2011 CRCCP Grantee Survey of Program Implementation CRCCP Cross Center Workgroup

CRCCP Committee Members CPCRN CDC  Peggy Hannon  Jennifer Allen  Andrea Dwyer  Michelle Carvalho  Cam Escoffery  James Hebert  Matt Kreuter  Annette Maxwell  Cathy Melvin  Sandra Morones  Debbie Pfeiffer  Sally Vernon  Thuy Vu  Rebecca Williams  And others!  Amy DeGroff  Vicki Bernard  Kathi Wilson  And others!

Colorectal Cancer  Cancer of the colon or rectum is the second leading cause of cancer-related deaths in the United States  Screening  Finds precancerous polyps (abnormal growths in the colon or rectum) so that they can be removed before turning into cancer.  Detects colorectal cancer at an early stage, when treatment often leads to a cure.  About 9 / 10 people whose colorectal cancer is found early and treated are still alive five years later

CDC's Colorectal Cancer Control Program (CRCCP)  Goal: to increase colorectal (colon) cancer screening rates among men and women aged 50 years and older from about 64% 1 to 80% in the funded states by  Program has two components: screening promotion and screening provision

CRCCP Grantees

CDC’s Colorectal Cancer Control Program:Simplified Logic Model Program Monitoring and Evaluation State and Tribal Grantees, in Collaboration with CCC Coalitions and Other Partners, Conduct These Activities… In Order to Achieve Population-Level Program Outcomes To Create These Changes that Improve or Increase… Provider Practices that Promote High Quality CRC Screening Social Norms that Support CRC Screening Proportion of Adults Seeking CRC Screening as Recommended Increased CRC Prevention via Polypectomy Increased, Appropriate CRC Screening Increased Detection of Early Stage CRC Decreased Disparities in CRC Screening and Detection Policy-Level Influence Policy/Legislation Policy-Level Influence Policy/Legislation Community-Level Increase General Population Awareness Community-Level Increase General Population Awareness Organizational-Level Influence Health Care Systems, Insurers, Workplaces, CBOs, Professional Organizations Organizational-Level Influence Health Care Systems, Insurers, Workplaces, CBOs, Professional Organizations Individual-Level Provide and/or Facilitate Screening for Medically Underserved Individual-Level Provide and/or Facilitate Screening for Medically Underserved Policies & Systems that Promote CRC Screening Population and Provider Knowledge, Attitudes, & Intentions about CRC Screening 5/25/2010

CRCCP Workgroup A unique opportunity for CPCRN Natural laboratory for dissemination Defined set of cancer control EBIs Large-scale practice settings Perfect timing

Overall Workgroup Goals CRCCP workgroup will implement the Annual Grantee Survey, CRCCP workgroup will develop and implement additional research projects to assess details of  Adoption  Implementation  Context  Technical support and Resources needed/available  Organizational Characteristics

Annual Grantee Survey Goals 1. Understand how grantees are implementing CDC’s Colorectal Cancer Control Program (CRCCP), 2. Establish a baseline to assess how implementation changes each year, and 3. Collect information related to technical assistance and training needs.

Methods  Audience: person responsible for day-to-day management of the CRCCP should complete this survey  Sample: 29 programs (25 states and 4 tribes) across the U.S.  Design: Cross-sectional online survey (Qualtrics) over 4 years

Sections of the Grantee Survey  CRCCP Management and Integration with Other Programs  Adoption and implementation of 5 Guide EBIs and patient navigation  CRC Screening Provision  CRC Screening Promotion  CRC Screening Data from FQHCs, IHS Clinics, etc.  Screening Policies & Strategies  Training and Technical Assistance for Evidence-Based Interventions  General Program Management (i.e. Monitoring & Evaluation, Administrative Issues)  Respondent characteristics

D&I Frameworks Guiding Survey Topics  Conceptual Model  RE-AIM with focus on Adoption, Implementation and Maintenance of 5 Community Guide evidence-based strategies  Client reminders  Small media  Reduce structural barriers  Provider reminders  Provide provider assessment and feedback  Interactive Systems Framework for Dissemination and Implementation (ISF)  Prevention Support System (training and technical assistance)

Implementation Research Questions  Adoption Topics  Which of the 5 evidence-based strategies do the grantees adopt?  How do the grantees translate the evidence-based strategies into interventions?  What are these sources of interventions? What resources does it take?  Implementation Topics  Which of the 5 strategies do the grantees implement?  What implementation barriers and facilitators do grantees encounter for each of the strategies they implement?  What type of training or technical assistance do they receive or provide to their contractors in using evidence?  Maintenance  What strategies are consistently adopted over time?

Implementation Research Questions ConstructConceptual Framework Sample Questions AdoptionRE-AIMDoes your organization use [small media] to promote colorectal cancer screening? Adoption Facilitators RE-AIMWhat are the top reasons your organizations chose to use [small media] to promote CRC screening? ImplementationRE-AIMPlease indicate where your organization uses each of the small media types listed in the table below, to promote CRC screening (e.g., video, flyers/posters, brochures, newsletters) Implementation Ease RE-AIMThinking about the evidence-based interventions (EBI) that your organization implements currently, rate the following EBIs by the level of difficulty it took to implement from 1=Easiest to 5=Most difficult to implement.

Implementation Research Questions ConstructConceptual Framework Sample Questions Implementation Barrier RE-AIMFor the evidence-based strategies that were the most difficult to implement, what made it difficult? Implementation Facilitator RE-AIMFor the evidence-based strategies that were the easiest to implement, what made it easy? Training needs for use of evidence ISF - Training and Technical Assistance Rate your desire for training in the following areas (e.g., find EBI, adapt a strategy) For which of the evidence-based strategies would you like to receive more training or technical assistance? Technical assistance ISF - Technical Assistance Do you have access to someone who can help you interpret and apply research evidence?

Survey Next Steps  Approvals for all IRBs (+ CDC) are in!!  Finalize survey administration in Qualtrics  Pilot-test survey  Administration in October/November 2011

Breakout Discussion Topics  Initial survey administration ideas  Case studies with high and low-implementing grantees  Assessing quality of what they implement  Surveying/interviewing grantees’ implementation partners  Offering training or other resources to meet grantees’ needs  Examining registry data  More with MIYO  How can our data inform:  Future D&I projects  CRCCP program improvement

Workplan  Grantee survey  1 st administration – November 2011  Analysis – December 2011-February 2012  Report back to grantees & CDC  Submit abstract to CDC Cancer Conference  Revise survey for 2012  2 nd administration – July 2012

Workplan, continued  Case studies with high and low-implementers  Identify cases & topics – February 2012  Design case study methods – February-March 2012  Conduct case studies/interviews – April-May 2012  Analyze findings – June-July 2012  Write paper(s)/abstracts – July-September 2012  Develop workplan/research questions for

Questions Peggy HannonCam EscofferyAnnette Maxwell