship with your clinic partners, and your established communication practices.
Phase 2 frequently asked questions
When should the readiness assessment be administered?
Since the assessment informs clinic planning to implement EBIs, the assessment should be conducted before a clinic begins implementing EBIs.
How many times should the readiness assessment be administered?
Once, if your assessment determines that the clinic is ready to participate. If your findings suggest the clinic is not ready to implement EBIs, wait to work with this clinic another time when they are better positioned to participate. The assessment or relevant portions of it can be administered again at that time.
What data need to be collected at a minimum?
The minimum required assessment domains are outlined in Activity 2.5. They include data routinely collected for CDC, denoted here with an asterisk (*), and information needed that is specific to the readiness assessment:
- Clinic characteristics.*
- Colorectal cancer screening tests that the clinic uses or plans to use.**
- Colorectal cancer screening rate.*
- How the clinic validates screening rates.*
- EBIs implemented.
- EBI implementation processes.
- Workflow processes for each colorectal cancer screening test.
- Evaluation practices for EBI implementation.
- Clinic resources and capacity.
- Electronic health record processes and capacity.
What should be done if a clinic does not have the capacity to collect the required data?
Award recipients can reach out to their CDC program consultant, who will connect them with the CDC program evaluation team. Most likely, this clinic does not have the capacity to participate at this time.
How do we develop a process map with clinic staff?
Examples of workflow process mapping can be found in Activity 2.3. The Evidence-Based Intervention Planning Guides and the CRCCP Manual (Appendix B: Clinic Readiness Assessment) also describe processes for implementing EBIs in clinics. The CRCCP Manual is available only to CRCCP award recipients.