Phase 2: Design and Administer the Readiness Assessment
Field Guide for Assessing Readiness to Implement Evidence-Based Cancer Screening Interventions
‹View Table of Contents
In Phase 2, we provide a process and tools to help your team design and administer your readiness assessment.
This phase aims to help you—
- Identify which readiness data are most relevant for your program.
- Understand and build capacity to assess the six domains that CDC requires.
- Determine the best way to collect data.
- Collect the data.
Why Phase 2 Matters
A readiness assessment that is designed well and administered properly helps clinics leverage strengths, identify barriers, and plan for success.
Phase 2 Activities
Complete these activities to design and administer your readiness assessment.
2.1 Determine Relevance and Feasibility of EBIs for the Clinic Setting
2.2 Understand the CRCCP Required Readiness Assessment Domains
2.3 Review Existing Readiness Data Collection Tools
2.4 Convene the Team to Determine Data Collection Strategies
2.5 Gather Data to Assess the Minimum Required Assessment Domains
“We considered use and effectiveness of each EBI and how each could address gaps in the partners’ clinics screening process. These interventions need to be feasible for partners.”
2.1 Determine Relevance and Feasibility of EBIs for the Clinic Settings
Evaluation of the 2015–2020 CRCCP recipients showed greater increases in CRC screening rates as the number of evidence-based interventions (EBIs) implemented increased. CDC requires clinics to implement at least two of the four priority EBIs for colorectal cancer screening recommended by the Community Preventive Services Task Force. The four priority EBIs are listed below.
Given clinics’ varying resources, patient and provider needs, and context, it is important to collaborate to determine which interventions are best suited for each clinic.
- Provider Assessment and Feedback
In this context, interventions that evaluate provider performance in delivering or offering screening to patients are called provider assessments. The presentation of information to providers about their performance in recommending or providing screening services is called provider feedback. - Provider Reminders
Reminders inform health care providers it is time for a patient’s cancer screening test. A recall is another form of provider reminder that alerts providers that a patient is overdue for screening. - Patient or Client Reminders
Written (letter, postcard, email, or text message) or telephone messages (including recorded or automated messages) are used to alert patients that they are due for screening. Patient reminders can be general to reach a group of people or tailored to reach one person. - Reducing Structural Barriers
Structural barriers make it difficult for people to access cancer screening services, such as inconvenient clinic hours or lack of transportation.
Clinics may implement additional supporting interventions, such as patient navigation and small media.
- Patient Navigators
Patient navigators assess and remove patient barriers and support the completion of screening tests (such as returning completed home stool tests), follow-up diagnostic tests, and referral to cancer treatment, if needed. Patient navigators may also help implement EBIs in clinics. - Small Media
Small media include videos or printed material such as letters, brochures, and newsletters that inform and motivate patients to be screened for cancer. These materials may be used to support patient navigation and implementation of patient reminder interventions.
2.2 Understand the CRCCP Required Readiness Assessment Domains
CDC CRCCP requires the following six readiness assessment domains for each participating clinic.
- Baseline CDC Rate
The proportion of eligible clinic patients who are up to date with colorectal cancer screening. - EBIs Implemented
The Community Preventive Services Task Force recommended strategies that clinics are implementing or enhancing to increase screening. They include at least two of CDC’s four priority EBIs for the CRCCP (provider assessment and feedback, provider reminders, patient reminders, and reducing structural barriers). - EBI Implementation Quality
The degree to which the Community Preventive Services Task Force recommended strategies are in place at the clinic. This includes assessing quality, whether EBIs are being implemented effectively (e.g., How many patient reminders result in screening?) and determining if clinical activities are EBIs. - Workflow and Screening Process
How the clinic team identifies patients who are due for screening, educates patients about cancer screening, recommends screening, schedules screening tests, records screening results, and follows up with patients. - Electronic Health Record (EHR) Capacity
If, how, and where patient screening test information is documented, screening rates are calculated and validated, and clinical workflows are integrated. - Clinic Resources and Capacity
Ability and support from clinic staff to implement EBIs, leadership support for EBI implementation, and tangible resources, such as space and materials, to implement EBIs.
The CRCCP Manual (Part 1, including Appendix B) describes the assessment domains in more detail. The CRCCP Manual is available only to CRCCP recipients.
2.3 Review Existing Readiness Data Collection Tools
To develop the Field Guide, our team reviewed assessment tools designed and administered by multiple CRCCP recipients. Recipients agreed to share their tools to inform others’ readiness assessment efforts. The tools highlighted here may be adapted for use across diverse clinic settings.
These tools were selected for inclusion based on their—
- Ability to meet a required readiness assessment domain.
- Ease of understanding without additional explanation.
- Applicability across various clinic settings.
You can click on the domains below to see the related data collection tools. An asterisk (*) next to the individual tool name indicates the minimum data required for that CDC readiness assessment domain.
Source: CDC
Description: Provides detailed guidance on how to measure the screening rate.
How to Use: When a clinic is recruited and annually thereafter. Data from routine reports can be used to populate this required assessment domain. The Guide is available only to CRCCP recipients.
Source: Washington State Department of Health Breast, Cervical, and Colon Health Program
Description: Includes questions to characterize the type, frequency of delivery, successes, barriers, facilitators, and resources available for implementing each EBI.
How to Use: Adapt questions for your setting to identify the ways in which the clinic is implementing EBIs.
Source: CDC
Description: The planning guide for each of the four priority EBIs includes a process flow diagram, process evaluation metrics, outputs, example measures, resources needed for implementation, lessons learned, and components.
How to Use: Assess the readiness and quality of each EBI being implemented in each setting. Results can guide the development of a plan to improve EBI quality.
Source: CDC
Description: This tool includes logic models specific to each of the following EBIs: Provider Assessment and Feedback, Provider Reminders, Patient or Client Reminders, Reducing Structural Barriers, Patient Navigation, and Small Media. It is available in the CRCCP Manual (Part 1, Chapter 2: Program Planning). It specifies outputs and outcomes for measurement and relates to planning as recipients consider how evaluation findings will be used to develop implementation plans. The CRCCP Manual is available only to CRCCP recipients.
How to Use: Refine logic models for use based on your own implementation approach. For example, work with implementers to review the logic model for provider reminders to ensure your planned activities will lead to the intended outcomes.
Source: New Hampshire Colorectal Cancer Screening Program
Description: One-page infographic that summarizes steps to implementing patient reminders by assessing current patient reminders, identifying a target population, choosing an appropriate patient reminder, allocating resources to establish a new process, and evaluating that process.
How to Use: Follow the steps as outlined to create patient reminders that will be effective for your target population. Facilitators and examples (see legend in box) noted in the At a Glance may also be helpful. This process is useful for completion of all aspects of the screening continuum, from initiation through adherence and completion of recommended testing.
Source: Illinois Colon CARES (Cancer Alliance to Reignite and Enhance Screening)
Description: This document illustrates a patient flowchart for colorectal cancer screening.
How to Use: Tailor a workflow to your settings. Use in implementation plans to ensure team members understands their own and others’ roles in the screening and workflow processes.
Source: New Hampshire Colorectal Cancer Screening Program
Description: This resource includes a description of the assessment, the assessment tool, and an example office flow summary document that would be presented to the partner staff after the data is collected by the CRCCP. This assessment observes office processes and support services for CRC screening. It is not an assessment of individual staff members. Benefits to the practice are identification of what is working well and where there are opportunities for processes improvements.
How to Use: Tailor to your setting to assess current actual workflows in the clinic through observation. Present findings to partner staff to guide implementation plan development and optimize EBI implementation.
Source: Michigan Department of Health and Human Services Colorectal Cancer Control Program
Description: This series of open-ended questions about priorities, resources, electronic health records (EHR) capacity, and workflow is a follow up to quantitative needs assessment (see Michigan’s Electronic Health Record Assessment Template and Clinic Needs Assessment in the Electronic Health Records Capacity section below). It is intended for recipients to use when interviewing clinic and health system staff to conduct interviews with clinic and health system staff.
How to Use: As a follow up to gather context into results of quantitative assessment.
Source: Washington University in St. Louis Center for Public Health Systems Science
Description: Clinical staff and implementing partners can take this free 35-item self-assessment to evaluate seven domains of a clinic’s capacity to implement colorectal cancer screening EBIs. The CSAT can be administered as a whole, or by domain. The Workflow Integration Domain (5 items) is useful for assessing workflow and screening processes.
How to Use: Administer the assessment among clinic teams to identify strengths and opportunities to improve screening efforts. Free resources are provided by CSAT developers to help you interpret scores and develop an implementation plan.
Source: Florida Department of Health Colorectal Cancer Control Program
Description: The Quality Improvement tab on this quantitative assessment tool includes 20 questions to assess EHR capacity and improve its quality. A scoring guide can be found under the Summary Findings tab.
How to Use: Adapt for your setting and use to determine the readiness of the clinic’s EHR system for cancer screening. Use the score to determine areas of strength and areas in need of attention for optimized EBI implementation.
Source: Michigan Department of Health and Human Services Colorectal Cancer Control Program
Description: The Electronic Health Record Functionality Assessment Template includes questions to ask when assessing 5 domains of EHR functionality: 1) Certification, 2) Customization, 3) Reporting, 4) Provider alerts, and 5) Usability. The quantitative needs assessment instrument includes EHR capacity-related questions (see Assessment Questions 36–47). Additional questions about EHR use for monitoring EBI implementation and cancer screening rates can be found in Assessment Questions 48–69.
How to Use: Adapt for your setting and use to determine readiness of the clinic’s information technology and Electronic Health Records systems for cancer screening.
Source: New Hampshire Colorectal Cancer Screening Program
Description: Items 6-9 on this section of the readiness assessment instrument assess aspects of EHR capacity.
How to Use: Adapt for your setting and use to determine readiness of the clinic’s information technology and Electronic Health Records systems for cancer screening.
Source: Washington University in St. Louis Center for Public Health Systems Science
Description: Clinical staff and stakeholders can take this free 35-item self-assessment to evaluate seven domains of a clinic’s capacity to implement colorectal cancer screening EBIs. It can be administered as a whole or by domain. The Organizational Readiness and Workflow Integration domains are useful for assessing EHR capacity. Each domain includes five items.
How to Use: Administer assessment among clinic teams to identify strengths and opportunities to enhance screening efforts. Free resources are provided by CSAT developers to assist you in interpreting scores and developing an implementation plan.
Source: Illinois Colon CARES (Cancer Alliance to Reignite and Enhance Screening)
Description: The 11 items in this survey aim to assess the clinic team’s perceived value of a cancer screening program, attitudes toward screening, and screening resources. Higher scores are correlated with a greater probability of implementation success.
How to Use: Calculate scores to determine which areas may need to be enhanced as part of the implementation plan.
Source: Michigan Department of Health and Human Services Colorectal Cancer Control Program
Description: This series of open-ended questions about priorities, resources, EHR capacity, and workflow as a follow up to quantitative needs assessment (see Michigan’s Electronic Health Record Assessment Template and Clinic Needs Assessment in the Electronic Health Records Capacity section). It is intended for recipients when interviewing clinic and health system staff.
How to Use: To gather context of the results of a quantitative assessment.
Source: South Carolina Department of Health Colorectal Cancer Screening Program
Description: Questions #4-20 on this quantitative survey are designed to be administered among clinic staff to assess readiness characteristics. The survey is based on a framework developed to assess organizational readiness in local, state, and national settings. This framework is described in the publication “R = MC2 readiness building process: A practical approach to support implementation in local, state, and national settings.”
How to Use: Calculate scores to determine which areas may need to be enhanced as part of the implementation plan.
Source: Washington University in St. Louis Center for Public Health Systems Science
Description: Clinical staff and stakeholders can take this free 35-item self-assessment to evaluate seven domains of a clinic’s capacity to implement colorectal cancer screening EBIs. It can be administered as a whole or by domain. Domains of the full instrument include: Engaged Staff and Leadership, Engaged Stakeholders, Organizational Readiness, Workflow Integration, Implementation and Training, Monitoring and Evaluation, and Outcomes and Effectiveness. Each domain includes 5 items.
How to Use: Administer the assessment among clinic teams to identify strengths and opportunities to enhance screening efforts. Free resources are provided by CSAT developers to assist you in interpreting scores and developing an implementation plan.
2.4 Determine Data Collection Strategies
After your team has completed the activities above, we suggest you come together to—
- Identify and discuss what data are already being collected by the clinic and what additional new data may need to be collected to meet readiness assessment requirements.
- Decide where and how assessment data will be stored.
- Determine how the available data can be compiled for analysis and decide how new additional data can be collected (in person, online, on paper, or by phone or video) considering available expertise and resources.
- Design or adapt data collection tools.
- Establish a time frame for conducting the assessment and analyzing the information (data) you have gathered.
As you design your assessment and select your approach, consider the timeline for collecting data. CRCCP recipients have used online, paper-based, and oral surveys, qualitative interviews and focus groups, and site or workflow observations. Below are questions that may help guide resources needed for each type of data collection tool.
Considerations for Determining Data Collection Strategies
All Strategies
- What is the estimated timeline for data collection?
- Who will respond to the survey and participate in the interviews?
- What is the clinic’s capacity to respond using the proposed format? For example, do they have the Internet bandwidth? Can they meet at one time?
- How many times will individuals be interviewed or surveyed?
- When will data be collected?
- How long will the survey or interview take to complete?
Interviews or Focus Groups
- Will the interview or focus group be conducted in person or by phone or video?
- Will you conduct focus groups or one-on-one interviews?
- What are your recording capabilities and transcription needs?
Survey
- Will the survey be conducted online, on paper, or a combination of both?
- Will the survey be self-administered or interviewer-administered? By phone or in person?
Site or Workflow Observations
- Which clinic and awardee staff members need to be present?
Analysis Considerations
- Will analysis software be needed?
- Who will analyze or interpret the results?
“It mattered how we asked questions. It was helpful to ask a measured number of open questions so conversations revealed current clinic capacity and then probe. Partners may become overwhelmed if they are asked too much during one session.”
2.5 Gather Data to Assess the Minimum Required Assessment Domains
In this activity, you will work with your clinic team to apply the approach you defined in the previous activity. You will collect the information needed to assess the minimum required assessment domains for the readiness assessment.
CRCCP Readiness Assessment Minimum Required Data Elements
Routinely Collected for CDC Baseline Clinic Data
- Clinic characteristics
- Colorectal cancer screening tests clinic uses or is planning to use
- Current colorectal cancer screening rate
- How the clinic validates screening rates
- EBIs implemented
Specific to the Readiness Assessment
- EBI implementation processes
- Workflow processes for each colorectal cancer screening test
- Evaluation practices for EBI implementation
- Clinic resources and capacity
- Electronic health record processes and capacity
2.6 Review Data
Your assessment team should work together to make sure the data you collected are ready for evaluation. For example, you will want to check surveys to make sure responses are not missing or entered incorrectly, and that notes from the site observations are clear.
2.7 Resolve Discrepancies
You may need to return to clinic partners for clarification or to answer additional questions. This can be done informally through email or as a more formal team meeting. Your resources and situation should determine the format, including — but not limited to — the number and type of questions, your relationship with clinic partners, and established communication practices.
Phase 2 Frequently Asked Questions
Field Guide Phases
- Phase 1: Convene Team Members and Determine Assessment Activities
- ›Phase 2: Design and Administer the Readiness Assessment
- Phase 3: Evaluate Assessment Data
- Phase 4: Develop an Implementation Plan