Difference-Making Factors for Successful Implementation of a Multicomponent Colorectal Cancer Screening Program in Rural Clinics (SMARTER CRC)

Amanda Petrik^1*Brittany Badicke²Melinda Davis^2,3,4Edward J Miech⁵Jennifer Coury²Erin S Kenzie^2,3Jennifer L Schneider¹Robert Durr²Anna C Edelmann¹Anders Herreid-O'Neill²Emily Myers²Gloria Coronado⁶

• ¹Kaiser Permanente Center for Health Research, Portland, Oregon, United States
• ²Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, Oregon, United States
• ³School of Public Health, Oregon Health and Science University, Portland, Oregon, United States
• ⁴Department of Family Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon, United States
• ⁵School of Medicine, Indiana University Bloomington, Indianapolis, Indiana, United States
• ⁶University of Arizona, Tucson, Arizona, United States

Rural disparities in colorectal cancer (CRC) screening persist despite the availability of effective, evidence-based interventions. We sought to understand what characteristics lead to success when implementing a multicomponent CRC screening intervention in rural primary care clinics in a pragmatic clinical trial, SMARTER CRC.We applied coincidence analysis to identify solution pathways that led to implementation success in year 1 SMARTER CRC intervention clinics. We assessed clinic success as high/low rates of fecal immunochemical testing (FIT) and overall CRC screening. Factors included in the analysis were collected through qualitative interviews, practice facilitation notes, and project datasets.A total of 14 intervention clinics were included in our analysis. Post-intervention overall clinic-level screening rates for CRC ranged from 12.6-22.0%, while FIT completion rates among patients mailed a kit ranged from 12.3% to 41.7%. Values for three factors perfectly distinguished between clinics with higher and lower CRC screening rates: clinics sending a pre-FIT introduction letter on their own, clinics having prior (or current) experience with CRC screening campaigns, and clinics changing the type of FIT test they used. For FIT screening rates, two factors perfectly distinguished between clinics with higher and lower rates: clinics sending introduction letters on their own and clinic staff attending 4 or more health plan/clinic meetings.Higher FIT and CRC screening rates were associated with clinics that were able to mail an introductory letter, had experience in CRC screening campaigns, did not change their FIT tests, and attended the health plan/clinic meetings. These clinic-level factors appear to be difference-makers to successful implementation of a CRC screening program in rural settings.