Table 1 SMARTER CRC intervention functions, forms, and scale-up approach

Planning

Build motivation for CRC screening outreach and organizational investment and buy-in

1. Provide scientific rationale and making the case for this model, including cost-effectiveness evidence

2. Identify an organizational champion

3. Conduct an organizational self-assessment

ECHO series presentations: Building a business case, choosing an implementation model

Facilitation guide

Workflow assessment

Support consistent implementation by developing a workflow collaboratively to better inform staffing and choose the best approach for all organizations

1. Teach the basics of mailed FIT programs, patient navigation to colonoscopy

2. Hold meeting with implementing organizations to develop a workflow for mailed FIT and patient navigation

3. Create a workflow document and validate it with participants

ECHO series presentation: Build engagement and implement a Collaborative Cancer Screening Program

Workshop

Facilitation guide & sample workflows

Learning collaborative meetings

Create a learning collaborative environment, share additional training

Troubleshoot implementation as roll-out happens across multiple organizations

1. Hold monthly meetings to bring all outreach partners together

2. Share implementation data monthly regarding mailed FIT and navigation outreach

Facilitation guide & toolkit

FIT selection

Ensure organizations are selecting high-quality FITs to ensure ability to distribute FITs by mail, high patient response, and accurate abnormal test rates

1. Share expert information about FIT quality and types and assist with FIT selection

2. Coach participants on how to choose distribution option

a. Variable FIT

b. Centralized FIT

ECHO series presentation: Build engagement and implement a Collaborative Cancer Screening Program

Facilitation guide

Technical assistance for organizations regarding FIT choices

Eligible patient identification

Support and provide tools to identify patients to ensure that patients who are truly eligible receive FITs

Ensure clinics were up to date on mailed FIT eligibility guidelines for their patients

1. Present different models of generating eligible patient list either generated by health plans based on claims and validate the list using EHR data or generated by other organizations

2. Present and share “scrub” training that teaches CRC screening eligibility guidelines

ECHO series presentation: Generating the eligible patient list

Facilitation guide with scrub training templates

Technical assistance

Report templates

Patient prompts and reminders

Use primers, such as texts, phone calls, and printed mailings before mailed outreach to increase return rates

Use reminders to initial non-completers to increase the return rate per best practice

1. Send introduction letters, phone calls, or text messages before the FIT mailing

2. Send reminders—mailed, phone, text, email, text-video after the FIT mailing to nonresponders or whole population

ECHO session: Patient outreach and communication

Letter and text templates and scripts

Videos

Patient engagement webinar

Mailing FITs

Remove the burden of mailing from clinical practices by using vendors, health plan support

Address challenges with generic FIT instructions and literacy

1. Mail FITs to everyone deemed eligible; include postage or a return USPS business reply code on the mailers to increase return

2. Use vendors for the mailing (optional)

3. Use a brief, easy to read invitation letter, plus simple FIT completion instructions customized per organization

4. Completed FITs are mailed back to either a lab or a clinic (or dropped off by patient)

ECHO session: Designing a mailed FIT program

Technical assistance

Outside resources

Patient navigation

Help increase staff support to transition patients from primary care to specialty care (i.e., for colonoscopy) where there is a severe gap in patient support

1. Teach the importance of patient navigation and why it is needed

2. Identify and train patient navigators at the clinic level or at the health plan level in navigation to follow-up colonoscopy

ECHO session: Navigating patients to follow-up colonoscopy

Facilitation guide

Patient navigation training class