Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA.
Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA.
J Gen Intern Med. 2020 Nov;35(Suppl 2):815-822. doi: 10.1007/s11606-020-06186-2. Epub 2020 Oct 26.
Evidence-based programs such as mailed fecal immunochemical test (FIT) outreach can only affect health outcomes if they can be successfully implemented. However, attempts to implement programs are often limited by organizational-level factors.
As part of the Strategies and Opportunities to Stop Colon Cancer in Priority Populations (STOP CRC) pragmatic trial, we evaluated how organizational factors impacted the extent to which health centers implemented a mailed FIT outreach program.
Eight health centers participated in STOP CRC. The intervention consisted of customized electronic health record tools and clinical staff training to facilitate mailing of an introduction letter, FIT kit, and reminder letter. Health centers had flexibility in how they delivered the program.
We categorized the health centers' level of implementation based on the proportion of eligible patients who were mailed a FIT kit, and applied configurational comparative methods to identify combinations of relevant organizational-level and program-level factors that distinguished among high, medium, and low implementing health centers. The factors were categorized according to the Consolidated Framework for Implementation Research model.
FIT tests were mailed to 21.0-81.7% of eligible participants at each health center. We identified a two-factor solution that distinguished among levels of implementation with 100% consistency and 100% coverage. The factors were having a centralized implementation team (inner setting) and mailing the introduction letter in advance of the FIT kit (intervention characteristics). Health centers with high levels of implementation had the joint presence of both factors. In health centers with medium levels of implementation, only one factor was present. Health centers with low levels of implementation had neither factor present.
Full implementation of the STOP CRC intervention relied on a centralized implementation team with dedicated staffing time, and the advance mailing of an introduction letter.
ClinicalTrials.gov Identifier: NCT01742065 Registered 05 December 2012-Prospectively registered.
基于证据的项目，如邮寄粪便免疫化学试验（FIT）外展，如果能够成功实施，才能对健康结果产生影响。然而，实施这些项目的尝试往往受到组织层面因素的限制。
作为策略和机会以停止优先人群结直肠癌（STOP CRC）实用试验的一部分，我们评估了组织因素如何影响卫生中心实施邮寄 FIT 外展计划的程度。
八家卫生中心参与了 STOP CRC。干预措施包括定制的电子健康记录工具和临床工作人员培训，以促进邮寄介绍信、FIT 试剂盒和提醒信。卫生中心在提供该计划方面具有灵活性。
我们根据邮寄 FIT 试剂盒的合格患者比例对卫生中心的实施程度进行分类，并应用配置比较方法来识别区分高、中、低实施卫生中心的相关组织层面和计划层面因素的组合。这些因素根据实施研究综合框架模型进行分类。
每个卫生中心的合格参与者中，有 21.0-81.7%的人收到了 FIT 测试。我们确定了一个能够区分实施水平的两因素解决方案，一致性为 100%，覆盖率为 100%。这两个因素分别是拥有集中的实施团队（内部环境）和在 FIT 试剂盒之前提前邮寄介绍信（干预特征）。实施水平较高的卫生中心同时存在这两个因素。在实施水平中等的卫生中心中，仅存在一个因素。实施水平较低的卫生中心均不存在这两个因素。
STOP CRC 干预措施的全面实施依赖于一个拥有专门人员配备时间的集中实施团队，以及提前邮寄介绍信。
ClinicalTrials.gov 标识符：NCT01742065 于 2012 年 12 月 5 日注册-前瞻性注册。
