We developed our dissemination plan based largely on AHRQ's
Dissemination Planning Tool (Carpenter, et al., 2005). The key components of
this tool are:
Content: What we intend to disseminate: the project
findings and the redesign intervention tools that we have found to be useful or
End users: The intended targets of our dissemination
efforts; those whom we will target to adopt and implement or otherwise use what
Dissemination partners: Those with whom we will partner to
help us disseminate our findings and encourage the spread and adoption of our
Communication: Our strategy for reaching our intended end
users; the communication channels we will use to reach these end users.
Evaluation: How we intend to assess the effectiveness of
our dissemination effort.
We discuss below how we incorporated each of these
components into our dissemination plan.
Our dissemination efforts have two components: a
SATIS-PHI/CRC intervention implementation toolkit and material and efforts beyond
the toolkit. The primary component is the toolkit. Through it, we intend to
inform potential new users and adopters about the SATIS-PHI/CRC intervention
and our experiences implementing it. To facilitate the spread of the
intervention, we will provide tools, guidelines, and tips for implementing
SATIS-PHI/CRC based on the lessons learned reported here and on what we found
effective and useful in our implementation efforts. To encourage the
intervention's spread, the toolkit provides evidence of the intervention's effectiveness
and reasons for its adoption. We describe the toolkit in greater detail below.
In addition to and beyond the toolkit, we will disseminate
various elements of our project findings and various elements of the
intervention. In particular, as part of our efforts beyond the toolkit, we will
disseminate our analytical findings from the practice surveys and focus groups
and report them at professional meetings and in professional publications. Similarly,
we will report the full details of our intervention study (implementation process
and outcomes) at professional meetings and in professional publications. We
will also report summaries of our intervention and assessment in trade
publications and to relevant professional associations and consortia of cancer
Topics for analysis and dissemination include:
Overall effectiveness of the intervention to increase CRC
Evaluation of the intervention effort using the PRISM and RE-AIM
Assessment of clinician beliefs and behaviors related to CRC
screening (based on the survey and focus groups).
Assessment of patient attitudes regarding the CRC screening
process (based on the focus groups).
Estimation of the extent of "ineligible eligibles"—patients whom
the initial electronic record review identified as eligible but whom we deemed
to be ineligible based on the SEA form, chart reviews, and subsequent
electronic record review—in our data.
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We envision two kinds of end users for our dissemination
efforts. The first are potential adopters of our intervention. These primarily include
integrated delivery systems, independent practice associations or foundations,
insurers owned or operated by delivery systems, insurers not owned or operated
by delivery systems, and State, county, or municipal public health agencies and
related entities. They are the principal target of the toolkit.
The second group of users includes those who are not
firstline new adopters but who may be able to inform and influence potential
new users. It also includes people who may be interested in our intervention
and findings for purposes of conducting followup research, incorporating our
intervention elements into other CRC screening efforts, or developing next
generation versions of the intervention. They are the principal target of our
dissemination efforts beyond the toolkit.
These types of end users, the target of the toolkit, include
the following in rough priority order of planned targets for our dissemination
The remaining LVPHO/EPICNet primary care practices that did not
participate as intervention practices in the SATIS-PHI/CRC intervention study.
Delivery systems affiliated with Thomas Jefferson University
(TJU) through Jefferson Health System or other collaborative arrangements.
Delivery systems, insurers, and public health agencies throughout
Delivery systems in the current CNA Health ACTION Team network.
Delivery systems in other ACTION partnerships.
Influencers of Potential Adopters
These types of end users, the target of our efforts beyond
the toolkit, include the following, in rough priority order:
Pennsylvania Cancer Control Consortium (PAC3).
Agency for Healthcare Research and Quality (AHRQ): staff members
affiliated with the Prevention and Care Management research portfolio (and
possibly the Health Information Technology research portfolio) and with the
Center for Primary Care, Prevention, and Clinical Partnerships.
Centers for Disease Control and Prevention (CDC): staff members
affiliated with the Division of Cancer Prevention and Control of the National
Center for Chronic Disease Prevention and Health Promotion in the Coordinating
Center for Health Promotion, including the CDC State Cancer Control Plans.
National Colorectal Cancer Roundtable (NCCRT).
American Cancer Society (ACS).
American Academy of Family Physicians (AAFP).
American College of Physicians (ACP).
America's Health Insurance Plans (AHIP).
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Our primary dissemination team consists of members of the
CNA Health ACTION Team who participated on this Task Order: (1) CNA; (2) Thomas
Jefferson University, including its School of Population Health, Department of
Family and Community Medicine, and Department of Medical Oncology; and (3) LVHN,
including the LVPHO and the Department of Family Medicine. In addition to our
efforts, we will work with AHRQ and CDC to help package and disseminate
information about our intervention and the availability of our intervention
We also plan to investigate the possibility of enlisting one
or more of our type 2 end users (PAC3, NCCRT, ACS, AAFP, ACP, AHIP) to become a
dissemination partner. We will work through contacts that team members already
have established with PAC3, NCCRT, ACS, and AAFP. We will seek to make new
contacts with ACP, AHIP, and other type 2 end users that we subsequently
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We will communicate our intervention implementation toolkit
to potential new users and adopters through direct and mediated contact. We
will directly disseminate it through the LVPHO to Lehigh Valley primary care
practices, through TJU to members of the Jefferson Health System, and through
CNA to other members of our ACTION partnership. We will work with AHRQ to
disseminate it more broadly to other ACTION partnerships. In addition, we will
work with both AHRQ and CDC, as well as our other targeted dissemination
partners, to disseminate it beyond that. Our final toolkit will undergo
remediation so that it can be compliant with Section 508 of the Rehabilitation
Act and therefore made available on the AHRQ Web site. This posting will help
disseminate the toolkit to both type 1 and 2 users.
We will also communicate information about the intervention
and the findings of our assessment to type 1 and type 2 end users, as well as
to the broader professional clinical and research communities. This
communication will include writing articles for professional journals and trade
publications, presenting papers and posters at professional and trade meetings,
informing professional and trade associations, and using the dissemination
capabilities of CNA and its partners on this ACTION Task Order.
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Since the dissemination effort is being conducted at the end
of this Task Order and will extend beyond it, we cannot evaluate its success
within the scope of the Task Order. Such effort exceeds the Task Order's
statement of work, period of performance, and funding. Still, we have an
interest in evaluating our effort and plan to monitor response to it as best we
can. One way we will gather data for our dissemination evaluation will be to
seek feedback from our dissemination partners regarding their perception of the
intervention and the toolkit and their experience helping to disseminate
information about it. We will also seek feedback from participants at the
professional meetings where we present our study findings.
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Our Dissemination Toolkit includes the following three
components: (1) introduction to the toolkit and its contents, (2) background
information about the intervention and our study findings—including supporting
evidence about the effectiveness of the intervention, and (3) intervention
steps and tools. We delivered the toolkit to AHRQ and CDC as a companion
deliverable document to this final report in satisfaction of our task order
contract. Others wanting a copy may request one from CNA by E-mailing the CNA
Health ACTION Partnership at CHAP@CNA.org.
The introduction to the toolkit contains a brief statement
of the purpose of the dissemination toolkit, its intended users, and ways the
toolkit can help users. It include a brief overview of the need for CRC
screening (including the prevalence and natural history of the disease) and a
brief summary of the current research literature regarding screening programs
and the need for the kind of intervention we developed and implemented. It also
provides a general overview of the contents of the toolkit and its structure.
In the background section, we briefly describe the Task
Order project and the system redesign intervention that is the basis for this
dissemination effort. We also provide descriptions of the intervention setting.
We describe the applicability of this intervention to other users that are most
conducive to successfully implementing the intervention or using the tools. Last,
we briefly describe the assessment of the intervention, noting general evidence
in support of its overall effectiveness and usefulness as well as that of
various tools contained in the toolkit. We describe the assessment in the
context of why a user would want to try to adopt our intervention and its
Intervention Steps and Tools
In the intervention protocol and steps section, we describe
each of the six main intervention steps and then describe the optional
assessment step. For each of the intervention and assessment steps, we describe
what it entails, provide instructions for implementing it, and offer tips for
implementing it based on lessons learned from our implementation experience,
including pitfalls to avoid and how to avoid them. We also identify possible
alternative ways of carrying out various steps and point out what would be
required to make such alternatives practical. In addition, we point out where
various steps may be considered optional and under what circumstances a user
may or may not want to apply one of those steps.
After describing each intervention step, we include the
appropriate corresponding intervention tools (forms, letters to patients,
academic detailing material, etc.). The tools are based on the materials we
used for our intervention. However, users can tailor and revise them as
appropriate for their organizations and settings.
Table 5.1 presents a detailed list of the material in the
intervention steps and tools section of the toolkit. Table 5.2 presents the
same information for the optional assessment protocol.
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Current Dissemination Activities
We are currently disseminating our intervention and its
findings across multiple outlets, including research conferences, statewide
clinical and policy working groups, peer-reviewed and trade manuscripts, and
the World Wide Web.
Upon completion of this Task Order, AHRQ will post our final
toolkit on their Web site, and it will also be linked from the CDC Web site. This
posting will allow the toolkit to be accessible to both the clinical and
research communities. The toolkit will undergo remediation to be accessible to
all populations. In addition, we plan to disseminate the toolkit to our ACTION partners
and throughout each primary care practice in the LVHN community. We also plan
on posting it on the PAC3 Portal, a statewide network working to reduce cancer
Clinical and Policy Working Groups
Steering Group members have become involved in various
panels and working groups through which they will continue to spread and
disseminate the findings from the intervention. Below is a summary of some of
Pennsylvania Improving Performance in Practice (IPIP) Project. Steering
Group members have been invited to participate as expert faculty in the
Pennsylvania IPIP project. This 3-year effort was started by the Governor's Office
of Healthcare Reform to move practices to the medical home concept and improve
the management of chronic disease through participation in primary care
collaboratives across the State. Starting in June 2010, Steering Group members planned
to make statewide Web presentations to primary care practices throughout
Pennsylvania. In some of the Web seminars, they included the content and
findings from our study's intervention, such as lessons learned from the
practice survey and focus groups in the Lehigh Valley, and tools to help
increase CRC screening.
Pennsylvania CRC screening Project. The Commonwealth of Pennsylvania
has been selected by CDC to receive State grant funding to increase CRC
screening in the low-income uninsured population. Steering Group members will
also serve as expert faculty on this project, working with the 10 public health
centers in the city and their points of referral.
National Colorectal Cancer Roundtable. Steering Group members planned
to attend the National Colorectal Cancer Roundtable meeting in November 2010 to
report the findings of our intervention.
Lehigh Valley Health Network Research Day. Steering Group members
will present the intervention and study findings at the LVHN Research Day.
Lehigh Valley Patient Centered Medical Home. LVHN is working
toward implementing the patient-centered medical home concept in their
practices, and they are looking at including CRC screening as one of the key
elements of the medical home. Steering Group members are working with LVHN to
incorporate elements of our CRC screening intervention in their medical home
Study findings have and will be disseminated at several key
research conferences. For example, some of our baseline study findings about
primary care practice involvement with CRC screening activities and the utility
of health information technology for population-based screening were
disseminated at the North American Primary Care Research Group (NAPCRG)
Conference in November 2009 and AcademyHealth Annual Research Meeting (ARM) in
June 2010. We also planned to disseminate additional findings at the American
Public Health Association (APHA) Annual Meeting in November 2010. This
presentation focused on our baseline findings of clinician attitudes and
behaviors associated with CRC screening.
The conference sessions included:
"Colorectal Cancer Screening Responsibilities in Primary Care
Practice," NAPCRG, November 2009, poster session.
"Ineligible Eligibles: Incorrect Information in Electronic Health
Data Affecting Intervention Implementation Research: A Report From the CNA
Health ACTION Team," AcademyHealth, June 2010, poster session.
"Primary Care and Colorectal Cancer (CRC): Attitudes and Behavior
Associated With Performing Preventative Screening and Followup: A Report From
the CNA Health ACTION Team," AcademyHealth, June 2010, poster session.
"From AHRQ ACTION: Colorectal Cancer Screening Steps Reported by
Primary Care Practices," APHA, November 2010, poster session.
We will draft and submit at least one peer-reviewed
manuscript and one trade journal manuscript to the appropriate publications. The
peer-reviewed manuscript will describe the intervention, research methods, and
study results. The trade journal manuscript will focus on the process of implementing
the intervention and will be geared more toward clinical entities that may be
interested in implementing our intervention. In addition to these two
publications, Steering Group members will be involved with publishing other
elements of the results, such as how findings from our baseline practice survey
align with the patient-centered medical home concept.
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