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Tracking and Improving Screening for Colorectal Cancer Intervention: A

Table 1. Intervention Steps and Implementation Tools

Intervention Protocol StepsIntervention Implementation Tools
Step 1: Recruit Practices
1.a. Recruit primary care practices to participate in intervention1.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 kitsN/A
Step 2: Conduct Academic Detailing
2.a. Administer baseline CRC screening survey, focus groups, and interviews in participating practicesa2.a-1. CRC screening preintervention survey for participating practicesa
2.a-2. CRC screening preintervention focus group guide for participating practicesa
2.a-3. CRC screening preintervention key informant interview guide for participating practicesa
2.b. Conduct preintervention academic detailing2.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 needed2.c-1. Sample academic detailing booster letter
Step 3: Identify Eligible Patients
3.a. Execute initial electronic record review3.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-outsaN/A
Step 4: Mail Screening Materials to Eligible Patients
4.a. Mail introduction and SEA forma4.a-1. Introduction letter to patients with instructions for completing the SEA forma
4.a-2. SEA forma

4.b. Mail screening invitation, educational materials, and stool test materialsb:

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 kitsc4.c-1. Cover letter to patients
4.d. Mail reminder letter to unscreened patients4.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 patientsaN/A
Step 5: Track Screening
5.a. Conduct "evidence of screening" electronic record review5.a-1. Master patient database elements
5.b. Conduct one or more subsequent "evidence of screening" electronic record reviewsaN/A
5.c. Conduct "evidence of complete diagnostic evaluation" (CDE) followup electronic record reviewN/A
5.d. Conduct chart reviews for patients lacking definitive electronic record informationa5.d-1. Chart audit review form
Step 6: Provide Feedback to Practices/Clinicians
6.a. Provide feedback to practices and clinicians about screening results6.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 CDE6.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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Page last reviewed December 2010
Internet Citation: Tracking and Improving Screening for Colorectal Cancer Intervention: A: Table 1. Intervention Steps and Implementation Tools. December 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/final-reports/crctoolkit/crctkittab1.html