1. This presentation was supported by Cooperative Agreement Numbers U48-DP001909, U48-DP001946, U48-DP001924, U48-DP001934, U48-DP001938(03), U48-DP001944, U48-DP001936, U48-DP001949-02, U48–DP001911, & U48-DP001903 from the Centers for Disease Control and Prevention. The findings and conclusions in this presentation are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Shin-Ping Tu, MD, MPH; Maria Fernandez, PhD, Vicki Young, PhD on behalf of the CPCRN FQHC Workgroup Investigators Emory UniversityUniversity of California Los Angeles University of ColoradoUniversity of South Carolina University of Texas HoustonUniversity of Washington Washington University at St. Louis Denver, CO 3-5PM Oct 3 rd, 2013 The CPCRN FQHC Workgroup Breakout Discussion

2. Agenda Research Questions & Survey Analysis Issues (45 min) Feedback & Reports for FQHC Partners (35 min) Next Steps (40 min)

3. Research Questions Primary Research Questions: What factors influence the implementation of evidence-based approaches for promoting CRC screening in FQHCs? What factors influence the implementation of PCMH best practices for CRC screening in FQHCs? Are there other research questions of interests ?

4. Overall Analytic Approach What are the best analytic approaches to answer these research questions? Shall we explore causal pathways between contructs and their direct and indirect influence on implementation? What process should we use to make decisions about which constructs to put into the model?

5. Analysis Issues—Implementation Outcomes How shall we determining implementation outcomes of EBAs for each clinic? –Implementation score based on responses on both surveys ? –Consider differences in perceived implementation level by roles of respondents (or demographic differences)?

6. Analysis Issues—Implementation Outcomes (Cont.) How to deal with the disagreement in terms of the level of implementation of EBAs in each clinic between the responses to the Main Survey (filled out by clinical staff) and the Clinic Characteristics Survey (filled out by clinic contacts/leaders) ? In general, there is 80% disagreement between individual responses to the main survey and the clinic characteristics survey regarding level of implementation for each EBA

7. Example: Level of Implementation of Provider Reminders Clinic 13176Main Survey (N=10) Clinic Characteristics Survey (N=1) Level 1 (Fully implemented)1 Level 2 (Inconsistently) Level 3 (Early stage of Implementing) 1 Planning3 No plan1 Missing : 5 How to determine the implementation outcome for clinic 13176?

8. Analysis Issues—Scaling & Modeling How to aggregate responses within clinics for the independent variables? How to deal with the scaling of EBA-specific constructs? How to deal with the variance of the number of clinics responding to general vs. EBA-specific constructs in building predictor models?

9. Analysis Issues—Nesting How shall we handle the differences in nesting of individuals within clinics and in some cases clinics within FQHC systems?

10. Other Analytic Issues Collinearity among some of the variables Confounding and Interaction

11. Feedback & Reports for FQHC Partners What format shall we use to provide feedback for FQHC partners? What are the potential deliverables for FQHC partners (NACHC, state PCAs, individual FQHCs)? What will be the process for producing such deliverables for partners at different level? How shall we continue to engage FQHC partners?

12. Next Steps What additional research can be done to improve evidence-based cancer control practices in FQHCs? What kind of interventions can help FQHCs in improving their cancer control practices? What grant opportunities can we pursue as a group?