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. Funded CRCCP recipients work with primary care clinics to implement EBIs.
As a CRCCP 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 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 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.
Baseline colorectal cancer screening rate
Guide for Measuring Cancer Screening Rates in Health System Clinics*
Source: CDC
Description: Provides detailed guidance on how to measure the screening rate.
How to Use: When a clinic is recruited to join your CRCCP efforts and annually thereafter. Data from routine reports can be used to populate this required assessment domain. This guide is available only to CRCCP recipients.
EBIs implemented
Survey to Assess Types of Cancer Screening EBIs Implemented*
Source: Washington State Department of Health Breast, Cervical, and Colon Health Program
Description: Includes questions to characterize the type, frequency of delivery, successes, barriers, facilitators, and resources available for implementing each EBI.
How to Use: Adapt questions for your setting to identify the ways in which the clinic is implementing EBIs.
EBIs implementation quality
Evidence-Based Intervention Planning Guides*
Source: CDC
Description: The planning guide for the four priority EBIs includes a process flow diagram, process evaluation metrics, outputs, example measures, resources needed for implementation, lessons learned, and components.
How to Use: Assess the readiness and quality of each EBI being implemented in each setting. Results can guide the development of a plan to improve EBI quality.
Evidence-Based Intervention and Supporting Activities Logic Models*
Source: CDC
Description: This tool includes logic models specific to the following EBIs: provider assessment and feedback, provider reminders, patient or client reminders, reducing structural barriers, patient navigation, and small media. It is available in the CRCCP Manual (Part 1, Chapter 2: Program Planning). It specifies outputs and outcomes for measurement and relates to planning as recipients consider how evaluation findings will be used to develop implementation plans. The CRCCP Manual is available only to CRCCP recipients.
How to Use: Refine logic models based on your own implementation approach. For example, work with implementers to review the logic model for provider reminders to ensure your planned activities will lead to the intended outcomes.
Patient Reminder Process: At a Glance*
Source: New Hampshire Colorectal Cancer Screening Program
Description: One-page infographic that summarizes steps to implementing patient reminders by assessing current patient reminders, identifying a target population, choosing an appropriate patient reminder, allocating resources to establish a new process, and evaluating that process.
How to Use: Follow the steps to create patient reminders that will be effective for your target population. The facilitators and examples provided may also be helpful. This process is useful for completion of all aspects of the screening continuum, from initiation through adherence and completion of recommended testing.
Workflow and screening process
Clinical Workflow Visualization*
Source: Illinois Colon CARES (Cancer Alliance to Reignite and Enhance Screening)
Description: This document illustrates a patient flowchart for colorectal cancer screening.
How to Use: Tailor a workflow to your settings. Use in implementation plans to ensure team members understands their own and others' roles in the screening and workflow processes.
Office Flow Assessment Approach
Source: New Hampshire Colorectal Cancer Screening Program
Description: This resource includes a description of the assessment, the assessment tool, and a sample office flow summary document that would be presented to the partner staff after the data are collected by the CRCCP. This assessment observes office process and support services for CRC screening. It is not an assessment of individual staff members. Benefits to the practice are identification of what is working well and where there are opportunities for processes improvements.
How to Use: Tailor to your setting to assess current workflows in the clinic through observation. Present findings to partner staff to guide implementation plan development and optimize EBI implementation.
Semi-structured Interview with Health System/Clinic Staff
Source: Michigan Department of Health and Human Services Colorectal Cancer Control Program
Description: This series of open-ended questions about priorities, resources, electronic health records (EHR) capacity, and workflow is a follow-up to a quantitative needs assessment (see Michigan's Electronic Health Record Assessment Template and Clinic Needs Assessment in the Electronic Health Records Capacity section below). It is intended for recipients to use when interviewing clinic and health system staff.
How to Use: As a follow-up to gather context information to go with the results of the quantitative assessment.
Clinical Sustainability Assessment Tool (CSAT): Workflow Integration Domain
Source: Washington University in St. Louis Center for Public Health Systems Science
Description: Clinical staff and implementing partners can take this free 35-item self-assessment to evaluate seven domains of a clinic's capacity to implement colorectal cancer screening EBIs. The CSAT can be administered as a whole or by domain. This tool (5 items) is useful for assessing workflow and screening processes.
How to Use: Administer the assessment among clinic teams to identify strengths and opportunities to improve screening efforts. Free resources are provided by CSAT developers to help you interpret scores and develop an implementation plan.
Electronic Health Record (EHR) capacity
Electronic Health Record Capacity Assessment Survey*
Source: Florida Department of Health Colorectal Cancer Control Program
Description: The Quality Improvement tab on this quantitative assessment tool includes 20 questions to assess EHR capacity and improve its quality. A scoring guide can be found under the Summary Findings tab.
How to Use: Adapt for your setting and use to determine the readiness of the clinic's EHR system for cancer screening. Use the score to determine areas of strength and areas in need of attention for optimized EBI implementation.
Electronic Health Record Functionality Assessment Template and Clinic Needs Assessment*
Source: Michigan Department of Health and Human Services Colorectal Cancer Control Program
Description: The Electronic Health Record Functionality Assessment Template includes questions to ask when assessing five domains of EHR functionality: certification, customization, reporting, provider alerts, and usability. The quantitative needs assessment instrument includes EHR capacity-related questions (see Assessment Questions 36–47). Additional questions about EHR use for monitoring EBI implementation and cancer screening rates can be found in Assessment Questions 48–69.
How to Use: Adapt for your setting and use to determine readiness of the clinic's information technology and EHR systems for cancer screening.
Electronic Health Record Capacity Assessment Survey*
Source: New Hampshire Colorectal Cancer Screening Program
Description: Items 6–9 on this section of the readiness assessment instrument assess aspects of EHR capacity.
How to Use: Adapt for your setting and use to determine readiness of the clinic's information technology and electronic health records systems for cancer screening.
Source: Washington University in St. Louis Center for Public Health Systems Science
Description: Clinical staff and stakeholders can take this free 35-item self-assessment to evaluate seven domains of a clinic's capacity to implement colorectal cancer screening EBIs. It can be administered as a whole or by domain. This tool is useful for assessing EHR capacity. Each domain includes five items.
How to Use: Administer assessment among clinic teams to identify strengths and opportunities to enhance screening efforts. CSAT developers provide free resources to help you interpret scores and develop an implementation plan.
Clinic resources and capacity
Clinic Staff Pre-Implementation Readiness Survey*
Source: Illinois Colon CARES (Cancer Alliance to Reignite and Enhance Screening)
Description: The 11 items in this survey aim to assess the clinic team's perceived value of a cancer screening program, attitudes toward screening, and screening resources. Higher scores are correlated with a greater probability of implementation success.
How to Use: Calculate scores to determine which areas may need to be enhanced as part of the implementation plan.
Semi-Structured Interview Guide for Assessing Screening Resources and Practices: Clinic Staff
Source: Michigan Department of Health and Human Services Colorectal Cancer Control Program
Description: This series of open-ended questions about priorities, resources, EHR capacity, and workflow is a follow up to a quantitative needs assessment (see Michigan's Electronic Health Record Assessment Template and Clinic Needs Assessment in the Electronic Health Records Capacity section). It is intended for recipients to use when interviewing clinic and health system staff.
How to Use: To gather context information to go with the results of a quantitative assessment.
Characteristics of Readiness Survey
Source: South Carolina Department of Health Colorectal Cancer Screening Program
Description: Questions 4–20 on this quantitative survey are designed to be administered among clinic staff to assess readiness characteristics. The survey is based on a framework developed to assess organizational readiness in local, state, and national settings. This framework is described in the journal article titled R = MC2 readiness building process: A practical approach to support implementation in local, state, and national settings.
How to Use: Calculate scores to determine which areas may need to be enhanced as part of the implementation plan.
Clinical Sustainability Assessment Tool (CSAT): Full Instrument
Source: Washington University in St. Louis Center for Public Health Systems Science
Description: Clinical staff and stakeholders can take this free 35-item self-assessment to evaluate seven domains of a clinic's capacity to implement colorectal cancer screening EBIs. It can be administered as a whole or by domain. Domains of the full instrument include Engaged Staff and Leadership, Engaged Stakeholders, Organizational Readiness, Workflow Integration, Implementation and Training, Monitoring and Evaluation, and Outcomes and Effectiveness. Each domain includes 5 items.
How to Use: Administer the assessment among clinic teams to identify strengths and opportunities to enhance screening efforts. CSAT developers provide free resources to help you interpret scores and develop an implementation plan.
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 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? Can they meet at one time?
- 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 awardee staff members need to be present?
Analyses:
- Will analysis software be needed?
- Who will analyze or interpret the results?
CRCCP award recipient insight
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?
The assessments inform 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?
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 recipients.