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In Phase 4, we provide guidance to support development of a practical implementation plan for clinics. These resources will also inform the Clinic Implementation Planning Summary that Colorectal Cancer Control Program (CRCCP) recipients must complete for each partner clinic prior to implementing evidence-based interventions (EBI). The summary can be found in the CRCCP Manual (Appendix C), which is available only to CRCCP recipients.

Collaboration is important in selecting EBIs for implementation. Recipients and clinics can consider the needs of the clinic, health system, and priority population, and the environment in which the interventions will be implemented.

Why Phase 4 Matters

A well-constructed implementation plan demonstrates readiness for implementation and a high likelihood of achieving the desired outcomes. The plan should summarize assessment findings and the rationale for selecting the EBIs to implement in a clinic.

An implementation plan promotes program success by ensuring that:

  • Clinics are selected based on need and readiness.
  • Recipients and participating clinics are collaborative partners in the process.
  • Clinic data and processes have been assessed thoroughly.
  • EBIs and process improvements match identified issues.
  • EBIs are implemented in a way that is feasible and sustainable.
  • Progress in implementing the plan is routinely assessed.
  • Excellent communication is established from day one forward.

Phase 4 Activities

Use these activities to develop an implementation plan.

4.1 Share and Collaboratively Interpret Assessment Findings

4.2 Agree on Ways to Improve Screening Rate Reporting & Validation

4.3 Identify and Document Gaps & Resources Available to Implement or Enhance EBIs

4.4 Select at Least Two EBIs to Implement or Enhance

4.5 Document Processes for Implementing or Enhancing EBIs

4.6 Develop a Plan to Address IT Challenges

4.7 Plan for Long-Term Sustainability

CRCCP Award Recipient Insight

“We found it was invaluable to explicitly consider how an EBI would address existing gaps in the clinic, and thereby improve and increase screening rates.”

4.1 Share and Collaboratively Interpret Assessment Findings

In this activity, the recipient meets with the assessment team named in Phase 1. The recipient shares assessment findings and interprets the findings together with clinic partners. Plan at least four hours (with breaks) to share, discuss, and interpret findings.

4.2 Agree on Ways to Improve Screening Rate Reporting and Validation

Recipients will work with the assessment team to agree on ways to improve screening rate reporting and validation. This can be done in the meeting described in Activity 4.1 or after the assessment team has had time to think about the assessment findings. For example, gaps may include issues with information technology (IT), clinical workflow, or staff time.

4.3 Identify and Document Gaps and Resources Available to Implement or Enhance EBIs

Similar to Activity 4.2, the recipient meets with the assessment team to agree on gaps to implementing or enhancing EBIs in the clinic. You and your clinic partners may not be able to address every gap identified in the readiness assessment, so work together to prioritize them. For example, you may decide to focus on improving electronic health record documentation or reminders, or training staff to improve the clinical workflow.

After you have identified the priority gaps, you will want to identify resources that are available to support EBI implementation or enhancement. Examples are listed below. As you develop the implementation plan, you can provide more detail about each resource.

  • Processes and protocols established for implementation.
  • Clinical, administrative, and IT leadership support for implementation.
  • Alignment between IT (including electronic health records) and EBIs.
  • Clinician and staff support for EBI implementation, including a screening champion.
  • Training available for clinicians and staff in new workflows and EBI implementation.
  • Staff, time, space, and funds.

4.4 Select at Least Two EBIs to Implement or Enhance

CDC requires clinics to implement at least two of the four priority EBIs. Award recipients and clinic partners will agree on EBIs to implement based on the clinic’s priorities and the resources identified in the previous activity. If EBIs have been implemented for some time, identify which ones are appropriate for improvement or enhancement. You and your clinic partners may modify your approach to EBI implementation or enhancement along the way to improve effectiveness of the intervention or decide to stop implementing an EBI if it is not addressing an identified need.

EBIs identified for implementation or enhancement should—

  • Address gaps identified and agreed on as clinic priorities.
  • Be feasible for the clinic to implement.
  • Meet guidelines described in CDC’s EBI Planning Guides.
  • Have potential for long-term sustainability.

You can use the Evidence-Based Intervention Planning Guides to ensure you implement EBIs that are important to each clinic. Remember, each EBI has several options. For instance, examples of different types of patient reminders are letters, postcards, email reminders, telephone calls, or text messages. Examples of different types of provider reminders are flags in clients’ charts, visual aids posted publicly, or care team huddles.

4.5 Document Processes for Implementing or Enhancing EBIs

Recipients and clinic partners work together to document the process for implementing or enhancing the EBIs. Include the name of the person responsible for each step, the resources that person will use, and how the work will be done. Draw from your assessment findings to document these processes.

4.6 Develop a Plan to Address IT Challenges

Information technology (IT) systems affect screening rate reporting and validation, screening workflows, and EBI implementation.

Recipients can work with clinics to—

  • Improve workflows.
  • Improve reporting.
  • Support EBI implementation.
  • Capture clinic data required for monitoring progress, improvements, and annual reporting.

4.7 Plan for Long-Term Sustainability

Planning for sustainability is critical for long-term program success. To document your plan for long-term sustainability, consider how you will maintain—

  • Staff, leadership, and partner engagement.
  • Systems for monitoring and evaluation to identify and address inefficiencies and document program outcomes.
  • Integration of screening processes in routine clinical workflows.
  • Training to ensure adherence to screening best practices.
  • IT support for workflows and reporting.

The Clinical Sustainability Assessment Tool may be a useful tool to gauge the sustainability capacity for EBI implementation.

Frequently Asked Question

Next Steps

If you have completed all the activities in this Field Guide, you have convened your team, designed and administered the readiness assessment, evaluated assessment data, and developed an implementation plan. Now, you are prepared to carry out the implementation plan you and your team have designed. Your program consultant is available to answer additional questions as you and your team complete the activities outlined in your implementation plan.

Congratulations on everything you have accomplished!