1. FQHC Workgroup Participating Centers Emory University Texas A&M University of Texas, Houston* University of Washington* University of Colorado University of California, Los Angeles Washington University in Saint Louis UNC-Chapel Hill University of South Carolina

2. FQHC Workgroup Goal To partner with FQHCs and state, regional and national associations representing FQHCs to advance the dissemination and implementation of cancer prevention and control programs in community health centers that provide primary care to underserved populations.

3. What We Did Studied many models before selecting the Practice Change and Development Model and the Consolidated Framework for Implementation Research (CFIR) to guide the group’s work. Over the years several sub-groups / mini-committees formed: 1) Partnership Subgroup 2) Data Subgroup 3) Cross-Center Survey Subgroup 4) Qualitative Inquiry Subgroup 5) Dissemination Subgroup

4. What We Did Partnership Subgroup engaged HRSA/Bureau of Primary Health Care, National Association of Community Health Centers (NACHC), National Center for Farmworker Health, and other state and local partners to guide and provide feedback for our work.

5. What We Did Data Subgroup began hosting guest presentations focused on the use of “big data” and EMRs to answer questions on cancer prevention and control strategies. Group then conducted cross-site studies using pre- existing FQHC data and incorporating GIS applications to explore cancer data and the impact of FQHCs at the neighborhood level.

6. What We Did Cross-Center Survey Subgroup conducted searches for and selected measures for constructs of CFIR, recruited FQHCs across 7 states, and conducted a survey of FQHCs related to implementation of evidence-based practices.

7. What We Did Qualitative Inquiry Subgroup conducted interviews and focus groups of leaders and staff members from FQHCs in 14 states to explore factors affecting implementation of evidence-based practices.

8. What We Did Dissemination Subgroup developed template for ways to share cross-center results with national, state and local partners.

9. What We Accomplished Practice adaptive reserve and colorectal cancer screening best practices at community health center clinics in seven states. S-P Tu, V Young, LJ Coombs, et al. Cancer. Accepted/ In press. Decreased cancer mortality-to-incidence ratios with increased accessibility of federally qualified health centers. SA Adams, SK Choi, L Khang, et al. Submitted to Journal of Community Health. Accepted/In press.

10. What We Accomplished Reported use of electronic health records to implement evidence-based approaches to colorectal cancer screening in community health centers. A Cole, S-P Tu, ME Fernandez, et al. Submitted to Journal of Health Care for the Poor and Underserved (Under Review) Is availability of mammography services at federally qualified health centers associated with breast cancer mortality-to-incidence ratios? An ecological analysis. SA Adams, SK Choi, JM Eberth, DB Friedman, et al. Submitted to Journal of Women’s Health (Under Review)

11. What We Accomplished Medicaid coverage expansion and cancer disparities. SK Choi, SA Adams, JM Eberth, et al. In preparation for submission to a special journal issue.​ Practice change in federally qualified health centers: Leaders' experiences in overcoming the challenges of implementing practice changes in FQHCs. ME Fernandez, N Woolf, M Kegler, et al. In progress. Developing measures to assess constructs of the consolidated framework for implementation research. M Kegler, M Carvalho, L Liang, et al. In progress. Developing measures to assess constructs from the inner settings of the consolidated framework for implementation research. MR Fernandez, W Calo, M Kegler, et al. In progress. FQHC implementation of electronic health records: A qualitative analysis. ME Fernandez, N Woolf, L Liang, et al. In progress.

12. What We Accomplished NCI P01 Tobacco TIPS: Translation into Practice Systems. (PI of Project 2: Fernandez; overall PI: Wetter). The aim of Project 2 study is to increase the adoption, implementation, and maintenance of AAC among health care systems that serve disadvantaged populations. Submitted May 2014. NCI-R15 A Geospatial Investigation of Breast Cancer Treatment (PI: Adams). Grant Awarded: August 2014. We propose to apply geospatial methodologies in innovative ways to the problem of breast cancer disparities among African American women. We plan to examine breast cancer treatment and mortality patterns among a racially and geographically (urban vs. rural) diverse cohort of women residing in South Carolina.

13. How We Worked Together Calls – to establish priorities and work By email – to write/edit protocols and papers Involved our partners in decision making – CRITICAL Assigned some roles – leaders, organizers, etc.

14. What Worked and What Didn’t What Worked Well: Co-chairing workgroup and having subgroups; sharing responsibilities for logistics Calls/meetings focused on specific analyses/projects/papers Checking in on progress What Didn’t Work Well: Important decisions about project aims, variables, etc. not being made upfront – can delay IRB, analysis, writing, etc. On and off participation by key players Confusion regarding leads on data analysis

15. Lessons Learned Don’t bite off more than you can chew! Allocate adequate $$ (e.g., incentives) and human resources right off the bat! Select call/meeting times that work for all key players. Ensure follow up and follow through between call/meeting dates. Agree upon specific roles for specific people/sites. Each site has different IRB timelines – beware and be prepared!