Att D1_CRCCP Grantees Sruvey (Screenshots/Layout Preview)

Form Approved
OMB No. 0920-XXXX
Expiration Date: XX/XX/20XX

CDC Colorectal Cancer Control Program (CRCCP)
Grantee Survey of Program Implementation
Public reporting burden of this collection of information is estimated to average 75
minutes per response including the time for reviewing the instructions and completing and
reviewing the collection of information. An agency may not conduct or sponsor, and a
person is not required to respond to a collection of information unless it displays a
currently valid OMB control number. Send comments regarding this burden estimate or any
other aspect of this collection of information, including suggestions for reducing this
burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road, NE, MS D-74,
Atlanta, GA 30333. ATTN: PRA(0920-XXXX)

SURVEY PURPOSE
Thank you for taking the time to complete the 2014 CRCCP Grantee Survey of Program
Implementation! This survey is very similar to the one you completed last fall; it will
take time, thought, and in some cases investigation on your part to answer the questions
thoroughly. The information you provide will help us understand how grantees are
implementing the CRCCP, including the evidence-based interventions recommended by
the Guide to Community Preventive Services (Community Guide). Results of the survey
will be incorporated into a year five CRCCP grantee report for you and other
stakeholders.
The purpose of this survey is to:
1. Understand how grantees are implementing CDC’s Colorectal Cancer Control
Program (CRCCP)
2. Assess how implementation changes each year
3. Collect information related to technical assistance and training needs
INSTRUCTIONS AND SURVEY INFORMATION
Updated: 9/25/14

Who should complete the survey?
The person responsible for day-to-day management of the program should complete this
survey. He or she is encouraged to consult with others as needed to answer the questions
as completely as possible.
For what time period am I reporting?
Please answer all questions for the program year 5 (PY5), time period: July 1, 2013 –
June 30, 2014.
How is this survey different from last year’s survey?
This year’s survey is similar to the annual Grantee surveys you’ve been completing since
2011. The majority of the content is the same. The biggest changes to this survey are:

Re-inserted questions: Last year we deleted items throughout the survey that were
unlikely to change since 2012. We have reinserted these questions. We have also added
new questions to help us continue to understand how your CRCCP may be affected by
Affordable Care Act (ACA) legislation.
What topics are covered in the survey?
The survey covers the same content as in the previous survey years. It is organized into
the following sections:
 Background: Respondent Information
 Section 1:
[Re-inserted] CRCCP Management and Integration with Other
Programs
 Section 2:
CRC Screening Provision
 Section 3:
CRC Screening Promotion
 Section 4:
CRC Screening Data from FQHCs and IHS Clinics
 Section 5:
Training and Technical Assistance for Evidence-Based
Interventions
 Section 6:
Screening Policies and Strategies
 Section 7:
General Program Management (i.e., Monitoring and Evaluation,
Administrative Issues)
However, some questions may not pertain to your organization and in such cases you
may skip those sections.
Given the length of the survey, you may wish to complete the survey in several sittings.
the following groupings may be “natural” chunks:
 Background + Sections 1 and 2
 Sections 3 and 4
 Sections 5, 6, and 7
If you leave the survey or close your Internet browser, the next time you visit the survey
link, you will be directed to the same page from which you left.
Are you including contractors and partner organizations when you refer to “my
CRCCP”?
For purposes of simplicity, the survey will refer to all grantees’ programs as the CRCCP,
even though most grantees have given their programs a unique name. Questions will also
refer to your CRCCP as “your organization.” In all instances, “your organization” is
meant to include the organization that is the main cooperative agreement recipient, as
well as any of your contractors. We understand that you may also be working with
unfunded partner organizations to implement your CRCCP. The survey includes
questions that will ask about partners, whether funded or unfunded.

2014 CRCCP Annual Grantees Survey Page 2 of 76

Sections 2 and 3: My state’s CRCCP program is funded by both state and federal
funds. All of our contractors use state funds to fund their colorectal cancer
screening, but only some use federal funds. When speaking of screening (promotion
or provision), do you only want us to talk only about screenings funded through the
CRCCP?
For the screening provision/promotion sections of the survey, please include only the
contractors that are paid by CRCCP (federal) funds.
However, to help us get a more complete picture of your state’s screening efforts, at the
end of the appropriate provision or promotion section(s), you'll be asked to tell us
"anything else" about your CRC provision/promotion efforts; please use these boxes to
tell us about your state’s CRCCP overall screening services that are funded by both
state/fed funds together, e.g., funding source proportion, anything about your other
contractors, their combined and/or separate reach, etc. If only some contractors receive
federal CRCCP funds, please also provide information in the comments areas regarding
why those contractors were chosen by your CRCCP, and based on what selection criteria
they were chosen, (e.g., was having contractors deal with CDC data collection of CDEs
an issue?)
Can I receive a summary of my survey results for our files?
Yes! Instructions for receiving a copy of your responses will appear at the end of the
survey.
Who can I contact with questions about the survey?
Please contact Thuy Vu at [email protected] or206-669-0897
Who can I contact about technical difficulties with the web survey?
Please contact Thuy Vu at [email protected] or 206-669-0897
Can I download and print out a hard copy of the survey?
Yes! You may find it helpful to download the survey and skim through it first. This will
add some time up-front, but it will give you an idea not just of the questions being asked,
but of where you might need to consult with your colleagues to answer the questions as
accurately as possible.
If you identify questions where you’ll need to consult with your colleagues, copy and
paste the question(s) from the print document (PDF) into a new document or email, or
print the document and flag the item(s) or page(s) to show your colleague; unfortunately
you cannot email specific questions directly from the web survey.

2014 CRCCP Annual Grantees Survey Page 3 of 76

The printed version of the survey will look long, but keep in mind that it includes every
question, even the ones that you will not need to answer. (In the web survey, as you
answer each question, you will be shown only the next question that you need to answer.
As a result, question numbering in the online survey may not seem sequential, as some
questions will be skipped.)
To download and print the survey:
Click here to download a PDF of the survey. [Sentence is hyperlink]
Right click on the link above and choose “Save link as” to save the PDF to a specific
location on your computer.
Open the PDF by double clicking it and click the print button. (If you do not have Adobe
Reader, you will have to install Adobe Reader. Click here to get the free Adobe Reader
software.
What are examples of types of questions where I’ll need to consult with colleagues
or partners to answer them?
Examples of questions that may require consultation with your colleagues or partners are
included in the FAQ. You can download the FAQ here, or by clicking on the FAQ link at
any time at the top of the survey screen.
Can I save my survey progress and continue it at a later time?
Yes! If you leave the survey or close your Internet browser, the next time you visit the
survey link, you will be directed to the same page from which you left.
Can I go back and review or change my answers?
Yes. Use the "Previous" button at the bottom of each screen to go back and review or
update your response.
Please note that at the end of the survey you will be able to review a summary of all the
answers you provided.

2014 CRCCP Annual Grantees Survey Page 4 of 76

RESPONDENT INFORMATION
1. With which grantee state or tribal organization are you affiliated?
[Dropdown list all 29 programs]

2. What is your name? (for follow-up purposes only; names will not be used in reports)
3. What is your contact information? (for follow-up purposes only, if necessary)
3a. Phone number: _____-_____-________
3b. Email. When you complete and submit your survey, an email confirmation
will automatically be sent to the address you provide.
3c. Confirm email.
4. What is your position with the CRCCP? (Check all that apply.)
•
Program director (the primary contact for the CRCCP Cooperative
Agreement)
•
Program manager/coordinator (the day-to-day manager for the
CRCCP)
•
Other (specify)
5. How long have you been working with the CRCCP in your state/tribal organization?
•
•
•
•
•

Less than 6 months
6 -11 months
12-23 months
24-35 months
3 or more years

6. How long have you been working on cancer-related issues in your state/tribal
organization or in other states/tribal/non-governmental organizations?
•
•
•
•
•

Less than 1 year
1 to 3 years
4 to 5 years
6 to 9 years
10 or more years

7. Has there been a change in either your CRCCP’s Program Director (PD) or Program
Manager (PM) during the duration of its funding period (through July 2014)? Check all
that apply
 Yes, the PM changed
 Yes, the PD changed
2014 CRCCP Annual Grantees Survey Page 5 of 76



No, there has been no change in either the PD or PM during our
funding period

SECTION 1: CRCCP MANAGEMENT AND INTEGRATION
These first questions will give us a better idea of how your CRCCP was managed in PY5,
and whether CRCCP staff were integrated with other CDC-funded programs or chronic
disease programs. Specifically, we ask about the integration of your CRCCP program
director, CRCCP program manager/coordinator, and any other CRCCP staff, regardless
of the funding source used to support them.
A.

CRCCP Management & Integration With Other CDC-Funded Programs

1.

Did the CRCCP program director (i.e., the person who is the primary program
contact for the cooperative agreement), have work responsibilities for any of
the following CDC-funded programs in your state/tribal organization
(regardless of the funding source used to support him/her)? (Check all that
apply.)
•
•
•
•
•
•

2.

WISEWOMAN
Comprehensive Cancer Control Program (CCC)
Breast and Cervical Cancer Early Detection Program (BCCEDP)
Central Cancer Registry
Other (please specify)
None

Was the program manager/coordinator and program director in your CRCCP, the
same person, or are these two positions filled by different people?



The CRCCP program manager/coordinator and CRCCP program director are
the same person.  GO TO Q3
The CRCCP program manager/coordinator and CRCCP program director are
different people.  CONTINUE TO Q2a

2a. Did the CRCCP program manager/coordinator, (i.e., the person who is the day-today manager), have work responsibilities for any of the following CDC-funded
programs in your state/tribal organization (regardless of the funding source used to
support them? (Check all that apply.)
•
•
•
•
•
•

WISEWOMAN
CCC Program
BCCEDP
Central Cancer Registry
Other (please specify)
None

2014 CRCCP Annual Grantees Survey Page 6 of 76

3.

Were any CRCCP staff* integrated with, or have work responsibilities for, any of
the following CDC-funded programs in your state/tribal organization,
(regardless of the funding source used to support him/her)? *Note: For this
question, CRCCP staff should not include the CRCCP program director or
program manager/coordinator.
 WISEWOMAN
 CCC Program
 BCCEDP
 Central Cancer Registry
 Other CDC-Funded Program
IF YES  CONTINUE TO Q4
IF NO  GO TO Q6

4.

Not including either the CRCCP program director, or program
manager/coordinator, complete the following sentence to tell us:
1) How many CRCCP staff were also integrated with, or have work
responsibilities for, any of the CDC-funded programs (listed below) in your
state/tribal organization, and
2) Across how many other programs these CRCCP staff members were
integrated.
CDC-funded programs:

WISEWOMAN

CCC Program

BCCEDP

Central Cancer Registry

Other CDC-Funded Program
[DROPDOWN: 1-9 (list); 10 or more; Don’t know]
[DROPDOWN: 1-9 (list); 10 or more; Don’t know]

5.

CRCCP staff is/are integrated across
other CDC-funded Programs.

In the table below, tell us how often your CRCCP staff* performed, or had work
responsibilities related to, the activities listed for other CDC-funded programs. If
there is no "other" program or activity you must still enter "NA" or "none."

*Do not include your program director or program manager/coordinator
**Select "NA" from the drop-down list if your staff is not integrated with the program listed.
***Select "Never" from the drop-down list if your staff is integrated with the program listed, but
they never perform the activity specified.

WISEWOMAN

CCC
Program

BCCEDP

Central
Cancer
Registry

Other
Program
(please
specify)

2014 CRCCP Annual Grantees Survey Page 7 of 76

a. Public
education,
outreach, or
recruitment

-NA
-Never
-Sometimes
-Often
-Always

-NA
-Never
-Sometimes
-Often
-Always

-NA
-Never
-Sometimes
-Often
-Always

-NA
-Never
-Sometimes
-Often
-Always

-NA
-Never
-Sometimes
-Often
-Always

b. Quality
assurance,
quality
improvement,
clinical
support
c. Data
management

-NA
-Never
-Sometimes
-Often
-Always

-NA
-Never
-Sometimes
-Often
-Always

-NA
-Never
-Sometimes
-Often
-Always

-NA
-Never
-Sometimes
-Often
-Always

-NA
-Never
-Sometimes
-Often
-Always

-NA
-Never
-Sometimes
-Often
-Always

-NA
-Never
-Sometimes
-Often
-Always

-NA
-Never
-Sometimes
-Often
-Always

-NA
-Never
-Sometimes
-Often
-Always

-NA
-Never
-Sometimes
-Often
-Always

d. Patient
navigation

-NA
-Never
-Sometimes
-Often
-Always

-NA
-Never
-Sometimes
-Often
-Always

-NA
-Never
-Sometimes
-Often
-Always

-NA
-Never
-Sometimes
-Often
-Always

-NA
-Never
-Sometimes
-Often
-Always

e. Other activity,
(please
specify)

-NA
-Never
-Sometimes
-Often
-Always

-NA
-Never
-Sometimes
-Often
-Always

-NA
-Never
-Sometimes
-Often
-Always

-NA
-Never
-Sometimes
-Often
-Always

-NA
-Never
-Sometimes
-Often
-Always

6.
Did your organization coordinate any training or professional development with
any of the following CDC-funded programs? Check all that apply.
 WISEWOMAN
 CCC Program
 BCCEDP
 Central Cancer Registry
 Other CDC-Funded Program
7.

Overall, how easy or difficult has it been to integrate your CRCCP with other
CDC-funded programs, such as WISEWOMAN, CCC Program, BCCEDP, etc.?
1
Very easy

2
Somewhat
easy

3
Neutral

4
Somewhat
difficult

5
Very difficult

IF 2 through 5 (i.e., Somewhat Easy through Very Difficult) 
7.a.
Describe the difficulties or barriers your organization experienced in trying to
2014 CRCCP Annual Grantees Survey Page 8 of 76

integrate with other CDC-funded programs. [Open text]
IF 1 (i.e., Very Easy) 
7.b.
Describe what made your CRCCP very easy to integrate with other CDC-funded
programs. [Open text]
B.
Coordination with Other Chronic Disease Programs
1.
Did your organization coordinate the delivery of any of your CRCCP program
activities (e.g. public education) with other chronic disease programs (not including
cancer programs or WISEWOMAN)?
 Yes  Go to 1.a.
 No  Go to 2
1.a.
With which chronic disease program(s) did your organization coordinate, for the
delivery of any of your CRCCP program activities? Check all that apply.
 Diabetes
 Cardiovascular health
 Community health
 Immunization/Family health
 Infectious disease
 Other, please specify

2.
Did your organization coordinate any staff training or professional development
with other chronic disease programs?
 Yes  Go to 2.a.
 No  Go to 3.
2.a. With which chronic disease program(s) did your organization coordinate staff
training or professional development? Check all that apply.
 Diabetes
 Cardiovascular health
 Community health
 Immunization/Family health
 Infectious disease
 Other, please specify

3.
Did your organization coordinate any other internal activities or services (e.g.
data management, planning, communications) with other chronic disease programs?
 Yes  Go to 3.a.
 No  Skip to Section 2: Screening Provision

2014 CRCCP Annual Grantees Survey Page 9 of 76

3.a. With which chronic disease program(s) did your organization coordinate other
internal activities? Check all that apply.
 Diabetes
 Cardiovascular health
 Community health
 Immunization/Family health
 Infectious disease
 Other, please specify

2014 CRCCP Annual Grantees Survey Page 10 of 76

SECTION 2: CRC SCREENING PROVISION
The screening provision component of the CRCCP includes activities that your
organization implements to provide or support direct CRC screening of low income,
uninsured, and underinsured patients using CDC funds. These activities may include:








Providing screening and diagnostic services directly
Identifying and contracting with physicians or clinics to deliver screening
services
Providing or promoting professional development/provider education
Promoting quality assurance (QA)/quality improvement (QI) standards
among funded provider sites
Identifying and recruiting patients for CRCCP screening
Implementing or supporting the use of patient navigation/case management
services for screening provision
Facilitating access to treatment for cancers diagnosed through your CRCCP

This section of the survey includes questions about each of those activities for program
year 5 (PY5; July 1, 2013- June 30, 2014).
Questions about monitoring and evaluation, including collection of Colorectal Clinical
Data Elements (CCDE) are asked later in this survey.
A.
1.a.

Screening Test Type And Provider Sites/Clinics
What screening tests were used by your CRCCP in PY5? (Check all that apply.)
 Colonoscopy
 FOBT
 FIT
 Sigmoidoscopy

1. What was the primary screening test used in PY5? (Select one.)
“Primary” refers to the test that your organization supports/reimburses for the majority
of your CRCCP-participating providers/clinics.

Colonoscopy

FOBT  If FOBT, specify brand(s) if known; if unknown
enter, “Don’t know”

FIT
 If FIT, specify brand(s) if known; if unknown
enter, “Don’t know”

Sigmoidoscopy
2. Did the primary screening test changed during PY5?

Yes  Go to 2.a.

No  Go to 3
2014 CRCCP Annual Grantees Survey Page 11 of 76

2.a Please explain why your primary screening test changed and, if relevant,
indicate whether the change was patient-, provider-, or policy-driven (or other).
[open-text]

3. How many CRCCP sites or clinics participate in the screening provision
component? In the questions below, enter the number of participating sites or clinics
according to the type of provider setting, e.g. primary care provider sites or clinics,
endoscopy/GI sites, etc.
We understand that some CRCCPs may have a single contract with an organization
that includes numerous sites or clinics and that not all of an organization’s sites or
clinics may participate in the CRCCP. Please provide the total number of CRCCPparticipating sites or clinics that actually deliver CDC-funded screening services.
Type of Provider Setting

For each type of provider
setting, enter the number of
CRCCP-participating sites or
clinics that deliver CDC-funded
screening services

NA – This
clinic type
does not
participate
in our
CRCCP

a. Individual or groups of primary care
provider (PCP) sites or clinics, not
including FQHCs
b. Endoscopy/Gastrointestinal (GI) sites or
clinics
c. Federally Qualified Health Center
(FQHCs)
d. Other, please specify

4.

What is the geographic location of each CRCCP-participating clinic type that
delivers CDC-funded screening services? For every row item, check all that
apply. If you do not have an “other” then you must still check, “NA.”
Mark all that apply
Region- al

Statewide

Multicounty/
tribe

Single
county/
tribe

City/
local

Communit
y-specific
e.g. neighborhood

NA This
clinic
type
does not
participa
te in our
CRCCP

a. Individual PCPs, not
including FQHCs
2014 CRCCP Annual Grantees Survey Page 12 of 76

b. Endoscopy/GI
c. FQHCs
d. Other, please
specify

5.
Since you began your screening efforts, has your CRCCP (including contractors)
experienced any challenges in regards to capacity to delivery screening services for the
underinsured or uninsured (e.g., not enough endoscopists to provide
colonoscopies/sigmoidoscopies, not enough endoscopists in some parts of your
state/tribe)? Please describe.

6.
If your program uses FOBT and/or FIT tests for screening provision, do you
implement specific activities to encourage patients to return those kits?
 Yes  Go to 6.a.
 No Go to 7
 Depends On Individual Providers  Go to 7
 NA – We do not use FOBT/FIT  Go to 8
6.a.
What activities does your program consistently implement to encourage
patients to return FOBT/FIT kits?
[OPEN FIELD]
7.
If your program has used FOBT and/or FIT tests for screening provision for
more than one year, do you implement specific activities to encourage annual
rescreening?
 Yes  Go to 7.a.
 No  Go to 8
 NA. My organization has used FOBT/FIT for screening provision for less
than one year (GO TO Q.8)

7.a.
What activities does your program implement to encourage annual
FOBT/FIT rescreening?
[OPEN FIELD]
8. What population subgroups are prioritized for CRC screening provision by your
program? (Check all that apply.)






Black or African American
White
Asian
American Indian or Alaskan Native
Native Hawaiian or other Pacific Islander
Hispanic, Latino or Spanish origin
2014 CRCCP Annual Grantees Survey Page 13 of 76










Persons in specific geographic areas
Rarely or never screened populations
Rural populations
Urban populations
Immigrant/refugee populations
LGBTQ
Other__________(please specify)
N/A – We do not prioritize any population subgroups for screening

B.
Support Services and Patient Navigation for Screening Provision
The following questions relate only to patient navigators/case managers serving patients
screened with CDC funds, i.e., used as part of the screening provision component of
your CRCCP. Questions about patient navigators/case managers used for screening
promotion will be asked in a different section of the survey.
1.

Were patient navigators or case managers used for the screening provision
component of your CRCCP?
IF YES  Go to 2
IF NO  Go to Part C

2.

How many patient navigators/case managers were supported as part of the CRCCP
for screening provision?

We are interested in knowing more about the patient navigators/case managers that were
supported as part of the CRCCP screening provision component. Using the dropdown menus in the table below, please complete the following sentence:
[Insert number] patient navigators/case managers, or [insert number] FTEs (regardless
of the number of people) were supported at [insert number] CRCCP-participating
sites or clinics in PY5.
If your organization supported only per-patient navigation reimbursement or per-patient
case management reimbursement, write-in “Don’t Know” (case sensitive) in each
applicable field.
#[Write-in + Don’t know] Patient navigators/case managers
# [Write- In + Don’t know] FTEs (regardless of the number of people)
At [Write-In + Don’t know] sites/clinics
3.

Please specify any core navigation activities that were routinely offered as part of
your organization’s CRC screening provision component. Check all that apply.
2014 CRCCP Annual Grantees Survey Page 14 of 76













4.

Patient assessment of barriers to screening
Patient education (about anatomy, CRC, CRC screening, bowel prep)
Assistance with transportation, language translation, child/eldercare
Assistance with appointment setting
Assistance with identifying payment for screening
Reminder calls/emails for bowel prep and/or appointments
Reminder calls/emails for return of FOBT/FIT tests
Peer support/motivation for screening
Follow-up with client about next steps for CRC screening and ensure
understanding of results provided by medical team
Community outreach to promote CRCCP and colorectal screening. (E.g.
linkages with health fairs and clients in the community)
Clinic in-reach activities to promote CRCCP and colorectal screening.
(E.g. flagging charts for medical providers for those eligible for
Program/CRC screening)

Where were navigators/case managers who support patients screened by your
organization housed? (Check all that apply.)
 Within the health department (state department of public health, tribal
agency)
 Regional or local agency(ies) (e.g., health department, contractor)
 Screening provider site(s)
 Partnering community agency(ies)
 Other (specify)_______________

5.
Among the patient navigator/case managers supported by your organization for
CRC screening provision, what is the highest level of education they typically have?
(Check one.)

Less than high school

High school diploma or GED equivalent

Associate degree

Nursing degree

College degree

Graduate degree

Other, please specify

Don’t know
6.
Among the patient navigator/case managers supported by your organization for
CRC screening provision, what type of background or experience do they typically
have? (Check all that apply.)

Knowledge of the priority population/community

Nursing
2014 CRCCP Annual Grantees Survey Page 15 of 76









Social work
Health systems
Public health
Cancer survivor
Community lay health/ natural helper
Other, please specify
Don’t know

7.
What types of navigation activities were supported by your organization through
the use of patient navigator/case managers for CRC screening provision?
(Check all that apply.)

Patient recruitment for screening

Patient assessment of patient barriers to screening

Patient education about CRC screening and testing modalities,
including bowel prep for endoscopy

Making CRC screening reminder calls for bowel prep

Making CRC screening reminder calls for colonoscopy

Making CRC screening reminder calls to return FOBT/FIT kits

Assisting patients to access bowel prep materials

Scheduling CRC screening appointments

Arranging transportation to/from CRC screening appointments

Peer support for cultural or emotional concerns about CRC screening

Arranging dependent care so patients can go to CRC screening
appointments

Meeting patients at endoscopic appointment

Arranging or providing translation services for CRC screening
appointments

Making follow-up calls after colonoscopy

Assisting patients diagnosed with cancer get into cancer treatment

Tracking patients to be sure they complete their colonoscopy

Tracking patients to be sure they return their FOBT/FIT kits

Other, please specify

I do not know what activities are provided

8. Did your organization offer any screening provision support services that are not
otherwise provided through a patient navigation or case management system?

Yes
IF YES  8.a. Please describe.

No
IF NO  Continue
9. How were the patient navigators/case managers for CRC screening provision
supported? (Check all that apply.)
 Reimbursement to providers for FTE support
2014 CRCCP Annual Grantees Survey Page 16 of 76






Per- patient navigation/case management reimbursement
Grantee staff serving as patient navigators/case managers
In-kind navigators/case managers from a community
partner/program
Other (specify) ____________

10. During PY5, did any of your patient navigators/case managers collect and report
non-clinical screening data about navigation services delivered (e.g., number of
clients receiving navigation/case management, number of clients assessed for
barriers, number and types of patient navigation contacts per client, percentage of
clients navigated that completed screening).
 Yes
 No – SKIP TO PART C
11. During PY5, did your CRCCP program use some type of patient navigation data
system to collect non-clinical data about navigation services delivered?
 Yes
 No
12. During PY5, did your CRCCP program collect CCDE data for non-CRCCP
clients who received navigation/case management?
 Yes
 No
13. During PY5, did your CRCCP encounter challenges related to accessing CCDE data
for non-CRCCP clients who received navigation/case management?
 Yes
 No
C.

Patient Recruitment (outreach and clinic in-reach) for Screening Provision

1.

What is the geographic reach of each resource listed below, to recruit patients for
screening provision provided within CRCCP? For every row item, check all that
apply. If you do not have an “other” then you must still check, “NA.”
Note: “In-reach,” in the questions below, means direct/indirect targeting of an
established patient or client population.
Regional

Statewide

Check all that apply
MultiSingle
City/
county/
county/
local
tribe
tribe

Commun
ityspecific
e.g.,
neighborhood

NA We do
not use
this
resour
ce

a. In-reach recruitment
(e.g., recruiting patients

2014 CRCCP Annual Grantees Survey Page 17 of 76

b.
c.
d.
e.
f.
g.
h.

of an existing program
like the NBCCEDP or
patients of a clinic)
Community health
workers
Community-based
organizations
Faith-based
organizations
Public health nurses at
local level
IHS Tribal Health Clinic
or Board
Non-IHS Tribal Health
Clinic or Board
Other, please specify

2.
What clinic in-reach* activities are conducted to provide information and
education about the screening provision provided through CRCCP?
(Check all that apply.)
*In-reach is direct/indirect targeting of an established patient or client population.







Distribution of brochures about colorectal cancer screening and CRCCP
Tailored letters or communication from health care provider
Flyers and information about CRCCP posted in clinic/hospital/health care
center
Pre-reviewing records/charts to identify patients eligible for CRCCP
screening provision and tagging charts for providers
Other (describe) _________________________________
None. Our CRCCP program does not conduct clinic in-reach activities to
recruit patients for screening provided by the CRCCP

2014 CRCCP Annual Grantees Survey Page 18 of 76

D.

Professional Development, Quality Assurance and Quality Improvement

The following questions ask about professional development/provider education and
quality assurance (QA)/quality improvement (QI) activities that your organization
provided in program year 5 (PY5) as part of your CRCCP screening provision
component.
1.

Who was the primary target audience for your professional
development/provider education activities in PY5? (Check all that apply.)
Examples of activities may include providing continuing medical education
(CME) opportunities, distributing physician tool kits, screening guidelines, or
conducting webcasts, among other activities.
 Endoscopists/gastroenterologists (GIs)
 PCPs/internal medicine specialists/family practice providers/OB-GYN
doctors
 Nurses
 Nurse practitioners/physician assistants
 Medical assistants
 Staff at local health department clinics
 Other, please specify _______________
 NA – We did not provide any professional development/provider education
activities in PY5  Answer Q1.a then Skip to Q6. Intro
1a.
We are interested in learning about professional
development activities around CRC in your state/tribal area even if your
organization did not provide them. Please use this space to describe these
other professional development activities around CRC that you may know of
in your state/tribal area, if any.  Q1. NA respondents: Go to 6 Intro; Q.1 All
other respondents: Continue

For the next questions you will be asked to indicate the types of professional
development/provider education provided by your CRCCP as part of the screening
provision component in program year 5 (PY5). For each type of activity you specify,
you will then be asked some additional questions to tell us more about that activity.
2. Did your CRCCP provide continuing medical education opportunities (e.g., at
physician conferences, through webinars, presentations) as part of the screening
provision component in PY5?
 Yes  IF YES, GO TO Intro/2a. [Programming note: INTRO + 2a-2c should appear
on same screen, if not at least INTRO + 2a]
 No  GO TO Q3
[Intro] Please tell us more about the continuing medical education (CME) opportunities
your CRCCP offers as part of the screening provision component.
2014 CRCCP Annual Grantees Survey Page 19 of 76

2a. Generally, how frequently were your CMEs offered?
[WRITE-IN] time(s) per [DROPDOWN: WEEK, MONTH, YEAR, NA – IT WAS A ONE TIME
ACTIVITY]

2b. Please describe the CME content.
2c. Who provided the CME training? (Check all that apply.)
 Medical Advisory Board members
 Grantee staff
 Contractor
 State or tribal medical organization
 Other, please specify
3. Did your CRCCP distribute or provide physician education materials (not
including CRC screening guidelines) as part of the screening provision component in
PY5? Examples of physician education materials include brochures, education outreach
visits (not academic detailing), webcasts, and physician tool kits, among other materials.
 Yes  IF YES, GO TO 3a.
 No  GO TO Q4
3a. Did your CRCCP distribute brochures for professional development as part of the
screening provision component?
 Yes  IF YES, GO TO 3a.i
 No  GO TO 3b
3a.i.
Generally, how frequently were these brochures distributed (across all
clinic sites)?
[WRITE-IN] time(s) per [DROPDOWN: WEEK, MONTH, YEAR, NA – IT WAS A ONE TIME
ACTIVITY]

3a.ii

Please describe the brochure content.

3a.iii.

Who provided these materials? (Check all that apply.)
 Medical Advisory Board members
 Grantee staff
 Contractor
 State or tribal medical organization
 Other, please specify

3b. Did your CRCCP conduct education outreach visits or webcasts for professional
development as part of the screening provision component?
 Yes  IF YES, GO TO 3b.i
 No  GO TO 3c
2014 CRCCP Annual Grantees Survey Page 20 of 76

3b.i.
webcasts?

Generally, what was the frequency of educational outreach visits or
[WRITE-IN] time(s)
ACTIVITY]

per [DROPDOWN: WEEK, MONTH, YEAR, NA – IT WAS A ONE TIME

3b.ii

Please describe the content of the outreach visits or webcasts.

3b.iii.

Who conducted or provided the visits or webcasts? (Check all that apply.)
 Medical Advisory Board members
 Grantee staff
 Contractor
 State or tribal medical organization
 Other, please specify

3c. Did your CRCCP distribute physician tool kits or programs, such as the National
Colorectal Cancer Round Table Provider Kit, for professional development as part of the
screening provision component?
 Yes  IF YES, GO TO 3c.i
 No  GO TO 3d
3c.i.
Generally, how frequently were these toolkits or programs distributed
(across all clinic sites)?
[WRITE-IN] time(s) per [DROPDOWN: WEEK, MONTH, YEAR, NA – IT WAS A ONE TIME
ACTIVITY]

3c.ii

Please describe the tool kit or program content.

3c.iii.

Who provided the kit(s) or program(s)? (Check all that apply.)
 Medical Advisory Board members
 Grantee staff
 Contractor
 State or tribal medical organization
 Other, please specify

3d. Did your CRCCP distribute any other physician education materials for
professional development as part of the screening provision component?
 Yes  IF YES, GO TO 3d.i
 No  GO TO 4

2014 CRCCP Annual Grantees Survey Page 21 of 76

3d.i.
Generally, how frequently were these other physician education materials
distributed (across all clinic sites)?
[WRITE-IN] time(s) per [DROPDOWN: WEEK, MONTH, YEAR, NA – IT WAS A ONE TIME
ACTIVITY]

3d.ii
Please describe these other physician education materials that were
distributed as part of your screening provision component.
3d.iii.

Who provided these other materials? (Check all that apply.)
 Medical Advisory Board members
 Grantee staff
 Contractor
 State or tribal medical organization
 Other, please specify

4. Did your CRCCP distribute clinical guidelines for CRC screening as part of the
screening provision component in PY5?
 Yes  IF YES, GO TO 4a.
 No  GO TO Q5
4a. Generally, how frequently were these clinical guidelines for CRC screening
distributed (across all clinic sites)?
[WRITE-IN] time(s) per [DROPDOWN: WEEK, MONTH, YEAR, NA – IT WAS A ONE TIME
ACTIVITY]

4b. Please indicate which guideline(s) were distributed (Check all that apply.)
 US Preventive Services Task Force
 American Cancer Society
 Multi-Society Task Force- CRC
 American College of Radiology Guidelines
 American College of Gastroenterology
 National Comprehensive Cancer Network
 Other, please specify
4c. Please describe the guidelines that were distributed as part of your screening
provision component.
4d. Who distributed the guidelines? (Check all that apply.)
 Medical Advisory Board members
 Grantee staff
 Contractor
 State or tribal medical organization
 Other, please specify

2014 CRCCP Annual Grantees Survey Page 22 of 76

5. Did your CRCCP provide any other type of professional development/provider
education as part of the screening provision component in PY5?
 Yes  IF YES, GO TO 5a.
 No  GO TO 6 Intro
5a.
Generally, how frequently were these other types of professional
development materials or activities provided (across all clinic sites)?
[WRITE-IN] time(s) per [DROPDOWN: WEEK, MONTH, YEAR, NA – IT WAS A ONE TIME
ACTIVITY]

5b.

Please describe these other types of professional development materials
or activities that were provided as part of your screening provision component.

5c.
Who provided these other types of professional development materials or
activities? (Check all that apply.)
 Medical Advisory Board members
 Grantee staff
 Contractor
 State or tribal medical organization
 Other, please specify

-----------------------[Intro] For the next questions you will be asked to indicate the types of quality
assurance (QA)/quality improvement (QI) activities that your organization provided
as part of your CRCCP screening provision component during program year 5 (PY5).
For each type of activity you specify, you will then be asked some additional questions
to tell us more about that activity.
6.
Who was the primary target audience for your QA/QI activities in PY5? (Check
all that apply.)
QA/QI activities include academic detail (i.e., educational outreach for physicians),
collecting and monitoring screening data, and performance monitoring.
 Endoscopists/gastroenterologists (GIs)
 PCPs/internal medicine specialists/family practice providers/OB-GYN
doctors
 Nurses
 Nurse practitioners/physician assistants
 Medical assistants
 Staff at local health department clinics
 Other, please specify _______________
2014 CRCCP Annual Grantees Survey Page 23 of 76

 NA - We do not provide any QA/QI activities  Go to 10
7.
Did your CRCCP provide academic detailing as part of your screening provision
component in PY5?
Academic detailing is educational outreach for physicians. Academic detailing is
intended to support clinical decision making by providing accurate, up-to-date synthesis
of relevant clinical information to physicians in a balanced and engaging format.
 Yes  IF YES, GO TO Intro/7a.
 No  GO TO Q8
[Intro]
Please tell us more about the academic detailing opportunities that your
CRCCP offered as part of the screening provision component.
7a.

Generally, how frequently was academic detailing provided
(across all clinic sites)?
[WRITE-IN] time(s) per [DROPDOWN: WEEK, MONTH, YEAR, NA – IT WAS A ONE
TIME ACTIVITY]

7b.

Please describe the academic detail provided as part of your
screening provision component.

7c.

Where was the academic detailing provided?

7d.






Who provided the academic detailing? (Check all that apply.)
Medical Advisory Board members
Grantee staff
Contractor
State or tribal medical organization
Other, please specify

8.
Did your CRCCP collect and monitor clinical data OTHER than the required
CCDEs, for screening or patient navigation in PY5?
 Yes  IF YES, GO TO Intro/8a.
 No  GO TO Q9
[Intro]
Please tell us more about these other clinical data collecting and
monitoring activities that your CRCCP conducted as part of the screening provision
component.

2014 CRCCP Annual Grantees Survey Page 24 of 76

8a.

Generally, how frequently were these other data (i.e. non-CCDE)
on screening provision or patient navigation collected and
monitored (across all clinic sites)?
[WRITE-IN] time(s) per [DROPDOWN: WEEK, MONTH, YEAR, NA – IT WAS A ONE
TIME ACTIVITY]

8b.

Please describe these other data collection and monitoring
activities that you conducted for either screening or patient
navigation.

9.
Did your CRCCP produce provider-level performance monitoring reports (e.g.,
using CCDE data to produce screening quality indicator reports) and feed them back to
your providers as part of your screening provision component in PY5? Performance
monitoring involves using data to assess performance on specified indicators of
performance.
 Yes  IF YES, GO TO Intro/9a.
 No  GO TO 10.
[Intro]
Please tell us more about the performance monitoring activities that your
CRCCP conducted as part of the screening provision component.
9a.

Generally, how often were performance monitoring reports given
back to your providers (across all clinic sites)?
[WRITE-IN] time(s) per [DROPDOWN: WEEK, MONTH, YEAR, NA – IT WAS A ONE
TIME ACTIVITY]

9b.

Please describe these performance monitoring reports that you
produced and gave to your providers as part of your screening
provision component.

10. We are interested in learning more about QA/QI activities around CRC in your
state/tribal area, even if your organization was not involved in them. Please use this
space to describe the other QA/QI activities around CRC that you may know of in your
state/tribal area, if any.

E.
1.

Other Population-based CRC Screening Provision Activities and Support
Were there any other programs in your state/tribal area, in addition to CRCCP,
that offered or supported CRC screening provision for the underinsured or
uninsured during program year 5 (PY5), excluding Medicaid/Medicare or other
resources related to the Affordable Care Act?
 Yes  Go to Q.1.a
 No  Go to Q2

2014 CRCCP Annual Grantees Survey Page 25 of 76

1.a.
Please describe the other program(s) in your state/tribal area that offered
CRC screening provision for the underinsured or uninsured in PY5. Please
describe the program reach and activities.
2.
Did your organization receive financial resources other than those from CDC to
support CRC screening provision in PY5?
 Yes  Go to Q.2.a
 No  Go to Part H: Eligibility for CRC Screening Provision
2.a
Describe the sources and amount of funds (other than CDC) that your
organization used to support CRC screening provision from July 1, 2013 through June
30, 2014, and check the activities that were supported by those funds.
☐Check here, if you did not receive additional funds (non-‐CDC) to support CRC
screening provision during July 1, 2012-‐June 30, 2013.
Funding
Approximate Provision-related activities
source
Amount
supported by funds (Check
all that apply)
Provide checklist for each row:
2.a.i

Providing screening and
2.a.ii
diagnostic services directly

Identifying and contracting with
2.a.iii
physicians or clinics to deliver









H.

screening services
Providing or promoting
professional
development/provider
education
Promoting quality assurance
(QA)/quality improvement (QI)
standards among funded
provider sites
Identifying and recruiting
patients for CRCCP screening
Implementing or supporting the
use of patient navigation/case
management services for
screening provision
Facilitating access to treatment
for cancers diagnosed through
your CRCCP

Eligibility for CRC Screening Provision

[Intro] Please answer the following questions about eligibility for screening provision
through your CRCCP for the Program Year 5 (PY5; 7/01/12-6/30/13).
1.
What Federal Poverty Level was used to determine eligibility for CRC
screening?
 250%
 200%
2014 CRCCP Annual Grantees Survey Page 26 of 76



Other, please specify: ______%

2.
What percentage of clients screened by your CRCCP had some form of
insurance coverage? Write in % or Don’t know

3.
Did your CRCCP require clients to provide any type of verification that they
were uninsured or underinsured?
 Yes
 No
4.

Did your CRCCP restrict program eligibility to any of the following groups?
 US citizens only
 Legal residents of state or territory
 Members or defined affiliation with Tribe/tribal council
 Others, please specify _______________
 Program eligibility varies by provider site
 N/A –None

5.
Did any of your CRCCP program eligibility criteria change during the reporting
period, (PY5)?
 Yes  go to 5a.
 No  continue to 6

5.a. Which program eligibility criteria changed? (Check all that apply.)
 Federal Poverty level
 Insurance status
 Citizenship/residency/Tribal affiliation
 Other, please specify _______________

5b. Why did you change your eligibility criteria? (Check all that apply.)
 To reduce the number of adults eligible for CRC screening
 To increase the number of adults eligible for CRC screening
 Funding limitations or reductions
 Expected impact of health reform
 Change in state/territory/tribe regulation
 _______________

2014 CRCCP Annual Grantees Survey Page 27 of 76

7.

8.

During PY5, did your CRCCP program facilitate men/women’s enrollment in
insurance coverage for colorectal cancer screening services?
 Yes, our CRCCP facilitated enrollment in Medicaid
 Yes, our CRCCP facilitated enrollment in Medicare
 Yes, our CRCCP facilitated enrollment in IHS
 Yes, our CRCCP facilitated enrollment in State-based insurance
 Yes, our CRCCP facilitated enrollment in Insurance marketplace
 Yes, our CRCCP facilitated enrollment, but I do not know the specific
insurance sources
 No (skip to question 10)
During PY5, what activities did your CRCCP program conduct in order to
facilitate men/women’s enrollment in insurance coverage? (Check all that apply)
 Provided men/women information about sources of insurance coverage
and related contact information (e.g., refer to website for the Insurance
Marketplace, provide Medicaid enrollment office phone number)
 Conducted assessments of men/women to see if they met eligibility
criteria for insurance coverage through specific sources such as
Medicaid, Medicare, IHS, State-based Insurance, Insurance Marketplace
 Provided assistance to men/women to complete insurance enrollment
processes
 Tracked and followed-up with men/women to see if they successfully
enrolled in insurance coverage
 Other:

9. During PY5, did you count the number of men/women that your CRCCP program
referred for insurance coverage?
 Yes  GO TO 9a.
 No  GO TO 10.
9.a. If yes, how many women did your CRCCP program refer for insurance coverage in
PY5? _____
10. How useful have you found the following technical assistance resources
provided by CDC? ?
N/A – did not
use

Very useful

Somewhat
useful

Not useful

CDC Webinars (e.g., QSST,
PETO)
Printed guide: An Action
Guide for Working with
Health Systems
Printed guide: An Action
Guide for Engaging
Employers and Professional
Medical Organizations
2014 CRCCP Annual Grantees Survey Page 28 of 76

ACA reference guide and
fact sheets
ACA messaging tool
On-going technical
assistance provided by PCs

11.
Has your CRCCP program developed tools related to health reform that may be
useful to others?
 Yes  GO TO 11.a.
 No
11.a.

If yes, please describe: _______________

G.

Other Comments – CRC Screening Provision

1.
What else would you like us to know about your organization’s CRC Screening
Provision efforts, including CRCCP screening provision activities funded or supported
by sources other than CDC?

2014 CRCCP Annual Grantees Survey Page 29 of 76

SECTION 3 – CRC SCREENING PROMOTION
This section asks about your CRCCP’s CRC screening promotion activities to
increase population-based screening implemented during program year 5 (PY5).
The questions focus primarily on your CRCCP’s use of each of the five strategies
recommended by the Community Guide to increase CRC screening broadly in the
population (rather than strategies focused solely on persons screened through the
program); these five strategies include:
1) Small media
2) Patient or client reminders
3) Provider reminders
4) Reducing structural barriers
5) Provider assessment and feedback
We also ask you to describe partner involvement, if any, in your implementation of each
strategy.
[Intro] Q1.
Please describe one of your organization’s major screening promotion goals or
objectives for the report year (PY5: July 1, 2013 – June 30, 2014).
[Intro] Q2.
What was the priority population your organization was trying to reach through the
screening promotion goal or objective you described (aside from people meeting
program eligibility requirements)?
A.
Small Media for Screening Promotion
Small media include videos and printed materials such as letters, brochures, flyers, and
newsletters used to inform and motivate people to be screened for colorectal cancer.
Small media can provide information tailored to specific or general audiences.
The following questions ask about small media activities for CRC screening
promotion that have been implemented as a part of the CRCCP in program year 5
(PY5).
1.

Did your organization use small media to promote colorectal cancer screening in
PY5?
“Your organization” refers to you, your contractors, and other partners.

Yes, we currently use small media to promote CRC screening 
Go to Q.2.


No, we do not currently use small media to promote CRC screening,
but we used it in the past (i.e. during any current or previous CRCCP
2014 CRCCP Annual Grantees Survey Page 30 of 76

contract year).  Go to Q.1.b.


No, we have never used small media to promote CRC screening but we
are planning or intend to in the next 12 months.  Go to Q.1.a.



No, we have never used small media to promote CRC screening, and
we are not planning or intend to use small media in the next 12 months.
 Q.1.a.
1.a. What are the main reasons your organization has not used small
media to promote CRC screening, to date?
[1.a. Respondents only  Skip to Part B: Patient Reminders]
1.b. Please describe your CRCCP’s previous attempts at using small
media to promote CRC screening, including for how long you used
them, partner involvement (if any), what type of small media was used
(e.g. flyers, brochures, videos, etc.), and where the materials were
distributed (e.g. provider offices, FQHCs, DOH, etc.).
[Go to 1.c]
1.c. Why did your CRCCP stop using small media to promote CRC
screening?
[Skip to Part B: Patient Reminders]

2.
For how long has your organization been using small media to promote
colorectal cancer screening?

Less than 6 months

6-11 months

1-2 years

3-4 years

5 years or more
3.
Has your organization used any of the following resources to create small media
as part of your CRC screening promotion activities? (Check all that apply.)

MIYO (Make It Your Own)

CDC’s Screen for Life  IF YES, 3a. Please describe

Other, please specify

No, we have not used any of these resources to create small media to
promote CRC screening

2014 CRCCP Annual Grantees Survey Page 31 of 76

6.
Where did your organization use each of the small media types listed in the table
below to promote CRC screening? For every row item, check all that apply. If you do
not have an “other” then you must still check, “NA.”

Small Media Type

Choose all that apply
Individual
Physician’s
Office

Provider
Group
(e.g. XX

Health
Care
Systems

FQHCs

Medicare

Medicaid

Insurance
providers

Local
Dept
of
Health

Workplace

Community
eg. CBOs,
faith
groups,
library

a. Videos

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

NA –
We don’t
use this
to
promote
CRC
screening
☐

b. Flyers or
posters

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

c. Brochures,
booklets or
FAQs

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

d. Newsletters,
inserts or
bookmarks

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

e. Checklists or
questions to
ask
providers

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

f.

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

Other leave
behinds, e.g.
tip sheets or
business
cards
g. Electronic
media, e.g.
text, social
media tools
(Twitter,
Facebook,
etc),
websites
h. Other,
please
specify

☐

☐

☐

☐

☐

☐

☐

☐

7.
What geographic areas best describe the intended geographic reach of each small
media type used by your organization to promote CRC screening? For every row item,
check all that apply. If you do not have an “other” then you must still check, “NA.”
Choose all that apply
Regional

State/tribewide

Multi-County
or MultiTribe

Single
County or
Tribe

City/local

Communityspecific
(Neighborho

2014 CRCCP Annual Grantees Survey Page 32 of 76

NA – We
don’t use
this to

☐

Small Media Type

od)

a. Videos

☐

☐

☐

☐

☐

☐

promote
CRC
screening
☐

b. Flyers or posters

☐

☐

☐

☐

☐

☐

☐

c. Brochures,
booklets or
FAQs

☐

☐

☐

☐

☐

☐

☐

d. Newsletters,
inserts or
bookmarks

☐

☐

☐

☐

☐

☐

☐

e. Checklists or
questions to ask
providers

☐

☐

☐

☐

☐

☐

☐

f.

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

☐

Other leave
behinds, e.g. tip
sheets or
business cards
g. Electronic
media, e.g. text,
social media
tools (Twitter,
Facebook, etc),
websites
h. Other, please
specify

Small Media - Partners
8.
How many partner organizations (e.g., non-funded partners, contractors) did you
work with to implement small media activities or disseminate small media materials to
promote CRC screening in PY5?
•
[WRITE-IN #] partners  Go to Q10.
•

None, we did not partner with any organizations to implement
small media activities or disseminate small media materials to
promote CRC screening  Go to 8.a.

8.a. Describe why partners were not used as part of your implementation
of small media. [Then skip to Q. 17]

10.
Which of the following best describes the partner organization(s) you worked
with to promote CRC screening through small media in PY5? (Check all that apply.)
•
Academic institution
•
Advocacy group/ Community-based organization/Community or
health coalition
•
American Cancer Society
•
Another CRCCP grantee
•
Comprehensive Cancer Control Coalition

Chronic Disease programs within your agency
2014 CRCCP Annual Grantees Survey Page 33 of 76

•

•
•
•
•

•
•
•
•
•
•
•


Employers/worksites
Federally qualified health center (FQHC)
Indian Health Service (IHS) clinic or board, IHS Urban Indian
health clinic
Individual health care provider/single practice
Local health department(s)
Medicare Quality Improvement Organization (QIO) office
Non-IHS tribal clinic, board, or health care facility
Private and/or non-profit health care system
Private health insurer
Professional organization (e.g., primary care provider association
in your state, state medical office)
Quality assurance organization
State Medicaid Office
State Office of Rural Health
Tribal council
Other (please specify)

10a. For each geographic designation in the table below, please specify the number of
partner organizations who used small media in that area to promote CRC screening in
PY5.
Enter the appropriate numeric value or "don't know."
Enter "0" if no partners used this EBI in PY5 in the designated area.
Geographic Designation
Definition

# of partners
using small
media in this
area

10ai. Large Metro
Counties with a population of 1 million or more
10aii. Medium Metro
Counties with a population of 250,000-999,999
10aiii. Small Metro
Counties with a population of 50,000-249,999
10aiv.Micropolitan
Counties of less than 50,000 that contain all or
part of a city of at least 10,000 or more
residents
10av. Rural
Counties that do not contain any part of a city of
10,000 or more residents
10avi. Multiple counties or statewide
2014 CRCCP Annual Grantees Survey Page 34 of 76

10.b. Did your CRCCP distribute small media materials as an enhancement to, or as a
part of any of the following activities during PY5 (Check all that apply.)







Patient navigation (e.g., a navigator gives a patient an educational brochure in
addition to addressing other barriers)
Client reminders (e.g., a postcard sent to a client to remind them that they are due
for screening also includes a general educational message about screening)
One-on-one education (e.g., a health worker gives a brochure to a community
member during outreach)
Group education (e.g., a health educator distributes brochures as part of an
educational session)
Other, please specify: ______________________________
NA – We did not distribute small media as an enhancement to, or as a part of any
of the above activities during PY5

Ease or Difficulty of Small Media Implementation for CRC Screening Promotion
17.
Thinking about the small media intervention activities that your CRCCP
implemented in PY5, rate the level of ease or difficulty it took to implement them on
average.
1
Very easy to
implement
☐

2
Somewhat easy

3
Neutral

☐

☐

4
Somewhat
difficult
☐

5
Very difficult to
implement
☐

2014 CRCCP Annual Grantees Survey Page 35 of 76

B.

Patient or Client Reminders for Population-level CRC Screening Promotion

Patient or client reminders include letters, postcards, or phone calls to alert patients that
it is time for their cancer screening. Some reminders note only that the test is due, while
other reminders include facts about the screening or offer to help set up an appointment,
in addition to including a reminder that the test is due.
The following questions ask about patient or client reminder systems for CRC
screening promotion that have been implemented as a part of the CRCCP in
program year 5 (PY5).
1. Does your organization use patient or client reminders to promote colorectal cancer
screening?
“Your organization” refers to you, your contractors and other partners.


Yes, we currently use patient reminders or client reminders to promote
CRC screening  Go to Q.2.



No, we do not currently use patient or client reminders to promote CRC
screening, but we used to in the past (i.e. during any current or previous
CRCCP contract year).  Go to 1.b.



No, we have never used patient or client reminders but we are planning
or intend to use them in the next 12 months  Go to 1.a.



No, we have never used patient or client reminders, and we are not
planning or intend to use it in the next 12 months.  Go to 1.a.
1.a. What are the main reasons your organization has not used patient
reminders to promote CRC screening, to date?
[1.a. Respondents only  Skip to Part C: Provider Reminders]

1.b. Please describe your CRCCP’s previous attempts at using patient
or client reminders to promote CRC screening, including for how
long you used them, partner involvement (if any), what type(s) of
patient or client reminders were used, and where they were distributed
(e.g. provider offices, FQHCs, DOH, etc.).
[Go to 1.c.]

2014 CRCCP Annual Grantees Survey Page 36 of 76

1.c. Why did your CRCCP stop using patient or client reminders to
promote CRC screening?
[Skip to Part C: Provider Reminders]

2.
For how long has your organization been using patient or client reminders to
promote colorectal cancer screening?

Less than 6 months

6-11 months

1-2 years

3-4 years

5 years or more
3.
Has your organization used any of the following resources to create patient or
client reminders as part of your organization’s CRC screening promotion activities?
(Check all that apply.)

MIYO (Make It Your Own)

Other, please specify

No, we have not used any of these resources to create patient or client
reminders as part of our CRCCP screening promotion activities

6.
Do you use any of the following types of patient or client reminders as a part of
your CRCCP screening promotion efforts?
a. Mailed postcards, letters, or greeting cards?
 Yes  GO TO 6.a.i.
 No
IF YES  6.a.i.Which types of organizations have implemented reminder
systems using post cards, letters, or greeting cards based on your program
efforts? (Check all that apply.)

Individual physician’s office

IHS or tribal clinic

Provider group (several or many physicians)

FQHCs

Health care system

Health insurer

Medicare Quality Improvement Organization (QIO) office

State Medicaid Office
2014 CRCCP Annual Grantees Survey Page 37 of 76

•


My CRCCP (We implement these reminder systems, ourselves.)
Other, please specify

b. Telephone, texts, or email messages?
 Yes  GO TO 6.b.i.
 No
IF YES  6.b.i. Which types of organizations have implemented reminder
systems using telephone, text, or email messages based on your program
efforts? (Check all that apply.)

Individual physician’s office

IHS or tribal clinic

Provider group (several or many physicians)

FQHCs

Health care system

Health insurer

Medicare Quality Improvement Organization (QIO) office

State Medicaid Office
•
My CRCCP (We implement these reminder systems, ourselves)

Other, please specify

Patient or Client Reminders – Partners
7.
How many partner organizations (e.g. non-funded partners, contractors) did you
work with to implement patient or client reminder activities to promote CRC screening
in PY5?
•
[WRITE-IN #] partners  Go to Q9.
•

None. We did not partner with any organizations to implement or
disseminate patient reminders to promote CRC screening.  Go
to 7.a.

7.a. Describe why partners were not used as part of your patient reminder
efforts for CRC screening. [Then skip to Q.18]

9.
Which of the following best describes the partner organization(s) you worked
with to promote CRC screening using patient reminders in PY5? (Check all that apply.)
•
Academic institution
•
Advocacy group/ Community-based organization/Community or
health coalition
•
American Cancer Society
2014 CRCCP Annual Grantees Survey Page 38 of 76

•

•
•

•
•
•
•

•
•
•
•
•
•
•


Another CRCCP Grantee
Chronic Disease programs within your agency
Comprehensive Cancer Control Coalition
Employers/worksites
Federally qualified health center (FQHC)
Indian Health Service (IHS) clinic or board, IHS Urban Indian
health clinic
Individual health care provider/single practice
Local health department(s)
Medicare Quality Improvement Organization (QIO) office
Non-IHS tribal clinic, board, or health care facility
Private and/or non-profit health care system
Private health insurer
Professional organization (e.g., primary care provider association
in your state, state medical office)
Quality assurance organization
State Medicaid office
State office of rural health
Tribal council
Other (please specify)

9.a. For each geographic designation in the table below, please specify the number of
partners that used patient or client reminders in that area to promote CRC screening in
PY5.
Enter the appropriate numeric value or "don't know."
Enter "0" if no partners used this EBI in PY5 in the designated area.
Geographic Designation
Definition

# of partner sites
using patient
reminders in this
area

i. Large Metro
Counties with a population of 1 million or more
ii.Medium Metro
Counties with a population of 250,000-999,999
iii.Small Metro
Counties with a population of 50,000-249,999
iv. Micropolitan
Counties of less than 50,000 that contain all or
part of a city of at least 10,000 or more residents
v. Rural
Counties that do not contain any part of a city of
10,000 or more residents

2014 CRCCP Annual Grantees Survey Page 39 of 76

Geographic Designation
Definition

# of partner sites
using patient
reminders in this
area

vi. Multiple counties or statewide

Ease or Difficulty of Implementing Patient or Client Reminders for CRC Screening
Promotion
18.
Thinking about the patient or client reminder activities that your CRCCP
implemented in PY5, rate the level of ease or difficulty it took to implement them on
average.
1
Very easy to
implement
☐

C.

2
Somewhat easy

3
Neutral

☐

☐

4
Somewhat
difficult
☐

5
Very difficult to
implement
☐

Provider Reminders for CRC Screening Promotion

Provider reminders inform health care providers that it is time for a client’s cancer
screening test (called a “reminder”) or that the client is overdue for screening (called a
“recall”). The reminders can be provided in different ways, such as flagging client
charts, building provider reminders into electronic medical record systems or provider
office appointment systems, or by e-mail to the provider.
The following questions ask about provider reminder activities for CRC screening
promotion that have been implemented as a part of the CRCCP in program year 5
(PY5).
1.
Did your organization use provider reminders to promote colorectal cancer
screening in PY5?
“Your organization” refers to you, your contractors and/or partners.
 Yes, we currently use provider reminders to promote CRC screening  Go to
2.


No, we do not currently use provider reminders to promote CRC screening, but
we used to in the past (i.e. during any current or previous CRCCP contract
year).  Go to 1.b.



No, have never used provider reminders but we are planning or intend to use
2014 CRCCP Annual Grantees Survey Page 40 of 76

them in the next 12 months to promote CRC screening Go to 1.a.


No, we have never used provider reminders to promote CRC screening, and
we are not planning or intend to do use them in the next 12 months  Go to
1.a.
1.a. What are the main reasons your organization has not used provider
reminders to promote CRC screening, to date?
[1.a. Respondents only  Skip to Part D: Reducing Structural Barriers]

1.b. Please describe your CRCCP’s previous attempts at using
provider reminders to promote CRC screening, including for how
long you used them, partner involvement (if any), what type of provider
reminders were used, and where they were distributed (e.g. provider
offices, FQHCs, DOH, etc.).
[Go to 1.c]

1.c. Why did your CRCCP stop using provider reminders to promote
CRC screening?
[Skip to Part D: Reducing Structural Barriers]

2.
For how long has your organization been using provider reminders to promote
colorectal cancer screening?

Less than 6 months

6-11 months

1-2 years

3-4 years

5 years or more

5.
Did you use any of the following types of provider reminders as a part of your
CRCCP screening promotion efforts in PY5? (Check all that apply.)
a. Patient chart reminders
 Yes  GO TO 5.a.i.
2014 CRCCP Annual Grantees Survey Page 41 of 76



No

IF YES  5.a.i. Where are chart reminders being used? (Check all that apply.)
•
•
•
•
•
•
•

Individual physician’s office
IHS or tribal clinic
Provider group
FQHCs
Health care system
My CRCCP (We implement these reminder systems, ourselves.)
Other, please specify
5aii. How many clinic sites implemented chart reminders in PY5?
[write-in # or Don’t know]

b. Provider reminders built into electronic medical record (EMR) systems?
 Yes  GO TO 5.b.i.
 No
IF YES  5.b.i. Where are EMR-based provider reminders being used? (Check
all that apply.)
•
Individual physician’s office
•
IHS or tribal clinic
•
Provider group
•
FQHCs
•
Health care system
•
My CRCCP (We implement these reminder systems, ourselves.)
•
Other, please specify
5bii. How many clinic sites implemented provider reminders using
an EMR in PY5? [write-in # or Don’t know]
c. Other, please describe:_____________________
 Yes  GO TO 5.c.i.
 No
IF YES  5.c.i. Where are the other provider reminders you mentioned being
used? (Check all that apply.)
•
Individual physician’s office
•
IHS clinic or tribe
•
Provider group
•
FQHCs
•
Health care system
•
My CRCCP (We implement these reminder systems, ourselves.)
•
Other, please specify

2014 CRCCP Annual Grantees Survey Page 42 of 76

 5cii. How many clinic sites implemented any of these other provider
reminders in PY5? [write-in # or Don’t know]
Provider Reminders – Partners
6. How many partner organizations did your organization work with to implement
provider reminder systems to promote CRC screening in PY5?
•
[WRITE-IN #] partners  GO to Q8.
•

None, we did not partner with any organizations to implement
provider reminder systems to promote CRC screening  Go to
6.a.

6.a. Describe why partners were not used as part of your efforts to use
providers reminders to promote CRC screening. [Then skip to
Q.17]

8.
Which of the following best describes the partner organization(s) you worked
with to promote CRC screening using provider reminder systems in PY5? (Check all
that apply.)
 Academic institution
 Advocacy group/ Community-based organization/Community or health
coalition
 American Cancer Society
 Another CRCCP Grantee
 Chronic Disease programs within your agency
 Comprehensive Cancer Control Coalition
 Employers/worksites
 Federally qualified health center (FQHC)
 Indian Health Service (IHS) Clinic or Board, IHS Urban Indian health clinic
 Individual health care provider/single practice
 Local health department(s)
 Medicare Quality Improvement Organization (QIO) office
 Non-IHS tribal clinic, board, or health care facility
 Private and/or non-profit health care system
 Private health insurer
 Professional organization (e.g., primary care provider association in your
state, state medical office)
 Quality assurance organization
 State Medicaid office
 State office of rural health
2014 CRCCP Annual Grantees Survey Page 43 of 76




Tribal council
Other (please specify)

8a. For each geographic designation in the table below, please specify the number of
partner sites that used provider reminder systems in that area to promote CRC screening
in PY5.
Enter the appropriate numeric value or "don't know."
Enter "0" if no partners used this EBI in PY5 in the designated area.

Geographic Designation
Definition

# of partner sites
using provider
reminders in this
area

i. Large Metro
Counties with a population of 1 million or more
ii.Medium Metro
Counties with a population of 250,000-999,999
iii.Small Metro
Counties with a population of 50,000-249,999
iv. Micropolitan
Counties of less than 50,000 that contain all or
part of a city of at least 10,000 or more residents
v. Rural
Counties that do not contain any part of a city of
10,000 or more residents
vi. Multiple counties or statewide

Ease or Difficulty of Implementing Provider Reminders for CRC Screening
Promotion
17.
Thinking about the provider reminder activities that your CRCCP implemented
in PY5, rate the level of ease or difficulty it took to implement them on average.
1
Very easy to
implement
☐

2
Somewhat easy

3
Neutral

☐

☐

4
Somewhat
difficult
☐

5
Very difficult to
implement
☐

2014 CRCCP Annual Grantees Survey Page 44 of 76

E.
Provider Assessment and Feedback for CRC Screening Promotion
Provider assessment and feedback interventions both evaluate provider performance in
delivering or offering screening to clients (assessment) and present providers with
information about their performance in providing screening services (feedback).
Feedback may describe the performance of a group of providers (e.g., average
performance for a practice) or an individual provider, and may or may not be compared
with a goal or standard.
The following questions ask about provider assessment and feedback systems for
CRC screening promotion that have been implemented as a part of the CRCCP
during program year 5 (PY5).
1. Did your organization offer provider assessment and feedback to promote colorectal
cancer screening in PY4?
“Your organization” refers to you, your contractors and/or partners.


Yes, we used provider assessment and feedback for CRC screening promotion
in PY4.  Go to Q.2.



No, we did not use provider assessment and feedback for CRC screening in
PY4, but we have in the past (i.e., during any previous CRCCP contract year).
 Go to 1.b.



No, we have never used provider assessment and feedback for CRC screening
promotion.  Skip to Section D: Reducing Structural Barriers

1.b. Please describe your CRCCP’s previous attempts at using
provider assessment and feedback to promote CRC screening,
including for how long you used them, partner involvement (if any),
and what type(s) of provider assessment feedback were used.
[Go to 1.c.]
1.c. Why did your CRCCP stop using provider assessment and
feedback to promote CRC screening?
[Skip to Section D: Reducing Structural Barriers]

2014 CRCCP Annual Grantees Survey Page 45 of 76

2.
For how long has your organization been using provider assessment and
feedback for colorectal cancer screening promotion?

Less than 6 months

6-11 months

1-2 years

3-4 years

5 years or more
Did you use any of the following types of provider assessment and feedback as a
part of your CRCCP screening promotion efforts in PY5? (Check all that apply.)
5.

a. Evaluating provider performance in delivering or offering screening to clients
(assessment).
 YES  GO TO 5ai
 NO
IF YES  5.a.i. Please describe your provider assessment efforts,
including what’s being assessed, how you’ve been
conducting the assessment, and how those efforts have been
going, to date.
IF YES 5.a.ii. Where is the provider assessment being used? (Check all
that apply.)
•
FQHCs
•
Health care system
•
Insurer
•
IHS or tribal clinic
•
Individual physician’s office
•
Provider group
•
My CRCCP
•
Other, please specify
b. Presenting providers with information about their performance in providing
screening services (feedback).
 YES  GO TO 5bi
 NO
IF YES  5.b.i. Please describe your provider feedback efforts,
including what type of feedback is provided, how you’ve
been delivering the feedback, and how those efforts have
been going, to date.
IF YES  5.b.ii. Where is the provider feedback being used? (Check all
that apply.)
2014 CRCCP Annual Grantees Survey Page 46 of 76

•
•
•
•
•
•
•
•

FQHCs
Health care system
Insurer
IHS or tribal clinic
Individual physician’s office
Provider group
My CRCCP
Other, please specify

Provider Assessment and Feedback – Partners
6.
How many partner organizations did your organization work with to implement
provider assessment and feedback systems to promote CRC screening in PY5?
•
[WRITE-IN #] partners  Go to Q8

None. We did not partner with any organizations to implement
provider assessment and feedback systems to promote CRC
screening.  Go to 6.a.
6.a. Describe why partners are not used as part of your efforts to use
provider assessment and feedback for CRC screening promotion.
[Then skip toQ.15]

8.
Which of the following best describes the partner organization(s) you worked
with to promote CRC screening using provider assessment and feedback in PY4? (Check
all that apply.)
•
Academic institution
•
Advocacy group/ Community-based organization/Community or
health coalition
•
American Cancer Society
•
Another CRCCP grantee

Chronic Disease programs within your agency
•
Comprehensive Cancer Control Coalition
•
Employers/worksites
•
Federally qualified health center (FQHC)
•
Indian Health Service (IHS) clinic or board, IHS Urban Indian
health clinic
•
Individual health care provider/single practice
•
Local health department(s)
•
Medicare Quality Improvement Organization (QIO) office

Non-IHS tribal clinic, board, or health care facility
•
Private and/or non-profit health care system
•
Private health insurer
•
Professional organization (e.g., primary care provider association
in your state, state medical office)
•
Quality assurance organization
2014 CRCCP Annual Grantees Survey Page 47 of 76

•
•
•


State Medicaid office
State office of rural health
Tribal council
Other (please specify)

8a. For each geographic designation in the table below, please specify the number of
partner sites that used provider assessment and feedback in that area to promote CRC
screening in PY4.
Enter the appropriate numeric value or "don't know."
Enter "0" if no partners used this EBI in PY4 in the designated area.
Geographic Designation
Definition

# of partner sites
using provider
assessment and
feedback in this
area

i. Large Metro
Counties with a population of 1 million or more
ii. Medium Metro
Counties with a population of 250,000-999,999
iii. Small Metro
Counties with a population of 50,000-249,999
iv. Micropolitan
Counties of less than 50,000 that contain all or
part of a city of at least 10,000 or more residents
v. Rural
Counties that do not contain any part of a city of
10,000 or more residents
vi. Multiple counties or statewide

Ease or Difficulty of Implementing Provider Assessment and Feedback Activities
for CRC Screening Promotion
15.
Thinking about the provider and assessment activities for CRC screening
promotion that your CRCCP implemented in PY4, rate the level of ease or difficulty it
took to implement them on average.
1
Very easy to
implement
☐

2
Somewhat easy

3
Neutral

☐

☐

4
Somewhat
difficult
☐

5
Very difficult to
implement
☐

2014 CRCCP Annual Grantees Survey Page 48 of 76

D.
Reducing Structural Barriers for CRC Screening Promotion
Structural barriers are non-economic burdens or obstacles that make it difficult for
people to access cancer screening. Interventions designed to reduce these barriers may
facilitate access by:


Reducing time or distance between service delivery settings and target
populations



Modifying hours of service to meet client needs



Offering services in alternative or non-clinical settings



Eliminating or simplifying administrative procedures and other obstacles
(e.g., revising clinic flow procedures, adopting electronic medical records
systems).

The following questions ask about interventions that have been implemented as a
part of the CRCCP to reduce structural barriers for CRC screening promotion in
program year 5 (PY5).
1.
Did your organization use interventions to reduce structural barriers to promote
colorectal cancer screening in PY5?
Please note: Patient Navigation services that specifically assist with transportation,
language translation and/or dependent care should be included here; The Community
Guide has identified these activities as examples of reducing structural barriers. All
other patient navigation services for screening promotion are asked about in the
Patient Navigation for Screening Promotion Section of the survey.
For these questions, “your organization” refers to you, your contractors or
partners.
 Yes, we currently use interventions to reduce structural barriers to promote CRC
screening.  Go to 2.


No, we do not currently use interventions to reduce structural barriers to promote
CRC screening, but we used to in the past (i.e. during any current or previous
CRCCP contract year).  Go to 1.b.



No, we have never used interventions to reduce structural barriers to promote
CRC screening, but we are planning or intend to in the next 12 months.  Go to
1.a.



No, we have never used interventions to reduce structural barriers to promote
CRC screening, and we are not planning or intend to use them in the next 12
months.  Go to 1.a.

2014 CRCCP Annual Grantees Survey Page 49 of 76

1.b. Please describe your CRCCP’s previous attempts at reducing
structural barriers to promote CRC screening, including for how long
you used them, partner involvement (if any), and what type(s) of
structural barriers were addressed.
[Go to 1.c.]

1.c. Why did your CRCCP stop using interventions to reduce structural
barriers to promote CRC screening?
[Skip to Part F: Patient Navigation]

2.
For how long has your organization been reducing structural barriers to promote
colorectal cancer screening?

Less than 6 months

6-11 months

1-2 years

3-4 years

5 years or more

3.
Which strategies for reducing structural barriers does your organization use?
(Check all that apply.)
 Reducing time or distance between service delivery settings and target
populations
 Modifying hours of service to meet client needs
 Offering services in alternative or non-clinical settings
 Eliminating or simplifying administrative procedures and other obstacles

5.
Did your organization conduct any assessment of structural barriers before
implementing strategies to reduce structural barriers to promote your CRC screening
activities?
 Yes  5.a. Please describe
 No

2014 CRCCP Annual Grantees Survey Page 50 of 76

Reducing Structural Barriers – Partners
7.
How many organizations did your organization partner with to reduce structural
barriers to promote CRC screening in PY5?
•
[WRITE-IN #] partners  GO to Q9
•

None. We did not partner with any organizations to reduce
structural barriers to promote CRC screening.  GO to 7.a.

7.a. Describe why partners were not used as part of your efforts to reduce
structural barriers to promote CRC screening. [Then skip to Q.16]

9.
Which of the following best describes the partner organization(s) you worked
with to promote CRC screening by reducing structural barriers in PY5? (Check all that
apply.)
•
Academic institution
•
Advocacy group/ Community-based organization/Community or
health coalition
•
American Cancer Society
•
Another CRCCP grantee

Chronic disease programs within your agency
•
Comprehensive Cancer Control Coalition
•
Employers/worksites

Federally qualified health center (FQHC)
•
Indian Health Service (IHS) Clinic or Board, IHS Urban Indian
health clinic
•
Individual health care provider/single practice
•
Local health department(s)
•
Medicare Quality Improvement Organization (QIO) office

Non-IHS tribal clinic, board, or health care facility
•
Private and/or non-profit health care system
•
Private health insurer
•
Professional organization (e.g., Primary care provider association
in your state, state medical office)
•
Quality assurance organization
•
State Medicaid office
•
State office of rural health
•
Tribal council

Other (please specify)
9a. For each geographic designation in the table below, please specify the number of
organizations your CRCCP partnered with to promote CRC screening by reducing
structural barriers in that area during PY4.
2014 CRCCP Annual Grantees Survey Page 51 of 76

Enter the appropriate numeric value or "don't know."
Enter "0" if no partners used this EBI in PY4 in the designated area.
Geographic Designation
Definition

# of partners
conducting
activities to reduce
structural barriers
in this area

i.Large Metro
Counties with a population of 1 million or more
ii.Medium Metro
Counties with a population of 250,000-999,999
iii.Small Metro
Counties with a population of 50,000-249,999
iv.Micropolitan
Counties of less than 50,000 that contain all or
part of a city of at least 10,000 or more residents
v. Rural
Counties that do not contain any part of a city of
10,000 or more residents
vi. Multiple counties or statewide

Ease or Difficulty of Reducing Structural Barriers for CRC Screening Promotion
16.
Thinking about the activities that your CRCCP implemented in PY4 to reduce
structural barriers for CRC screening, rate the level of ease or difficulty it took to
implement them on average.
1
Very easy to
implement
☐

2
Somewhat easy

3
Neutral

☐

☐

4
Somewhat
difficult
☐

5
Very difficult to
implement
☐

2014 CRCCP Annual Grantees Survey Page 52 of 76

F.
Patient Navigation for CRC Screening Promotion
A patient navigator guides the patient through the process of completing colorectal
cancer screening by helping to reduce patient-specific barriers. Some programs may
refer to this as case management. Some roles of the patient navigator (PN) include:
•
Assisting with scheduling appointments, transportation, or dependent care

Providing patient education about CRC screening and testing modalities
for screening (e.g., rationale, importance, bowel prep)

Reminding patients about their colonoscopy appointment or returning their
FOBT/FIT kits

Providing peer support to help with cultural or emotional concerns (e.g.,
allay fears)
The following questions ask about your CRCCP’s support for patient navigators
(PN)/case managers (CM) for CRC screening promotion. We are interested in
your support for PN/CMs in settings where you are paying for CRC screening
directly (screening provision), and in settings where you are not.
[Intro] These first questions ask about the use of patient navigators or case managers in
organizations other than those providers/clinics where you are paying for CRC
screening directly (screening provision).
1.
Did you support the implementation of patient navigator program(s) in any
organizations (e.g., FQHCs, IHS clinics) other than those providers/clinics where you
are paying for CRC screening directly (screening provision) in PY5?
 Yes, we used patient navigation or case management in PY5 for CRC screening
promotion in organizations other than those providers/clinics where we are
paying for CRC screening directly.  Go to 1b.


No, we did not use patient navigation or case management in PY5 to promote
CRC screening in organizations other than those providers/clinics where we are
paying for CRC screening directly, but we have in the past (i.e. during any
previous CRCCP contract year).  Go to 1.ai.



No, we have never used patient navigation or case management for CRC
screening promotion in organizations other than those providers/clinics where
we are paying for CRC screening directly.  Go to [Intro] 2

1.ai. Please describe your CRCCP’s previous attempts at using patient
navigation or case management in these settings to promote populationbased CRC screening, including for how long you used it, partner
involvement (if any), and types of activities or services the PN/CM was
responsible for.
2014 CRCCP Annual Grantees Survey Page 53 of 76

[Go to 1aii.]
1.aii. Why did your CRCCP stop using patient navigators or case
managers to promote CRC screening in these settings?
[Go to Q2]

1.b
For how long has your organization supported patient navigators or
case managers in organizations other than those providers/clinics where you
are paying for CRC screening directly (screening provision)?

Less than 6 months

6-11 months

1-2 years

3-4 years

5 years or more
1.c. How are these patient navigators/case managers for CRC screening
promotion supported? (Check all that apply.)
a.
Reimbursement to providers for FTE support
b.
Per- patient navigation/case management reimbursement
c.
Grantee staff serving as patient navigators/case managers
d.
In- kind from a community partner/program
e.
Other (specify) ____________
1.d. Please specify any core navigation activities that are routinely offered as part
of those organizations’ CRC screening promotion component. (Check all that
apply.)











Patient assessment of barriers to screening
Patient education (about anatomy, CRC, CRC screening, bowel prep)
Assistance with transportation, language translation, child/eldercare
Assistance with appointment setting
Assistance with identifying payment for screening
Reminder calls/emails for bowel prep and/or appointments
Reminder calls/emails for return of FOBT/FIT tests
Peer support/motivation for screening
Follow-up with client about next steps for CRC screening and ensure
understanding of results provided by medical team
Community outreach to promote CRCCP and CRC screening (E.g.
Linkages with health fairs and clients in community)

2014 CRCCP Annual Grantees Survey Page 54 of 76



Clinic in-reach activities to promote CRCCP and colorectal screening,
(E.g., flagging charts for medical providers for those eligible for
Program/CRC screening)

1.e. We are interested in knowing more about the patient navigators/case
managers that are supported in organizations other than those providers/clinics
where you are paying for CRC screening directly. Using the drop-down menus
in the table below, please complete the following sentence:
[Insert number] patient navigators/case managers, or [insert number] FTEs (regardless
of the number of people) are supported at [insert number] sites or clinics.

If your organization supports only per-patient navigation reimbursement or perpatient case management reimbursement, write-in “Don’t Know” (case sensitive)
in each applicable field.
#[WRITE-IN + Don’t Know] Patient Navigators/Case Managers  Go to Q1f IF 1 OR
MORE IS SELECTED
#[WRITE-IN + Don’t Know] Full Time Equivalents, i.e., FTEs (regardless of the number
of people)
At [WRITE-IN + Don’t Know] Sites/Clinics

1f. Do some or all of the patient navigators/case managers for screening promotion also
provide patient navigation/case management support for your screening provision
activities?
 No
 Yes  Please describe. [Open text]
 Don’t know
1.g. About how many CRC screening patients (total) do these organizations’
patient navigators/case managers support in a year?

1-100 patients

101-500 patients

501-1000 patients

1001-5000 patients

More than 5000 patients

Don’t know

2014 CRCCP Annual Grantees Survey Page 55 of 76

[Intro] These next questions ask about your organization’s use of patient navigators or
case management to promote colorectal cancer at provider/clinic sites where you are
paying for CRC screening directly.
2. Did your organization use patient navigation (PN) or case management (CM) to
promote colorectal cancer screening at provider/clinic sites where you are paying for CRC
screening directly in PY4?
 Yes, we used patient navigation or case management in PY4 for CRC screening
promotion at provider/clinic sites where we are paying for CRC screening
directly.  Go to 3.


No, we did not use patient navigation or case management in PY4 to promote
CRC screening at provider/clinic sites where you are paying for CRC screening
directly, but we have in the past (i.e. during anyprevious CRCCP contract year).
 Go to 2.b.



No, we have never used patient navigation or case management for CRC
screening promotion.  Skip to Section G: Other Interventions

2.b. Please describe your CRCCP’s previous attempts at using patient
navigation or case management to promote population-based CRC
screening, including for how long you used it, partner involvement (if
any), and types of activities or services the PN/CM was responsible for.
[Go to 2.c.]
2.c. Why did your CRCCP stop using patient navigators or case
managers to promote CRC screening?
[Skip to Section G: Other Interventions]

3.
For how long has your organization been using patient navigators or case
managers to promote colorectal cancer screening?

Less than 6 months

6-11 months

1-2 years

3-4 years

5 years or more
4.
How are these patient navigators/case managers for CRC screening promotion
supported? (Check all that apply.)
f.
Reimbursement to providers for FTE support
2014 CRCCP Annual Grantees Survey Page 56 of 76

g.
h.
i.
j.

Per- patient navigation/case management reimbursement
Grantee staff serving as patient navigators/case managers
In- kind from a community partner/program
Other (specify) ____________

5. Please specify any core navigation activities that are routinely offered as part of
your organization’s CRC screening promotion component. Check all that apply.












Patient assessment of barriers to screening
Patient education (about anatomy, CRC, CRC screening, bowel prep)
Assistance with transportation, language translation, child/eldercare
Assistance with appointment setting
Assistance with identifying payment for screening
Reminder calls/emails for bowel prep and/or appointments
Reminder calls/emails for return of FOBT/FIT tests
Peer support/motivation for screening
Follow-up with client about next steps for CRC screening and ensure
understanding of results provided by medical team
Community outreach to promote CRCCP and CRC screening (E.g.
Linkages with health fairs and clients in community)
Clinic in-reach activities to promote CRCCP and colorectal screening,
(E.g. flagging charts for medical providers for those eligible for
Program/CRC screening)

6. We are interested in knowing more about the patient navigators/case managers that
are supported at provider/clinic sites where you are paying for CRC screening directly.
Using the drop-down menus in the table below, please complete the following sentence:
[Insert number] patient navigators/case managers, or [insert number] FTEs (regardless of the
number of people) are supported at [insert number] CRCCP-participating sites or clinics.

If your organization supports only per-patient navigation reimbursement or per-patient
case management reimbursement, write-in “Don’t Know” (case sensitive) in each
applicable field.
#[WRITE-IN + Don’t Know] Patient Navigators/Case Managers  Go to Q6a IF 1 OR
MORE IS SELECTED
#[WRITE-IN + Don’t Know] Full Time Equivalents, i.e., FTEs (regardless of the number
of people)
At [WRITE-IN + Don’t Know] Sites/Clinics

2014 CRCCP Annual Grantees Survey Page 57 of 76

6a. Do some or all of your patient navigators/case managers for screening promotion
also provide patient navigation/case management support for your screening provision
activities?
 No
 Yes  Please describe. [Open text]

7.
About how many CRC screening patients (total) do your patient navigators/case
managers support in a year?

1-100 patients

101-500 patients

501-1000 patients

1001-5000 patients

More than 5000 patients

Don’t know
Patient Navigation – Partners
8.
How many organizations did you partner with to implement patient
navigation/case management systems to promote CRC screening in PY4?
•
[WRITE-IN #] partners  Go to Q10
•

None. We did not partner with any organizations to implement patient
navigation/case management systems to promote CRC screening. Go
to 8.a.
8.a. Describe why partners were not used as part of your implementation
of patient navigation systems. [Then skip to 19]

10.
Which of the following best describes the partner organization(s) you worked
with to promote CRC screening using patient navigator/case management systems in
PY4? (Check all that apply.)
•
Academic institution
•
Advocacy group/ Community-based organization/Community or health
coalition
•
American Cancer Society
•
Another CRCCP grantee

Chronic disease programs within your agency
•
Comprehensive Cancer Control Coalition
•
Employers/worksites
•
Federally qualified health center (FQHC)
•
Indian Health Service (IHS) clinic or board, IHS Urban Indian health
clinic
2014 CRCCP Annual Grantees Survey Page 58 of 76

•
•
•

•
•
•
•
•
•
•


Individual health care provider/single practice
Local health department(s)
Medicare Quality Improvement Organization (QIO) office
Non-IHS tribal clinic, board, or health care facility
Private and/or non-profit health care system
Private health insurer
Professional organization (e.g., Primary care provider association in your
state, state medical office)
Quality assurance organization
State Medicaid office
State office of rural health
Tribal council
Other (please specify)

Ease or Difficulty of Implementing Patient Navigation or Case Management
Activities for CRC Screening Promotion
19.
Thinking about the patient navigation or case management activities for CRC
screening promotion that your CRCCP implemented in PY5, rate the level of ease or
difficulty it took to implement them on average.
1
Very easy to
implement
☐

2
Somewhat easy

3
Neutral

☐

☐

4
Somewhat
difficult
☐

5
Very difficult to
implement
☐

G.
Other Interventions for CRC Screening Promotion
This section asks about your organization’s use of any other interventions to promote
colorectal cancer screening to the wider population during program year 5 (PY5). These
other interventions may include those that have been evaluated as having insufficient
evidence of effectiveness, according to the Guide to Community Preventive Services.
1.

Did your organization use any other interventions to promote colorectal cancer
screening in PY5? These other interventions may include:
 Provider education/professional development, including physician to
physician education
 1:1 education (other than patient navigation activities)
 Group education
 Mass media
 Quality assurance (QA)/Quality improvement (QI), including academic
detailing, performance monitoring
 Client or provider incentives
“Your organization” refers to you, your contractors, and your partners.

2014 CRCCP Annual Grantees Survey Page 59 of 76



Yes, we used other interventions to promote CRC screening in PY4. 
GO TO Q2.



No, we did not use other intervention to promote CRC screening in PY4,
but have in the past (in any previous CRCCP contract year).  GO TO
Q2



No, we have never used other interventions to promote CRC screening.
 Go to Part H: Highlighting a successful evidence-based
intervention (EBI) activity.

2.
Which other interventions did your organization use (or plan to use) for CRC
screening promotion in PY5? (Check all that apply.)

Provider education/professional development, including physician to
physician education  GO TO PART H

1:1 education  GO TO PART H

Group education  GO TO PART H

Mass media  GO TO PART H

Quality assurance (QA)/Quality improvement (QI), including academic
detailing, performance monitoring GO TO Q3[x]iii

Client or provider incentives  GO TO PART H

Other, please specify: _________ GO TO PART H

We do not use any of these other interventions.  GO TO PART H:
Highlighting a successful evidence-based intervention (EBI) activity.
3[x]iii. Describe your [INSERT CATEGORY INDICATED FROM Q2; USE CATEGORY NAME AS LISTED
ABOVE] activity for CRC screening promotion in PY5. Include details, such as the formal
name (if any) of the effort, type of QA effort, how it was implemented, etc.

3[x]iv. Describe any partnership involvement in your organization’s [INSERT CATEGORY
INDICATED FROM Q2; USE CATEGORY NAME AS LISTED ABOVE] efforts or activities in PY5, e.g.,
what partners were involved, how they were involved, how they came to be involved,
etc.

3[x]v. For how long has/did your organization been using [INSERT CATEGORY INDICATED
FROM Q2; USE CATEGORY NAME AS LISTED ABOVE] to promote colorectal cancer screening?
 Less than 6 months
 6-11 months
 1-2 years
 3-4 years
 5 years or more
H.
Highlighting a successful evidence-based intervention (EBI) activity

2014 CRCCP Annual Grantees Survey Page 60 of 76

We are interested in learning more about a successful EBI activity your organization has
implemented for screening promotion since the start of your program. Please tell us
about one EBI activity that you think has been the most effective or successful in your
CRC screening promotion efforts.
Note: The EBI should be one of the Community Guide-recommended strategies: small
media, patient or client reminders, provider reminders, reducing structural barriers, and
provider assessment and feedback.
1. Name of activity (as it’s referred to by your organization):
2. Please describe the main components of the EBI activity: what you did/do, how
you did/do it, who was/is the target audience
3. Who was/is involved in your implementation efforts? (e.g. types of partners,
their roll, etc.)
4. Did you adapt an existing intervention for this activity?
 Yes  Go to 4a.
 No  Go to 5
4.a. What was the source for the original intervention?
4.b. Why did you adapt the intervention? I.e. Why could you not use the
intervention “as is?”
4.c. Describe the process for how you adapted it. (e.g. Were changes
based on literature review, needs assessment, Community Advisory
Boards, focus groups, etc)
5. What do you think contributed to the success or effectiveness of this EBI?
Please include any details about methods, partners, or processes that you think
were particularly innovative or important that contributed to the success of your
efforts.
6. What were the biggest challenges you encountered, if any, in implementing this
EBI and how do you address them?
7. Is this EBI effort ongoing? If no, please tell us why not.
I.

Other Comments – CRC Screening Promotion

1.
What else would you like us to know about your organization’s CRC Screening
Promotion efforts?

SECTION 4: CANCER SCREENING DATA FROM FQHCs AND
IHS CLINICS
2014 CRCCP Annual Grantees Survey Page 61 of 76

These next questions are about health centers such as Federally Qualified Health Centers
(FQHCs) and Indian Health Services (IHS) clinics that you may have worked work with
in your state/tribal area during program year 5 (PY5).
1. Did any FQHCs clinics in your state report the following data to your CRCCP in
PY5?
Yes

No

a. CRC screening rates
b. HEDIS data from insurers
c. CCDE or similar data for patients screened with resources
other than CDC funds
d. Other CRC data, please describe: ____________

IF YES TO ANY IN TABLE ABOVE:  1a.
screening data to your CRCCP?
[WRITE-IN OR DON’T KNOW]

How many FQHCs reported CRC

FQHC(s) reported CRC screening data to my CRCCP

2. Are there any IHS clinics in your state/tribal area?
 Yes  GO TO Q2a.
 No  GO TO Q3
 Don’t know  GO TO Q3
IF YES  2a.
Did any IHS clinics in your state/tribal area report the following
data to your CRCCP in PY5?
Yes

No

a. CRC screening rates
b. RPMS data other than screening rates
c. CCDE or similar data for patients screened with
resources other than CDC funds
d. Other CRC data, please describe: ____________

IF YES TO ANY IN TABLE ABOVE:  2b.
CRC screening data to your CRCCP?
[WRITE-IN OR DON’T KNOW]

How many IHS clinics reported

IHS clinic(s) reported CRC screening data to my CRCCP

2014 CRCCP Annual Grantees Survey Page 62 of 76

3. Did any health systems, insurers, or other clinic types (i.e., not including FQHCs, IHS
or CRCCP-participating clinics that you are funding for screening provision) in your
state/tribal area report the following data to your CRCCP in PY5?
Yes
No
a. CRC screening rates
b. HEDIS data from insurers
c. CCDE or similar data for patients screened with
resources other than CDC funds
d. Other CRC data, please describe: ____________

IF YES  3a. How many health systems, insurers, or other clinics (i.e. not including
FQHCs or IHSs), report these CRC screening data to your CRCCP?
[WRITE-IN + DON’T KNOW]

Reported CRC screening data to my CRCCP

2014 CRCCP Annual Grantees Survey Page 63 of 76

SECTION 5: TRAINING AND TECHNICAL ASSISTANCE FOR
EVIDENCE-BASED INTERVENTIONS
A.
Program Training and Technical Assistance on Use of Evidence-Based
Interventions
1.

For which of the evidence-based strategies would you like to receive more
training or technical assistance? (Check all that apply.)
 Small media (e.g., brochures, flyers)
 Reducing structural barriers
 Patient reminders
 Provider reminders
 Provider assessment and feedback systems
 None

2.

Do you have access to someone who can help you interpret and apply research
evidence?
 Yes  Go to 2.a
 No  Go to 3
IF YES 

3.

2a. Who is that person?
2b. With what type of organization is s/he affiliated?

How would you rate your desire for training in the following areas?
High=3

Desire for training
Medium=2
Low=1

a. Find evidence-based strategies or programs
b. Assess the strength of the evidence in support of
a strategy or program’s effectiveness
c. Assess the fit of potential strategies or programs
with my population
d. Assess the fit of potential strategies or programs
with my organization’s systems, staff, and
resources
e. Assess organizational capacity to implement
selected strategy
f. Adapt an evidence-based strategy or program to
my population or setting
g. Implement a strategy/program with
quality/fidelity
h. Conduct a process evaluation of an evidencebased strategy or program
i. Conduct an outcome evaluation of an evidencebased strategy

2014 CRCCP Annual Grantees Survey Page 64 of 76

B.
Partner and Staff Training and Technical Assistance on Use of EvidenceBased Interventions
1.

Did you offer training on how to use any of the five Community Guiderecommended evidence-based interventions (EBIs) to increase colorectal cancer
screening to your partners, subcontractors, community health workers, patient
navigators, or provider network in program year 5 (PY5)?
 Yes  Go to Q 1.a.
1a. Please describe the training you offered on how to use any of
the five Community Guide-recommended EBIs to increase CRC
screening. Please describe training content, target audience, etc.
 No
 Don’t know

2.

Did you offer technical assistance (TA) on how to use any of the five
Community Guide-recommended EBIs to increase colorectal cancer screening to
your partners, subcontractors, community health workers, patient navigators, or
provider network in PY5?
 Yes  Go to Q 2.a.
2a. Please describe the technical assistance (TA) you offered on
how to use any of the five Community Guide-recommended EBIs
to increase CRC screening. Please describe training content, target
audience, etc.
 No
 Don’t know

3.

In questions 3.a. through 3.d, for which CRCCP activities do you/your staff most
need technical assistance, training, or other support to enhance program
implementation in the coming year?
3.a.

Program Management – (Check up to 3.)












Developing program infrastructure
Staffing
Recruiting providers for screening provision
Contract management
Comprehensive program planning
Grant writing
Identifying funding
Managing CRCCP budget funding
Communication
Integrating the CRCCP with other programs
Working with or managing contractors
2014 CRCCP Annual Grantees Survey Page 65 of 76



3.b.















3.c.

Other, please specify
None. We do not desire any training in this area.
Partnership Development (Check up to 3.)
This area (partnership development) has not been addressed yet by our
program.
Maintain a relationship with CDC-funded programs (e.g. CCC,
NBCCEDP, WISEWOMAN)
Maintain a relationship with the Central Cancer Registry
Develop and maintain a partnership with your state/tribal organization’s
CCC coalition
Develop and maintain partnerships with private and nonprofit health care
systems
Develop and maintain partnerships with private health insurers
Develop and maintain a partnership with your state State Medicare and
Medicaid office
Develop and maintain a partnership with FQHCs
Develop and maintain partnerships with professional organizations (e.g.,
state GI or primary care provider association)
Develop and maintain partnerships with other organizations. Please
specify
Developing partnership agreements (e.g. MOU/MOA)
Evaluating partnerships
Severing ineffective partnerships
Other, please specify
None. We do not desire any training in this area.
Screening Provision (Check up to 3.)













Establish program infrastructure
Convene and maintain a Medical Advisory Board
Convene and maintain a Community Advisory Board
Recruit underinsured and uninsured individuals for CRC screening with
CDC funds
Implement patient navigation and other support services
Provide or support the provision of screening and diagnostic services
Ensure appropriate treatment for complications and cancers
Support insurance enrollment
Develop and promote quality control standards and mechanisms among
program-funded providers
Develop and promote CRCCP clinical policies and procedures among
program-funded providers
Develop, promote, or enhance training to educate health care
professionals among program-funded providers
2014 CRCCP Annual Grantees Survey Page 66 of 76




3.d.

Address or resolve billing issues, e.g., determining Medicare
rates/overbilling, dissatisfaction with rates
Other, (please specify)
None. We do no desire any training in this area.
Data Collection and Evaluation (Check up to 3.)













Establish a patient data tracking system that meets CCDE reporting
requirements for screening provision component
Collect and report patient data and monitor data quality through the
CCDEs
Collect and report program activity cost data through the CAT
Develop an evaluation plan for your CRCCP (e.g., formative, process,
outcome, impact)
Conduct evaluation activities for your CRCCP
Identify and collect data from other sources (e.g., CRC screening rates
from large health systems)
Collaborate with central cancer registry for data linkages and other
purposes
Use data for program monitoring and program improvement
Implement strategies to document and communicate program value to
stakeholders (e.g. legislators, funders, administrators)
Other (please specify)
None. We do no desire training in this area.

4.

Are there any other resources or materials not previously covered in this section,
that would be helpful to you as you implement any of the five evidence-based
strategies recommended by the Community Guide?
 Yes  IF YES, 4.a Please describe
 No

5.

How satisfied are you with the technical assistance (TA) that CDC provided in
PY5? Technical assistance refers to any assistance provided directly to you by
CDC staff; for example assistance provided by program consultants and team
leads.
1 = Not at all satisfied  5.a. Please describe how the TA can be improved
2 = Somewhat satisfied  5.a. Please describe how the TA can be improved
3 = Moderately satisfied 5.a. Please describe how the TA can be improved
4 = Very satisfied  Continue
5 = Extremely satisfied  Continue

2014 CRCCP Annual Grantees Survey Page 67 of 76

6.

How satisfied are you with the training(s) that CDC provided or offered in PY5?
Trainings may include but are not limited to webinars, workshops at annual
meetings, and workgroups.
1 = Not at all satisfied  6.a. Please describe how the training can be improved
2 = Somewhat satisfied  6.a Please describe how the training can be improved
3 = Moderately satisfied 6.a. Please describe how the training can be improved
4 = Very satisfied  Continue
5 = Extremely satisfied  Continue

7.
What other CRCCP programs did you go to for advice or support to use the five
Community Guide-recommended (evidence-based) strategies? (Check all that apply.)
[List all 29 programs + None]

FOR EACH PROGRAM SELECTED 
7.a.
How often were you given advice or received information from this CRCCP
program?







A couple of times a year
Less than once a month
Once or twice a month
Weekly (1 or more times/week)
About once a day
More than once a day

8.
What other CRCCP programs did you collaborate with to implement any of the
five Community Guide-recommended (evidence-based) strategies? (Check all that
apply.)
[List all 29 programs + None]

8.a.
What unfunded CRCCP programs did you collaborate with, if any, to
implement any of the five Community Guide-recommended strategies for CRC
screening promotion? (Check all that apply)
[List all UNFUNDED programs + None]

9.
What non CDC-funded colorectal screening programs did you go to, or research,
for advice or support to use the five Community Guide-recommended (evidence-based)
strategies? [open text]

2014 CRCCP Annual Grantees Survey Page 68 of 76

C.

Comments – TA and Training
1. Do you have any other comments about training or technical assistance for
evidence-based interventions?

2014 CRCCP Annual Grantees Survey Page 69 of 76

SECTION 6: SCREENING POLICIES & STRATEGIES
A.
Tobacco Screening Policies and Strategies
These next questions ask about policies and strategies to support tobacco screening and
referral to quit lines for both CRCCP patients and non-CDC paid patients of CDCfunded program providers.
1. Does your program have a written policy in place that requires all contracted
providers to both assess the smoking status of every person screened by the
CRCCP and refer those who smoke to their state tobacco quit line?
 Yes  Go to 1.a.
 No  Go to Part B
 Don’t know  Go to Part B
IF YES  1.a. Has your program distributed this tobacco screening and referral
policy to all providers funded through the program to screen men and women for
CRCCP?
 Yes, all providers
 Yes, some providers
 No
 Don’t know
B.
Strategies to Support CRC Screening
1.
In program year 5 (PY5), did you execute two or more formal agreements (e.g.,
MOU, MOA, contract) with a health care system, health insurer, or large workplace to
facilitate and support CRC screening?
The agreement may include things such as:
1) Data reporting
2) A formal CRC quality improvement effort
3) An organizational policy or benefits package to cover screening
4) An uncompensated screening commitment; and/or
5) Implementation of Community Guide evidenced-based interventions



Yes  Go to 1a. Intro
No  Go to 2.

IF YES  [Intro] Please tell us how many formal agreements (MOU, MOA, or
contract), you executed with each entity below to facilitate and support CRC screening:
1a. Health care system: [write-in]  Please provide health care system name(s). Write-in
'NA' if you entered zero above.

[open text 3-5 lines]
1b. Health insurer: [write-in]  Please provide health insurer name(s). Write-in 'NA' if you
entered zero above.

2014 CRCCP Annual Grantees Survey Page 70 of 76

[open text 3-5 lines]
1c. Workplace: [write-in]  Please provide workplace name(s). Write-in 'NA' if
you entered zero above. [open text 3-5 lines]
2. In program year 5 (PY5), were there any new or revised organizational policies (e.g.,
insurer reduces co-pay for CRC screening, workplace provides time off for
colonoscopy) and systems changes in any of your partner organizations (e.g.,
workplaces, Insurers, health systems) that affect colorectal cancer control?
 Yes  Go to 2a
 No  Skip to Section 7: General Program Management
IF YES  2.a. How many new or revised organizational policies have there
been in PY5 that affect colorectal cancer control?





1
2
3
4 or more

IF YES  2.b. Of these new or revised policies that affect colorectal cancer
control, please tell us about the policy that you view to be the most successful, or
that has the potential for most impact:
2b.i.
State the name of the organization ______________
2.b.ii.
Indicate the type of organization
 Large employer/worksite
 Private/nonprofit health care system
 FQHCs
 Private health insurers
 Other_________________
2b.iii.

Indicate the scope of the organization
 State/tribal organization-wide
 County-wide
 City-wide
 Other

2.b.iv.

Describe the policy’s major requirements or mandates
[OPEN FIELD]

2.b.v.

Describe your CRCCP program’s role in supporting its
development and/or adoption [OPEN FIELD]

2014 CRCCP Annual Grantees Survey Page 71 of 76

SECTION 7: GENERAL PROGRAM MANAGEMENT
A.

Monitoring and Evaluation

1.
What level of ease or difficulty did you experienced for each of the following
monitoring and evaluation issues in the past year?
Very Easy
1

a.

b.
c.

Using BRFSS data for
program planning or
evaluation

e.

Acquiring claims or HEDIS
data
Using claims or HEDIS data
for program planning or
evaluation

g.
h.

i.
j.
k.
l.

Neutral
3

Somewhat
Difficult
4

Very
Difficult
5

Not
Applicable
77

Collecting clinical data for
persons screened through
our CRC screening
provision efforts
Conducting program
evaluation
Acquiring BRFSS data

d.

f.

Somewhat
Easy
2

Acquiring CRC screening
rate data from clinics, health
systems, or insurers
Using CRC screening data
for program planning or
evaluation
Gathering new data (e.g.,
from providers or specific
communities)
Analyzing/interpreting new
data
Acquiring
Medicare/Medicaid data
Acquiring RPMS data

1. Did you conduct any evaluation of your CRC screening promotion or provision

activities in program year 5 (PY5)? This could include formative, process, outcome,
or impact evaluations (e.g., referrals, screening numbers) of your activities?
Examples of evaluation types and activities:
 Formative – what messages or activities people would like to know/have
about CRC
 Process – information about how program activities were implemented
 Impact – knowledge, attitudes, screening behaviors
2014 CRCCP Annual Grantees Survey Page 72 of 76





Outcome – screening rates at state level

Yes  Go to 2.a.
No  Go to Part B

2.a. If yes, tell us what type of activity was evaluated?
2.b. How did you conduct the evaluation?

2014 CRCCP Annual Grantees Survey Page 73 of 76

B.

Administrative Challenges

1.
What level of ease or difficulty did you experience for each of the following
administrative issues in PY5?
Very Easy

a.

Spending CDC funding

b.

Hiring staff

c.

Training staff

d.

Retaining staff

e.

Establishing contracts with
partners
Establishing MOAs/ MOUs
with partners
Securing funding from
sources other than CDC to
support promoting or
providing CRC screening
Having sufficient funding
across funding sources
(CDC + other) to support
CRCCP program goals

f.
g.

h.

i.

Gaining approvals for
traveling to CDC or other
professional development
opportunities

j.

Political issues within the
state/tribe

k.

Immigrant/legal residency
issues

l.

Securing furloughs

Somewhat
Easy

Neutral

Somewhat
Difficult

Very
Difficult

Not
Applicable

IF 1.e [RE: CONTRACTS] = SOMEWHAT EASY to VERY DIFFICULT 
1.e.i Describe why establishing contracts with partners was challenging.
For example, was the contracting process too burdensome, do partners not
want to contract with your state/tribe, etc.
IF 1.f [RE: MOAs/MOUs] = SOMEWHAT EASY to VERY DIFFICULT 
2014 CRCCP Annual Grantees Survey Page 74 of 76

1.f.i Describe why establishing MOA/MOU with partners was challenging.
For example, was the MOA/MOU process too burdensome, do partners not
want to formalize an agreement with your state/tribe, etc.
C.
Final Comments
1.
What was the biggest challenge you faced in this last contract year (PY5; 7/1/136/30/14) and how did you overcome it?
2.
What has been your greatest success in this last contract year (PY5; 7/1/136/30/14) and how have you promoted it?

CLOSING QUESTIONS
1. Did you consult with anyone (e.g. colleagues, partners, subcontractors, etc) to answer
any of the survey questions?
 Yes  GO TO 1.a
 No  END SURVEY
1a. Tell us with whom you consulted to complete this survey. Check all that apply.












CRCCP Program Director
CRCCP Program Manager/Coordinator
CRCCP Data Manager
CRCCP-participating clinics
CDC CRCCP Program Staff
CRCCP Administrator
Insurer
Partner
Other 1, please specify
Other 2, please specify
Other 3, please specify

END SURVEY
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2014 CRCCP Annual Grantees Survey Page 76 of 76