Cited references for this diagram
Implementation readiness — an organization’s combined capacity, commitment, and willingness to implement a new program, policy, or practice — facilitates implementation success.16–18 Because public health resources are limited, identifying a clinic’s readiness to successfully implement and sustain interventions, as well as gaps in clinic resources or practices that need to be addressed before implementation, is critical. Such assessment practices can guide clinics to select interventions with the greatest potential for long-term sustainability, and in turn help maximize the impact of public health spending, optimize clinic success, reduce cancer disparities, and improve population health.
Key informants who represented current and previous recipients generally said that mixed-methods assessments conducted before implementation prepared them to use results to inform development of tailored action plans for EBI implementation and technical assistance with partners.
Only 58% of clinics reported having good leadership support to maintain implementation of CRC screening EBIs, including mailed fecal testing. Fewer clinics reported having funding stability, organizational capacity, or the ability to adapt practices to ensure sustainability of EBI implementation. Although the CRCCP and other programs are designed with sustainability as a long-term goal, sustainability is an on-going challenge in clinics with limited resources and changing priorities that are reflected in budget changes.
This study demonstrates that EBIs to increase CRC screening may be effective in clinics with fewer resources that serve populations who have poor access to or under-utilize health care services. Tailoring the EBIs to the needs and capacity of participating clinics may have been key to their effectiveness.
Using a participatory implementation approach, a pre-implementation assessment was conducted to assess readiness for implementation of EBIs in order to increase CRC screening uptake.
First, the pre-implementation process allowed the awardee to determine the infrastructure needs and their capacity to implement EBIs.
Given the limited nature of public health funding cycles, it is critical that health systems change efforts not only work to achieve population health outcomes but also dedicate time and resources to integrating effective strategies for increased likelihood of long-term sustainability. Integrating EBIs and SAs into existing FQHC processes proved essential to CRCCP sustainability.
Integrating evidence-based processes into multiple aspects of clinic operations—including funding allocation, staff training, care delivery models, and EHR systems—can be complex but improve the prospect of sustainability.
A key theme across all awardees was the essential nature of coordinating EBIs and SAs with existing FQHC practices to expand reach of clinics’ prevention efforts and increase efficiency.
Respondents from three awardees described working with FQHCs to formally assess their implementation readiness during the application process or initial site visits. Although the scope of assessments and definitions of “readiness” varied, awardees generally examined: (a) CRC burden and risk, (b) CRC screening practices, (c) experience implementing similar EBIs and SAs, (d) effectively engaging partners, (e) current EHR systems, including problems with EHRs related to EBI implementation or measuring CRC screening rates, and (f) CRC screening rates. FQHC staff, in collaboration with awardees, used assessment results to inform selection of EBIs and SAs for implementation and address EHR issues.
To determine appropriate EBIs and ensure clinic capacity to implement them, programs can conduct readiness assessments of clinics prior to implementation. However, clinics may lack resources to implement all available interventions, and may strategically choose EBIs that are less resource intensive.
Integrating CRC interventions into the standard operating procedures and work flow processes of health systems, when possible, will contribute to sustainability (e.g., incorporating client reminders into the electronic health record system so that reminders are automated).
According to ID-DHW stakeholders, there were several program elements that facilitated the initiation of cancer screening prevention integration after their planning phase. The first of these elements was a pre-implementation checklist for health clinics to determine their capacity for implementing each type of cancer screening and undertake specific enhancements for coordinated and integrated screenings to be initiated.
