Table 5.1. Intervention Steps and Implementation Tools

Health Care Systems for Tracking Colorectal Cancer Screening Tests

Intervention Protocol Steps	Intervention Implementation Tools
Step 1: Recruit Practices
1.a. Recruit primary care practices to participate in intervention	1.a-1. Information packet for participating practices describing the intervention, their roles and responsibilities, instructions for receiving stool test kits from patients and sending them to the clinical lab for processing (note: copies of the patient mailings should also be sent to the practices—see Step 4 materials)
1.b. Recruit a stool test kit supplier and a clinical lab to process/develop kits	N/A
Step 2: Conduct Academic Detailing
2.a. Administer baseline CRC screening survey, focus groups, and interviews in participating practices^a	2.a-1. CRC screening preintervention survey for participating practices^a 2.a-2. CRC screening preintervention focus group guide for participating practices^a 2.a-3. CRC screening preintervention key informant interview guide for participating practices^a
2.b. Conduct preintervention academic detailing	2.b-1. Academic detailing PowerPoint slides 2.b-2. Web link to most recent screening guidelines on CRC from the American Cancer Society (ACS), U.S. Multi-Society Task Force on Colorectal Cancer, and American College of Radiology (ACR), and the U.S. Preventive Services Task Force (USPSTF) 2.b-3. Screening tracking sheet for participating practices
2.c. Conduct academic detailing boosters as needed	2.c-1. Sample academic detailing booster letter
Step 3: Identify Eligible Patients
3.a. Execute initial electronic record review	3.a-1. Sample programming criteria for initial electronic record review
3.b. Review returned screening eligibility assessment (SEA) forms to identify additional ineligibles and opt-outs^a	N/A
Step 4: Mail Screening Materials to Eligible Patients
4.a. Mail introduction and SEA form^a	4.a-1. Introduction letter to patients with instructions for completing the SEA form^a 4.a-2. SEA form^a
4.b. Mail screening invitation, educational materials, and stool test materials^b: Version 1: Stool test kit enclosed Version 2: Request card for stool test kit enclosed	4.b-1. Letter to patients (Version 1) 4.b-2. Letter to patients (Version 2) 4.b-3. Web link to CDC patient information on CRC (English and Spanish version) 4.b-4. Reply card for requesting stool test kit (Version 2)
4.c. Respond to requests for stool test kits^c	4.c-1. Cover letter to patients
4.d. Mail reminder letter to unscreened patients	4.d-1. Reminder letter to patients (who received a stool test kit)^b 4.d-2. Reminder letter to patients (who received a stool test kit request card)^b
4.e. Mail subsequent reminder letter to unscreened patients^a	N/A
Step 5: Track Screening
5.a. Conduct "evidence of screening" electronic record review	5.a-1. Master patient database elements
5.b. Conduct one or more subsequent "evidence of screening" electronic record reviews^a	N/A
5.c. Conduct "evidence of complete diagnostic evaluation" (CDE) followup electronic record review	N/A
5.d. Conduct chart reviews for patients lacking definitive electronic record information^a	5.d-1. Chart audit review form
Step 6: Provide Feedback to Practices/Clinicians
6.a. Provide feedback to practices and clinicians about screening results	6.a-1. Feedback form for stool test positive 6.a-2. Feedback form for stool test negative
6.b. Provide feedback to practices and clinicians about CDE	6.b-1. Feedback form for CDE

^a. This step and/or tools is/are optional.
^b.These two versions are alternatives; either can be used for all patients or some patients can receive one version and the remainder can receive the other version depending on the availability of stool test kits.
^c. This step is only implemented if stool test kit request card is used (step 4.b version 2).

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Current as of December 2010

Internet Citation: Table 5.1. Intervention Steps and Implementation Tools: Health Care Systems for Tracking Colorectal Cancer Screening Tests. December 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/final-reports/crcscreeningrpt/crcscreentab5-1.html