Article Figures & Data
Figures
- Figure 1.
Final model from CCM analysis: 3 clinic-level factors that distinguish clinics with higher and lower FIT completion rates.
CCM = configurational comparative method; CRC = colorectal cancer; FIT = fecal immunochemical test; SP = solution pathway.
Note: This figure displays how the same 3 factors operate in both the positive and negative solutions. This means that the presence of any of the 3 factors can appear in the positive model (clinics with higher FIT screening rates) and that these same 3 factors are all absent in the negative model (clinics with lower screening rates). For the positive model, clinics in bold only fall in 1 solution pathway, such that each pathway uniquely explains at least 2 clinics. Although Clinic 1 (a higher-performing clinic) was not accounted for by the positive solution, overall consistency and coverage for both models was high.
Tables
Program Component Standardized Workflows Flexible Workflows Centralized mailed FIT Annually, the quality department is responsible for (1) identifying age-eligible members due for CRC screening, (2) partnering with a vendor to mail FITs and an information sheet in English and Spanish to each member’s address of record, and (3) generating a list of patients 4 weeks after the mailing who have not returned the mailed FIT. The quality department distributes these lists to each clinic; clinics are encouraged but not required to conduct patient outreach calls to encourage FIT completion. Clinic-level workflows Daily, staff at individual clinics are expected to promote visit-based CRC screening emphasizing FIT by (1) chart scrubbing 1-2 days before scheduled appointments to identify patients due, (2) communicating to care team verbally (eg, huddle) or via notations on the schedule regarding who is coming in and due for CRC screening, and (3) reviewing the EHR point-of-care reminder system during patient rooming.
Medical assistants place a standing medical order for patients due and educate patients on CRC screening importance and how to complete the FIT. If patients decline FIT or prefer colonoscopy, medical assistants inform the provider, who will then engage the patient in a CRC screening discussion.Other decisions regarding the type and frequency of CRC screening outreach, follow-up (eg, number and timing of patient reminders, patient incentives for FIT completion), and other strategies (eg, promotional flyers, health fairs) to encourage completion of FIT testing are determined by local clinic leadership and staff. CRC = colorectal cancer; EHR = electronic health record; FIT = fecal immunochemical test; FQHC = federally qualified health center.
Characteristic Mean % (Range) Hispanic 79.7 (47.6-96.8) Non-English speaker 69.3 (43.5-87.5) Female 57.4 (40.0-62.8) Medicaid 54.3 (40.4-71.7) Uninsured 9.8 (4.1-21.0) FIT = fecal immunochemical test.
SUPPLEMENTAL MATERIALS IN PDF FILE BELOW
- DavisSupp.pdf -
Supplemental Appendix 1. PROMPT Baseline Clinic Interview Guide
Supplemental Table 1. Interview Guide Questions Aligned with CFIR Domains
Supplemental Figure 1. Consort Diagram of FQHC Patients Eligible for Colorectal Cancer Screening and Exposed to the Mailed FIT Program
Supplemental Table 2. Patient Demographics Across Clinics with Higher versus Lower FIT Completion Rates (N = 155,316)
Supplemental Table 3. Qualitative Factors Included in CCMs Analysis.
- DavisSupp.pdf -
