Role of an Implementation Economics Analysis in Providing the Evidence Base for Increasing Colorectal Cancer Screening

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This flowchart shows the relationship among 3 entities: RTI International Colorectal Cancer Control Program Learning Collaborative Coordinating Center, the Centers for Disease Control and Prevention, and the awardees, health centers, medical centers, and clinics. These entities are arranged in a triangle. In the center of the triangle are these words: process evaluation, cost-effectiveness studies, research tools/methods, implementation procedures/manuals, intervention case studies, webinars/presentations, peer-reviewed publications.

Figure 1.
Overview of the Colorectal Cancer Control Program Learning Collaborative. Abbreviations: CDC, Centers for Disease Control and Prevention; CRCCP, Colorectal Cancer Control Program.

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This flowchart shows a series of boxes that read from left to right. The first box has the following text: Interventions to Increase Screening: Interventions can be implemented at multiple levels: individual, provider, clinic or health system, and community. The next box has the following text: Process Measures: number of individuals, providers, clinics or communities receiving interventions, frequency and intensity of the interventions, and changes in procedures at the clinic impacting patient or data flow. The next 2 boxes are stacked one on top of the other. The top box has the following text: Effectiveness Measures: Short-term: number of individuals screened, number of individuals completing diagnostic follow-up after positive fecal test, number of individuals referred for treatment; Long-term: CRC incidence and mortality. The bottom box has the following text: Cost Measures: activity-based costs, including intervention development, implementation, and evaluation; long-term changes in cost of implementing and sustaining the interventions(s). The last box has the following text: Implementation Economics Analysis: incremental cost per individual screened (short-term cost-effectiveness), return on investment analysis to support resources allocation, cost per life year/quality-adjusted life year saved (long-term cost-effectiveness). Along the bottom of the boxes is the following text: Feedback loop to allow for continuous quality improvement and cost efficiency analysis. Arrows lead from the first box to the second box and from the first box to each of the 2 stacked boxes, from the second box to each of the 2 stacked boxes, from each of the 2 stacked boxes to the last box, and from the last box to the first box.

Figure 2.
Framework for the implementation economics evaluation used by the Colorectal Cancer Control Program Learning Collaborative. Abbreviation: CRC, colorectal cancer.

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