CRCCP Workgroup Update

1. CRCCP Workgroup Update Workgroup leaders: Peggy Hannon, Cam Escoffery, & Annette Maxwell CPCRN Annual Meeting October 4, 2013

2. Overview CRCCP & CPCRN workgroup 2012 Grantee Survey Projects in progress In-depth interviews 2013 survey 2013-14 work-plan

3. Colorectal Cancer Control Program (CRCCP) Goal: Increase CRC screening to 80% by 2014 Provide screening to un/underinsured Promote screening population-wide

4. CRCCP Grantees

5. Community Guide Strategies 5 strategies* to promote CRC screening: Client-oriented Small media Client reminders Reducing structural barriers Provider-oriented Provider reminders Provider assessment and feedback *One-on-one education was added in 2012

6. Opportunity for CPCRN Mission: Accelerate evidence-based intervention (EBI) adoption Shift in CDC’s approach from NBCCEDP to CRCCP Grantees urged to use Guide-recommended EBIs

7. CRCCP Workgroup Goals Study EBI adoption, implementation, maintenance Implement Annual Grantee Survey 2011-2014 Develop additional studies

8. Annual Grantee Survey Goals • Understand how grantees are implementing CDC’s Colorectal Cancer Control Program (CRCCP) • Establish a baseline to assess how implementation changes each year • Collect information related to technical assistance and training needs

9. D&I Frameworks Guiding Survey RE-AIM with focus on Adoption, Implementation and Maintenance of 5 Community Guide strategies Interactive Systems Framework for Dissemination and Implementation Prevention Support System (training and technical assistance)

10. 2012 Survey Grantees & Unfunded Sites Annette’s slides starting here

11. Methods Survey completed by person responsible for day-to-day management of the CRCCP or the BCCEDP Grantee Sample (2011, 2012, 2013, 2014): 29 CRCCPs (25 states and 4 tribes) across the U.S. Unfunded Sample (2012): 33 BCCEDPs Design: Online survey administered annually

12. 2012 Survey Administration & Participation Survey administered via Web, Sep 28 to Dec 10, 2012 29 CRCCP Grantees completed the survey (100%) 24 of 33 Unfunded states and tribes completed the Unfunded Survey (73%). NBCCEDP grantees were approached for completion of the Unfunded Survey. Respondents of both surveys were similar with respect to their role in the organization and level of experience.

13. Screening Promotion

14. EBI Use by CRCCP Grantees 2011 & 2012 – small changes

15. 2012: Grantees Use More EBIs than Unfunded Sites

16. Use of Patient Navigators to promote CRC screening 2011: 18/28 grantees used PN to promote screening (64%) 2012: 21/29 grantees used PN to promote screening (72%) 2012: 4/24 unfunded organizations used PN to promote screening (17%) Most common navigator activities Patient education Scheduling appointments Reminder calls for bowel prep or appointments

17. Screening Provision

18. CRC Screening Provision • All of the grantees but only half of the unfunded sites offered any CRC screening test. • About half of the grantees offered FOBT/FIT, while the majority of unfunded sites (8/12=67%) offered colonoscopy.

19. Patient Recruitment for Screening Provision Grantees conduct more clinic in-reach activities to provide information and education about CRC screening than unfunded organizations.

20. Providing Treatment of Patients diagnosed with CRC via CRC screening provision More Grantees have resources to support treatment for diagnosed patients than unfunded organizations.

21. Desire for Training depends on EBI Both Grantees and Unfunded Organizations have the greatest need for training and technical assistance with respect to provider assessment and feedback, reducing structural barriers and provider reminders. In addition, almost half of the Unfunded Organizations need TA for small media.

22. Professional Development & Quality Assurance related to CRC Screening Provision More Grantees engage in professional development and quality assurance related to CRC screening provision than unfunded organizations.

23. Summary • 2012 Grantee Survey provided a lot of information on • integration with other programs • program implementation • TA needs • Grantees continue to use more heavily patient-oriented strategies (small media, client reminders) than provider-focused strategies (provider reminders, provider assessment and feedback). • Patient navigation remains a prominent strategy among CRCCP Grantees. • Much more activity regarding screening promotion, screening provision and professional development and quality assurance among grantees than among unfunded organizations. Differences in type of screening test offered. • Results are being disseminated to grantees via annual CRCCP “Grantee Highlights Report” and webinars.

24. Current CRCCP Workgroup Projects In-depth Interview Study 2013 Grantee Survey Current CRCCP Projects

25. Purpose of the Qualitative Study • Describe the CRCCP grantees’ screening promotion goals • Describe grantees’ experience transitioning from primarily providing screening services (like in B/C) to integrating population-level promotion activities • Describe the grantee’s implementation of EBIs (e.g., EBI used, implementation strategy, barriers and facilitators to implementation) • Explore engagement of partners to promote CRC cancer screening • Describe efforts to leverage organizational-level policy change • Identify technical assistance needs for use of EBIs and screening promotion

26. Interview Instrument

27. Interview Instrument

28. Interview Instrument

29. Theoretical Frameworks ISF=Interactive Systems Framework CFIR = Consolidated Framework for Implementation Research

30. Methods • Sample: Interview at least half of grantees who adopt many EBIs and those who have organizational/systems changes • Semi structured guide (~ 1 ½ hr) • Analysis • Codebook • Thematic analysis in Nvivo • Case stories of successful EBI implementation or partnerships/policy changes • Emory IRB approval with interviewers added from UNC and Univ of Co • Pilot interviews conducted in early summer (4 sites)

31. Preliminary Results • 14 of 29 grantees interviewed (12 states, 2 tribes) • Goals • Focused on population level promotion of screening • A small proportion focused provider education/prof. development • Facilitators of EBIs • Data integration (e.g., electronic records) • Collaboration with partners • Integration with other cancer programs (NBCCEDP, comprehensive cancer)

32. Shift to Screening Promotion • What helped with the transition? Well, the infrastructure of the breast and cervical program is from [state] and I think the credibility of that program has made it pretty easy for us to do the work that we’ve in this program. Well, the initial year it was a shock to have the program shift from the screening program to 30% of it or so screening and the rest of the population focus…Once we got over that we became very excited about doing the population work. It energized staff to spend some time thinking about messaging, health messaging that would really motivate people to get screened…It was also nice to be able to think about how we could add colorectal education for lay health workers.

33. Policy Change • We have a program called the [state] Cancer Consortium Challenge that focused on organizational policies for breast, cervical and colorectal cancer screening. I think we had 8 total organizations participate and review their polices for employees around breast, cervical and colorectal cancer screening…We told them we would promote their work and give them an award. • We asked them to work with their insurance vendor to get an aggregate screening rate for their employees before they started the challenge…and that was the biggest barrier trying to figure out how to do that with them working with their insurance vendor.

34. Affordable Care Act • To promote population level screening rates, [stat e] grantee is working to "bridge a partnership with our Medicaid, especially as they start expanding and what not with the new exchange in market place.” • Although you’ve had healthcare reform in your state, how is the ACA affecting the current one coming out nationally • Female Respondent. Yes. It’s changing the context a little bit in terms of the availability of the exchange, because we’ve had an exchange for many years. So this will expand the exchange. And it will also, we also have elected to expand Medicaid…So that provision, there will be additional people that will now be eligible for Medicaid that may have only been eligible for safety net or something like that in the past

35. ACA, cont. • I will so however that we are just starting, and this is very, very recent, when people call the program to inquire about screening availability, or when we talk to people about the program, we are starting to incorporate more information, as much as we have available, on Affordable Care Act, and encouraging people to, and trying to channel people into the marketplace, so that they can get insurance.

36. 2013 Survey: Grantees Only 2013 survey launched 9/17/13 In the field now New questions Assess EBI reach ACA impact

37. Collaboration with CRCCP Program Evaluation Team Develop Annual Grantee Survey & additional studies Data collection, analysis, and interpretation Integrate survey findings with other evaluation activities Feedback to grantees (highlights report, webinars) Broader dissemination

38. Papers and Presentations Papers Grantees’ use of EBIs, AJPM, in press Grantees’ use of patient navigation, under review Comparison of grantees and unfunded sites, in development Presentations (national meetings) 2011 National Colorectal Cancer Roundtable 2012 CDC Cancer Conference

39. 2013-14 Workplan Objectives Projects & Products 2013-14 Work-plan Objectives

40. Projects Analyze in-depth interview data Complete & analyze 2013 survey Prepare & field 2014 survey Collaborate with CDC and others on emerging project and/or training opportunities Example: NBCCEDP survey

41. Products Papers & conference presentations Next 6 months: 2012 comparison Training/TA Additional topics: In-depth interview study Trends in EBI use over time Screening provision

42. Discussion Peggy Hannon Cam Escoffery Annette Maxwell peggyh@uw.edu cescoff@emory.edu amaxwell@ucla.edu