Evaluating Uptake of Evidence-Based Interventions in 355 Clinics Partnering With the Colorectal Cancer Control Program, 2015–2018

Annette E. Maxwell, DrPH; Amy DeGroff, PhD; Sarah D. Hohl, PhD; Krishna P. Sharma, PhD; Juzhong Sun; Cam Escoffery, PhD; Peggy A. Hannon, PhD

Disclosures

Prev Chronic Dis. 2022;19(5):e26 

In This Article

Abstract and Introduction

Abstract

Purpose and Objectives: Colorectal cancer screening rates remain suboptimal in the US. The Colorectal Cancer Control Program (CRCCP) of the Centers for Disease Control and Prevention (CDC) seeks to increase screening in health system clinics through implementation of evidence-based interventions (EBIs) and supporting activities (SAs). This program provided an opportunity to assess the uptake of EBIs and SAs in 355 clinics that participated from 2015 to 2018.

Intervention Approach: The 30 funded awardees of CRCCP partnered with clinics to implement at least 2 of 4 EBIs that CDC prioritized (patient reminders, provider reminders, reducing structural barriers, provider assessment and feedback) and 4 optional strategies that CDC identified as SAs (small media, professional development and provider education, patient navigation, and community health workers).

Evaluation Methods: Clinics completed 3 annual surveys to report uptake, implementation, and integration and perceived sustainability of the priority EBIs and SAs.

Results: In our sample of 355 clinics, uptake of 4 EBIs and 2 SAs significantly increased over time. By year 3, 82% of clinics implemented patient reminder systems, 88% implemented provider reminder systems, 82% implemented provider assessment and feedback, 76% implemented activities to reduce structural barriers, 51% implemented provider education, and 84% used small media. Most clinics that implemented these strategies (>90%) considered them fully integrated into the health system or clinic operations and sustainable by year 3. Fewer clinics used patient navigation (30%) and community health workers (19%), with no increase over the years of the study.

Implications for Public Health: Clinics participating in the CRCCP reported high uptake and perceived sustainability of EBIs that can be integrated into electronic medical record systems but limited uptake of patient navigation and community health workers, which are uniquely suited to reduce cancer disparities. Future research should determine how to promote uptake and assess cost-effectiveness of CRCCP interventions.

Introduction

Screening reduces deaths related to colorectal cancer (CRC), the second-leading cause of cancer death in the US.[1] However, despite recommendation by the US Preventive Services Task Force, CRC screening rates remain suboptimal (66% in 2018);[2] rates among uninsured and low-income populations are even lower. For example, in 2018, only about 30% of people who were uninsured and fewer than 50% of individuals who received care at Federally Qualified Health Centers, government-supported safety net clinics, were up to date with CRC screening.[2,3]

The Community Preventive Services Task Force oversees rigorous, systematic reviews of the scientific literature to identify prevention strategies with evidence of effectiveness. On the basis of these reviews, the Task Force recommends the following evidence-based interventions (EBIs) to increase CRC screening: patient reminders, provider reminders, reducing structural barriers, provider assessment and feedback, small media, one-on-one education, and community health workers, including patient navigators[4] (Table 1). Few studies have evaluated the uptake and sustainability of EBIs in a large sample of health care clinics.[5,6] Such data are needed to understand how these interventions affect population health, as well as how best to increase the scale of effective interventions. Scalability is defined as the ability of an efficacious health intervention to be expanded under real-world conditions to reach a large proportion of the eligible population.[7]

In 2015, the Centers for Disease Control and Prevention (CDC) funded the Colorectal Cancer Control Program (CRCCP) with the goal of increasing CRC screening. Thirty awardees were required to partner with primary care clinics that serve high-need populations to implement EBIs to increase CRC screening. On the basis of recommendations from the Task Force, CDC named 4 EBIs as priority for implementation (patient reminders, provider reminders, reducing structural barriers, provider assessment and feedback). These 4 priority EBIs can be implemented at the health system level to change screening rates. CDC deemed the 4 other EBIs that focus on the individual level (small media, one-on-one education, community health workers, patient navigators) as optional supporting activities (SAs). Awardees could implement both EBIs and SAs.

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