Table 1 Key SCORE implementation strategies, definitions, and outcomes used during the Exploration phase

1. Conduct local needs assessment

Collect and analyze data related to the need for the innovation

Research team

Conduct a literature review and a secondary data analysis of epidemiological data specific to NC, and a systematic review and meta-analysis of CRC screening interventions

State of NC

Partner CHC regions

Prior to funding and during the early stages of the Exploration phase

• Identified colorectal cancer hotspot

• Identified inequities (e.g., insurance status, rurality, proximity to colonscopy services)

• Identified strong evidence supporting mailed FIT outreach

• Identified evidence supporting navigation in promoting colonoscopy completion

2. Build a coalition

Recruit and cultivate relationships with partners in the implementation effort

Research team

Engage cancer center leadership, the NC CRC Roundtable, others across state working to increase CRC screening, including endoscopy centers, and CHC stakeholders

Cancer center leadership; NC CRC Roundtable;

NC Society for Gastroenterology; gastroenterologists across the state; CHCs ready and willing to partner around a CRC screening intervention

During late stages of Exploration, after ACCSIS funding received

• Cancer center leadership committed resources

• Established partnerships with two CHCs with diverse populations

• Established partnerships with colonoscopy providers in the western region and relationships with providers in the eastern region

• Established stakeholder relationships with NC CRC Roundtable and members of the NC Society for Gastroenterology

3. Conduct local consensus discussions

Include local providers and other stakeholders in discussions that address whether the chosen problem is important and whether the clinical innovation to address it is appropriate

Research team and community health center administrators including executive directors, medical directors, and practice managers

Develop consensus about criteria to guide intervention design and implementation based on needs assessment and stakeholder input

Research team and CHC administrators and leadership

During Exploration, after partner CHCs identified

• Developed guiding criteria for the intervention: (1) act across the screening care continuum and at multiple levels; (2) account for CHC staff time constraints; (3) focus on non-visit-based (outreach) approaches to screening as a complement to visit-based screening; (4) facilitate follow-up colonoscopy for an abnormal FIT; (5) be replicable across multiple CHCs with varying context