This presentation was supported by Cooperative Agreement Numbers U48-DP001909, U48-DP001946, U48-DP001924, U48-DP001934, U48-DP001938(03), U48-DP001944, U48-DP001936, U48-DP001949-02, U48–DP001911, & U48-DP001903 from the Centers for Disease Control and Prevention. The findings and conclusions in this presentation are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Shin-Ping Tu, MD, MPH; Maria Fernandez, PhD, Vicki Young, PhDon behalf of the CPCRN FQHC Workgroup Investigators

Emory University University of California Los AngelesUniversity of Colorado University of South Carolina

University of Texas Houston University of WashingtonWashington University at St. Louis

Denver, CO3-5PM Oct 3rd, 2013

The CPCRN FQHC WorkgroupBreakout Discussion 

Agenda

• Research Questions & Survey Analysis Issues (45 min)

• Feedback & Reports for FQHC Partners (35 min)

• Next Steps (40 min)

Research Questions

Primary Research Questions: • What factors influence the implementation of

evidence-based approaches for promoting CRC screening in FQHCs?

• What factors influence the implementation of PCMH best practices for CRC screening in FQHCs?

• Are there other research questions of interests ?

Overall Analytic Approach

• What are the best analytic approaches to answer these research questions?

• Shall we explore causal pathways between contructs and their direct and indirect influence on implementation?

• What process should we use to make decisions about which constructs to put into the model?

Analysis Issues—Implementation Outcomes

• How shall we determining implementation outcomes of EBAs for each clinic?– Implementation score based on responses on

both surveys ?– Consider differences in perceived

implementation level by roles of respondents (or demographic differences)?

Analysis Issues—Implementation Outcomes (Cont.)• How to deal with the disagreement in terms of the level of

implementation of EBAs in each clinic between the responses to the Main Survey (filled out by clinical staff) and the Clinic Characteristics Survey (filled out by clinic contacts/leaders) ?

• In general, there is 80% disagreement between individual responses to the main survey and the clinic characteristics survey regarding level of implementation for each EBA

Example: Level of Implementation of Provider Reminders

Clinic 13176 Main Survey (N=10)

Clinic Characteristics Survey (N=1)

Level 1 (Fully implemented) 1

Level 2 (Inconsistently)

Level 3 (Early stage of Implementing)

1

Planning 3

No plan 1

Missing : 5

How to determine the implementation outcome for clinic 13176?

Analysis Issues—Scaling & Modeling

• How to aggregate responses within clinics for the independent variables?

• How to deal with the scaling of EBA-specific constructs?

• How to deal with the variance of the number of clinics responding to general vs. EBA-specific constructs in building predictor models?

Analysis Issues—Nesting

• How shall we handle the differences in nesting of individuals within clinics and in some cases clinics within FQHC systems?

Other Analytic Issues

• Collinearity among some of the variables• Confounding and Interaction

Feedback & Reports for FQHC Partners• What format shall we use to provide feedback for

FQHC partners?

• What are the potential deliverables for FQHC partners (NACHC, state PCAs, individual FQHCs)?

• What will be the process for producing such deliverables for partners at different level?

• How shall we continue to engage FQHC partners?

Next Steps

• What additional research can be done to improve evidence-based cancer control practices in FQHCs?

• What kind of interventions can help FQHCs in improving their cancer control practices?

• What grant opportunities can we pursue as a group?