Table 4 Adoption, implementation, and outcomes of the selected EBIs

EBIs selected

Small Media; Client Reminder (Source: CommunityGuide)

Flu-FIT/FOBT (Source: RTIPs)

EBI descriptions

Mailing a postcard to patients aged 50-75 who are due for CRCS to inform patients regarding CRCS followed by telephone reminders

Having injection nurses to recommend CRCS for patients who visit the clinic for receiving the flu vaccine (Sept – Feb)

Adaptation

Target patients covered by a large commercial plan (about 50% of clinic patients)

Use the quarterly ‘gap’ report shared by the commercial plan to identify target population and track performances

Sending 20 postcards at a time (rather than a mass-mailing) on a biweekly basis, and followed by phone reminder

-Target patients who physically visit clinic for a flu-shot and who are due for CRC screening

-Recommend all options for CRCS test

-Instead of mailing postcards/letters, use social media for advertising (facebook)

-(COVID-19 specific) Train medical assistants for injection due to nurse shortage

-(COVID-19 specific) Use curbside injection at the clinic parking lot

Activities planned and implementation status

1. Prepare postcards and pamphlets with tailored messages and design for target group (implemented)

2. Mail out 1st batch of postcards (n=20) and complete follow up calls (implemented with 6 month delay)

3. Create a tracking log, update the mailing/phone call status, and share with the team (partially implemented)

4. Assess pilot runs and plan for next cycle (implemented)

5. Mail out 2nd batch of postcards and complete follow-up calls (not implemented)

6. Mail out 3nd batch of postcards and complete follow-up calls (not implemented)

Note: 3.5/6 = 58% implemented (implementation delayed about 6 month due to loss of a lead physician and staff turnover. A support staff not in the training took over the implementation on July 2021).

1. Prepare resources (flu vaccine shipment, CRCS handouts, signs for curbside visit, FIT/FOBT kit) (implemented)

2. Meet and communicate injection nurses, referral coordinator, and frontline staff and confirm the workflow (implemented)

3. Run pilot test (Oct, 2020 – Feb, 2021) (implemented)

4. Assess pilot runs and plan for next cycle (implemented)

5. Run second implementation cycle with revised plan (Oct, 2021 – Feb 2022) (implemented)

6. Assess 2nd cycle and develop plans for next year (implemented)

Note: 6/6 = 100% implemented (implementation went smoothly according to initial plans with a few adaptations).

CRCS uptake outcomes

Between July 2021 and January 2022, 34 postcards were sent and 24 follow up calls completed. Placed 1 colonoscopy referral and 1 FIT-DNA ordered; Between FY20 and FY21, there was an increase of CRCS from 71% to 77% (gap report).

Year 1 (8/1/20 – 2/15/21): 977 came for flu shot; of these, 163 were due for CRCS. Of 163, 29 (17.8%) completed CRCS within the 6 months. Year 2 (8/1/21 – 2/15/22): 1175 came for flu shot; Of these, 214 were due for CRCS. Of 214, 38 (17.7%) completed CRCS within the 6 months.