Clinic-level Breast Cancer Screening Data

National Breast and Cervical Cancer Early Detection Program (NBCCEDP) Monitoring Activities

Att 7a_NBCCEDP Clinic Data Dictionary- BREAST

Clinic-level Breast Cancer Screening Data

OMB: 0920-1046

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OMB Control No. 0920-1046

Expiration Date: xxxxxx



National Breast and Cervical Cancer Early Detection Program (NBCCEDP)

Clinic-level Data Dictionary for Breast Cancer Screening Data












Public reporting burden of this collection of information is estimated to average 45 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, 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 Reports Clearance Officer; 1600 Clifton Road NE, MS D‐74, Atlanta, Georgia 30329; ATTN: PRA (0920-1046).



TABLE OF CONTENTS



Sections 1-4 contain descriptive data reported at BASELINE assessment for each clinic where NBCCEDP interventions are planned:

Section 1: Record Identification Fields

Section 2: Partner Health System Characteristics

Section 3: Clinic Characteristics

Section 4: Clinic Patient Population Characteristics for Breast Cancer Screening


Sections 5-12 contain longitudinal data reported at BASELINE and ANNUALLY (as indicated) through the end of the FOA for each participating clinic:


Section 5: Report Period

Section 6: Chart Review (CR) Screening Rate Data for Breast Cancer

Section 7: Electronic Health Record (EHR) Screening Rate Data for Breast Cancer

Section 8: Monitoring and Quality Improvement for Breast Cancer Screening

Section 9: Evidence-Based Interventions (EBIs)

Section 10: Professional Development and Provider Education

Section 11: Community outreach, education, and support

Section 12: Patient navigation for screening, diagnostics, and/or treatment initiation

Section 13: Other Breast Cancer-Related Strategies



National Breast and Cervical Cancer Early Detection Program (NBCCEDP)

Clinic-level Data Dictionary for Breast Cancer Screening Data

Item #

Item Type

NBCCEDP Data Item

Definition

Field Type

Response Options


Sections 1-4 contain descriptive data reported at BASELINE assessment for each clinic where interventions are planned. Descriptive data in sections 2-4 may be updated over time as needed to complete missing information or to reflect a substantial change. New clinics may be added throughout the FOA period.

Section 1: RECORD IDENTIFICATION FIELDS

Section 2: PARTNER HEALTH SYSTEM CHARACTERISTICS

Section 3: CLINIC CHARACTERISTICS

Section 4: CLINIC PATIENT POPULATION CHARACTERISTICS



Section 1: RECORD IDENTIFICATION FIELDS

1a

B*

Grantee code

Two-character Grantee Code (assigned by CDC)

List

AC= Arctic Slope

AI= American Indian Cancer Fnd.

AS= American Samoa

CN= Cherokee Nation

CR= Cheyenne River Sioux

GP= Great Plains

GU= Guam

HT= Hopi

KW= Kaw Nation

MH= Marshall Islands

MP= Northern Mariana Islands

NW= NARA

NN= Navajo Nation

PR= Puerto Rico

PW= Palau

SP= South Puget

SO= Southcentral Fnd.

SE= SEARHC

YK= Yukon

or

State Postal code

1b

B*

Baseline Assessment Date

Date the clinic baseline data assessment was completed and represents the starting point for tracking clinic-level breast cancer screening implementation activities and breast cancer screening rates.

Date




MM/DD/YYYY



Section 2: PARTNER HEALTH SYSTEM CHARACTERISTICS

2a

B*

Health system name

Name of the partner health system under which the clinic (intervention site) operates.

Char

Free text

100 Char limit

2b

B*

Health system ID

Unique three-digit identification code for the partner health system assigned by the grantee. Start with “001” and continue assigning numbers sequentially as health system partnerships are established.


If this is a health system where NBCCEDP activities focused on cervical cancer screening are also being implemented, use the same three-digit identification code assigned by the NBCCEDP staff.


If this is a health system where CDC’s Colorectal Cancer Control Program (CRCCP) activities are also being implemented, we encourage using the same three-digit identification code assigned by the CRCCP staff. Contact the CRCCP staff in your state for a list of clinics participating in the CRCCP.

Num

001-999

2c

B

Total # of primary care clinics in health system

The total number of primary health care clinics that operate under the partner health system, including those serving specific populations such as pediatric clinics. A clinic is defined as a location where primary care services are delivered. Clinics may also be referred to as "sites" or “practices”.

Num

1-9999999

2d

B*

Health system type

Type of health system partner. Choose the best fit regardless of whether the health system is private, public, or non-profit.


Community Health Center/Federally Qualified Heath Center (CHC/FQHC) includes “FQHC look-alikes” that meet program requirements but do not receive funding from the HRSA Health Center Program.


A tribal health system includes IHS, Tribal, or Urban Indian clinics (I/T/U) that serve American Indian/Alaska Native (AI/AN) populations.

List

CHC/FQHC

Academic health system

Local health department

Health Plan Clinic Network

Hospital

Tribal health system

Primary care facility (non-CHC/FQHC)

Other

2e

B*

Other health system type

Specify the “other organization type” of the health system partner.

Char

Free text

100 Char limit

2f

B*

Type of agreement in place with the health system

Type of formal agreement the grantee currently has in place with the partner health system.

List

 

MOU/MOA

Contract

Other

None

2g

B

Date of formal agreement

Date the formal agreement was finalized between the grantee and partner health system.

Date

MM/DD/YYYY

2h

B

Health Center Controlled Network name

For CHCs/FQHCs only, name of the Health Center Controlled Network with which they partner, if any.

Char

Free text
100 Char limit

2i

B

Section 2 Comments

Optional comments for Section 2.

Char

Free text

200 Char limit



Section 3: CLINIC CHARACTERISTICS

3a

B*

Clinic name

Name of the primary care clinic/site. A clinic is defined as a location where primary care services are delivered. Clinics may also be referred to as "sites" or “practices”.

Char

Free text
100 Char limit

3b

B*

Clinic ID

Unique three-digit identification code for the clinic assigned by the grantee. Start with “001” and continue assigning codes sequentially as clinics are recruited.


If this is a clinic where NBCCEDP activities focused on cervical cancer screening are also being implemented, use the same three-digit identification code assigned by the NBCCEDP staff.


If this is a clinic where CDC’s Colorectal Cancer Control Program (CRCCP) activities are also being implemented, we encourage using the same three-digit identification code assigned by the CRCCP staff. Contact the CRCCP staff in your state for a list of clinics participating in the CRCCP.

Num

001-999

3c

B*

Clinic street address

Street address of the clinic. If the street address is more than two lines, use a comma for separation.

Char

Free text
100 Char limit

3d

B*

Clinic city

City in which the clinic is located.

Char

Free text
50 Char limit

3e

B*

Clinic state

Two-letter state postal code where the clinic is located.

List

Various

3f

B*

Clinic zip

5-digit zip code where the clinic is located

Num

00001-99999

3g

B*

Clinic type

Type of clinic.


Community Health Center/Federally Qualified Heath Center (CHC/FQHC) includes “FQHC look-alikes” that meet program requirements but do not receive funding from the HRSA Health Center Program.


Tribal health clinic includes IHS, Tribal, or Urban Indian clinics (I/T/U) that serve AI/AN populations.

List

CHC/FQHC

Health system/Hospital owned

Private/Physician owned

Health department

Tribal health

Primary care facility (non-CHC/FQHC)

Other

3h

B*

# of primary care providers at clinic

Total number of primary care providers who are delivering services at the clinic. Primary care providers include physicians (e.g., internists, family practice, OB/GYN), nurses, nurse practitioners, and physician assistants. Do not include specialty providers in this number. Report on individuals, not full time equivalents (FTEs), which may include attending physicians, fellows and residents.

Num

1-9998

9999 (Unk)

3i

B*

Name of primary EHR vendor at clinic

Name of the primary electronic health record (EHR) vendor used by the clinic or health system.

List

 

Allscripts

AthenaHealth

Cerner

eClinicalWorks

Epic

GE Centricity

Greenway-Intergy

Greenway-SuccessEHS

NextGen

Other

None

3j

B

Other EHR, please specify

Name of the 'other' electronic health record vendor(s) used by the clinic or health system.

Char

Free text
100 Char limit

3k

B*

Other HIT tools used for data analytics and reporting

Report if clinic is using other health information technology (HIT) tools (such as EHR overlays or Population Health Management software) to perform data analytics and reporting to monitor and improve screening.


List

Yes

No

Unk

3l

B*

PCMH Recognition

Indicates whether the clinic is currently recognized, certified, or accredited as a Patient Centered Medical Home (PCMH).


National recognition and accreditation programs include the: National Committee for Quality Assurance (NCQA) PCMH Recognition, Accreditation Association for Ambulatory Health Care (AAAHC) Medical Home On-site Certification, The Joint Commission (TJC) Designation For Your Primary Care Home, and URAC Patient-Centered Medical Home Accreditation.

List

Yes

No

Unk


3m

B*

Newly opened clinic

Identify newly established clinics based on the amount of time the clinic was operational at the time of the baseline assessment. A new clinic is defined as in operation for less than 1 year at the time of assessment.


The baseline assessment for a newly opened clinic should be delayed for at least 6 months after the clinic is operational to access information on the clinic and patient population characteristics.


Baseline screening rates should not be reported for “newly opened” clinics.

List

Yes (< 1 year)

No (1 or more years)

3n

B

Section 3 Comments

Optional comments for Section 3.

Char

Free text

200 Char limit



Section 4: CLINIC PATIENT POPULATION CHARACTERISTICS for BREAST CANCER SCREENING

( # of Patients, Gender, Insurance Status, Ethnicity, Race )

4a

B*, A*

Total # of clinic patients, age 50-74, women

The total number of patients aged 50-74, women, who have had at least one medical visit to the clinic in the last complete calendar year (January-December).


If unavailable, it is acceptable to report on a similar age range used by the clinic for measuring screening rates (e.g., 52-74 used for calculating a HEDIS screening rate).

Num

1-9999999

4b

B

% of clinic patients, age 50-74, women

The percent of patients aged 50-74, women. Report whole number as percent. For example, enter 67 for 67%, not 0.67. Leave blank if unknown.

It is acceptable to report the percent based on the total clinic population if unknown for those age 50-74.

Num

00-100

4c

B

% of patients, age 50-74, uninsured, women

The percent of the "Total # of clinic patients, 50-74, women" who do not have any form of public or private health insurance. Report whole number as percent. For example, enter 67 for 67%, not 0.67. Leave blank if unknown.

It is acceptable to report the percent based on the total clinic population if unknown for those age 50-74.

Num

00-100

4d

B

% of patients, age 50-74, Hispanic, women

The percent of the "Total # of clinic patients, 50-74, women" who are Hispanic or Latino (i.e., persons of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race). Report whole number as percent. For example, enter 67 for 67%, not 0.67. Leave blank if unknown.

It is acceptable to report the percent based on the total clinic population if unknown for those age 50-74.

Num

00-100

( Race )

4e

B

% of patients, age 50-74, White, women

The percent of the "Total # of clinic patients, 50-74, women" who are White/Caucasian (i.e., persons having origins in any of the original peoples of Europe, the Middle East, or North Africa). Report whole number as percent. For example, enter 67 for 67%, not 0.67. Leave blank if unknown.

It is acceptable to report the percent based on the total clinic population if unknown for those age 50-74.

Num

00-100

4f

B

% of patients, age 50-74, Black or African American, women

The percent of the "Total # of clinic patients, 50-74, women" who are Black or African American (i.e., persons having origins in any of the black racial groups of Africa). Report whole number as percent. For example, enter 67 for 67%, not 0.67. Leave blank if unknown.

It is acceptable to report the percent based on the total clinic population if unknown for those age 50-74.

Num

00-100

4g

B

% of patients, age 50-74, Asian, women

The percent of the "Total # of clinic patients, 50-74, women" who are Asian (i.e., persons having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam). Report whole number as percent. For example, enter 67 for 67%, not 0.67. Leave blank if unknown.

It is acceptable to report the percent based on the total clinic population if unknown for those age 50-74.

Num

00-100

4h

B

% of patients, age 50-74, Native Hawaiian or other Pacific Islander, women

The percent of the "Total # of clinic patients, 50-74, women" who are Native Hawaiian or other Pacific Islander (i.e., persons having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands). Report whole number as percent. For example, enter 67 for 67%, not 0.67. Leave blank if unknown.

It is acceptable to report the percent based on the total clinic population if unknown for those age 50-74.

Num

00-100

4i

B

% of patients, age 50-74, American Indian or Alaskan Native, women

The percent of the "Total # of clinic patients, 50-74, women" who are American Indian or Alaskan Native (i.e., persons having origins in any of the original peoples of North and South America, including Central America, and who maintain tribal affiliation or community attachment). Report whole number as percent. For example, enter 67 for 67%, not 0.67. Leave blank if unknown.

It is acceptable to report the percent based on the total clinic population if unknown for those age 50-74.

Num

00-100

4j

B

% of patients, age 50-74, More than one race, women

The percent of the "Total # of clinic patients, 50-74, women" who are more than one race (i.e., persons having origins in two or more of the federally designated racial categories). Report whole number as percent. For example, enter 67 for 67%, not 0.67. Leave blank if unknown.

It is acceptable to report the percent based on the total clinic population if unknown for those age 50-74.

Num

00-100

4k

B

Section 4 Comments

Optional comments for Section 4.

Char

Free text

200 char limit




Sections 5-12 contain longitudinal data reported at BASELINE and ANNUALLY (as indicated) through the end of the FOA for each participating clinic.

Section 5: REPORT PERIOD

Section 6: CHART REVIEW (CR) SCREENING RATE DATA FOR BREAST CANCER

Section 7: ELECTRONIC HEALTH RECORDS (EHR) SCREENING RATE DATA FOR BREAST CANCER

Section 8: MONITORING AND QUALITY IMPROVEMENT FOR BREAST CANCER SCREENING

Section 9: EVIDENCE-BASED INTERVENTIONS (EBIs)

Section 10: PROFESSIONAL DEVELOPMENT AND PROVIDER EDUCATION

Section 11: COMMUNITY OUTREACH, EDUCATION, AND SUPPORT

Section 12: PATIENT NAVIGATION FOR SCREENING, DIAGNOSTICS, AND/OR TREATMENT INITIATION

Section 13: OTHER BREAST CANCER-RELATED STRATEGIES



Section 5: REPORT PERIOD

5a


B*, A*

Report period

Reporting period represented in sections 5-12 where longitudinal data items are reported.

Baseline data are reported once as new clinics are recruited to participate in NBCCEDP breast cancer activities and prior to the start of NBCCEDP supported implementation activities.


Annual data are reported at the end of each program year (py).


Note that the screening rates reported at baseline and annually use a consistent 12-month reporting period.

List

Baseline

NBCCEDP 1701-py1

NBCCEDP 1701-py2

NBCCEDP 1701-py3

NBCCEDP 1701-py4

NBCCEDP 1701-py5

5b

A*

Implementation status

Indicates if implementation activities have started using NBCCEDP resources to support 1 or more EBIs to increase breast cancer screening during the program year. If resources were used for EBI planning only (see items 9a-g4), report ‘Not started’.


If implementation has not started, skip to 5d.

List

Started

Not started

5c

A*

Implementation start date

Month and year when implementation is started. For this variable, implementation is defined as using NBCCEDP resources to put one or more new EBIs in place or enhance/improve an EBI (or EBIs) that was in place at baseline.


MM/YYYY


5d

A*

Breast cancer activity partnership status


Indicates if the NBCCEDP breast cancer EBI activities with this clinic have been terminated with no implementation or breast cancer screening rate monitoring activities conducted this program year or planned through the end of the FOA.

If not terminated, skip to 6a.

List

Not terminated

Terminated


5e

A*

Reason for termination

Reason that breast cancer EBI implementation and screening rate monitoring activities have been terminated.

Char


Free text

200 char limit

5f

A*

Termination date

Month and year when the clinic partnership for breast cancer EBI activities and screening rate monitoring activities were terminated.

Date

MM/YYYY


Section 6: CHART REVIEW (CR) SCREENING RATE DATA for BREAST CANCER

(*Screening rate data may be reported using chart review, EHR or both)

(*Baseline screening rate data are not reported for newly opened clinics, Item 3m)

6a

Comp

CR Screening rate (%)

THIS RATE WILL BE AUTOMATICALLY CALCULATED USING THE NUMERATOR AND DENOMINATOR REPORTED BELOW.

Num

00-100

6b

B*, A*

CR Denominator to calculate screening rate

Denominator is dependent on the measure used (e.g., GPRA, HEDIS, NQF). Please see Appendix 1 in CDC Guidance for Measuring Breast, Cervical, and Colorectal Cancer Screening Rates in Health System Clinics.

Num

1-9999999

6c

B*, A*

CR Numerator to calculate screening rate

Numerator is dependent on the measure used (e.g., GPRA, HEDIS, NQF). Please see Appendix 1 in CDC Guidance for Measuring Breast, Cervical, and Colorectal Cancer Screening Rates in Health System Clinics.

Num

0-9999999

6d

B*, A*

If screening rate unavailable, date the rate will be available

If a screening rate cannot be obtained when completing the clinic baseline or annual assessment, provide the approximate date that the screening rate will be available.


A baseline screening rate will not be available for a new clinic that was not in operation for at least one full year prior to the baseline assessment. Refer to item 3m.

Date

MM/DD/YYYY

6e

B*, A*

Measure used

Indicates the measure that was used to calculate the numerator and denominator for the screening rate.

If an existing measure (i.e., HEDIS, GPRA) was not used, the
CDC Guidance for Measuring Breast, Cervical, and Colorectal Cancer Screening Rates in Health System Clinics provides information on calculating a NQF-endorsed measure. If this is used, “NQF” should be selected.

The same measure reported at baseline should be used for reporting in subsequent years.

List

 

GPRA

HEDIS

NQF

Other

6f

B*, A*

Start date of 12-month reporting period

The reporting period for the baseline screening rate should be the most recent 12-month reporting period available. The start date for this 12-month reporting period should not be more than 2 years prior to the anticipated start date of NBCCEDP supported activities.
The same 12-month measurement period should be used for all subsequent years of breast cancer screening rate data collection for this clinic.

Date

MM/DD/YYYY

6g

B*, A*

End date of 12-month reporting period


The reporting period for the baseline screening rate should be the most recent 12-month measurement period available.
The same 12-month measurement period should be used for all subsequent years of breast cancer screening rate data collection for this clinic.

Date

MM/DD/YYYY


6h

B*, A*

% of charts reviewed to calculate screening rate

Indicates the percent of medical charts that were reviewed. A minimum of 10% or 100 charts should be reviewed. The percent should be based on the number of women meeting the denominator definition for the measure used (e.g., for HEDIS, 10% of charts for women ages 52-74, who had at least one medical visit during the measurement year). See CDC Guidance for Measuring Breast, Cervical, and Colorectal Cancer Screening Rates in Health System Clinics.


THIS % WILL BE AUTOMATICALLY CALCULATED USING THE DENOMINATOR AND TOTAL # OF CLINIC PATIENTS REPORTED ABOVE FOR THIS PY.

Num

00-100

6i

B*, A*

Sampling method

Were records selected (through either a random or systematic sampling method) to generate a representative sample of the entire population of patients who meet the inclusion/selection criteria? See CDC Guidance for Measuring Breast, Cervical, and Colorectal Cancer Screening Rates in Health System Clinics.


A random sample takes a randomly assigned subset of the population identified in the sampling frame. This is typically accomplished through generating a random number that will be assigned to each patient in the sampling frame. This can be accomplished in many ways (e.g., random number table, web-based software, computer software).


A systematic sample orders every patient (e.g., alphabetically, by ID) in the sampling frame and then selects every nth patient.

List

Yes

No

Unk

6j

B, A

Section 6 Comments

Optional comments for Section 6.

Char

Free text

200 Char limit











Section 7: ELECTRONIC HEALTH RECORDS (EHR) SCREENING RATE DATA for BREAST CANCER

(*Screening rate data may be reported using chart review, EHR or both)

(*Baseline screening rate data are not reported for newly opened clinics, Item 3m)

7a

Comp

EHR Screening rate (%)

THIS RATE WILL BE AUTOMATICALLY CALCULATED USING THE NUMERATOR AND DENOMINATOR REPORTED BELOW.

Num

00-100

7b

B*, A*

EHR Denominator to calculate screening rate

Denominator is dependent on the measure used (e.g., GPRA, HEDIS, NQF). Please see Appendix 1 in CDC Guidance for Measuring Breast, Cervical, and Colorectal Cancer Screening Rates in Health System Clinics.

Num

1-9999999

7c

B*, A*

EHR Numerator to calculate screening rate

Numerator is dependent on the measure used (e.g., GPRA, HEDIS, NQF). Please see Appendix 1 in CDC Guidance for Measuring Breast, Cervical, and Colorectal Cancer Screening Rates in Health System Clinics.

Num

0-9999999

7d

B*, A*

If screening rate unavailable, date the rate will be available

If a screening rate cannot be obtained when completing the clinic baseline or annual assessment, provide the approximate date that the screening rate will be available.

(Report '15' as default value for the day).


A baseline screening rate will not be available for a new clinic that was not in operation for at least one full year prior to the baseline assessment. Refer to item 3m.

Date

MM/DD/YYYY

7e

B*, A*

Measure used

 

 

 

 

Indicates the measure that was used to calculate the numerator and denominator for the screening rate.

If an existing measure (i.e., HEDIS, GPRA) was not used, the
CDC Guidance for Measuring Breast, Cervical, and Colorectal Cancer Screening Rates in Health System Clinics provides information on calculating a NQF-endorsed measure. If this is used, "NQF" should be selected.

The same measure reported at baseline should be used for reporting in subsequent years.

List

 

GPRA

HEDIS

NQF

Other

7f

B*, A*

Start date of 12-month reporting period

The reporting period for the baseline screening rate should be the most recent 12-month reporting period available and consistent with the measure used (see CDC Guidance for Measuring Breast, Cervical, and Colorectal Cancer Screening Rates in Health System Clinics). The start date for this 12-month reporting period should not be more than 2 years prior to the anticipated start date of NBCCEDP supported activities.

The same 12-month measurement period should be used for all subsequent years of breast cancer screening rate data collection for this clinic.

Date

MM/DD/YYYY

7g

B*, A*

End date of 12-month reporting period

The reporting period for the baseline screening rate should be the most recent 12-month reporting period available.
The same 12-month measurement period should be used for all subsequent years of breast cancer screening rate data collection for this clinic.

Date

MM/DD/YYYY

7h

B*, A*

EHR rate reporting source

Indicates the source of the denominator and numerator data reported for the EHR screening rate.

List

HCCN data warehouse

Clinic EHR

Health system EHR

EHR Vendor

Other

7i

B*, A*

How confident are you in the accuracy of the EHR-calculated screening rate?

Indicates the grantee's confidence in the accuracy of the EHR-calculated screening rate. Accuracy of EHR-calculated screening rates can vary depending on how data are documented and entered into the EHR. For additional information, see the National Colorectal Cancer Roundtable’s summary report, “Use of Electronic Medical Records to Facilitate Colorectal Cancer Screening in Community Health Centers" and CDC Guidance for Measuring Breast, Cervical, and Colorectal Cancer Screening Rates in Health System Clinics.

List

Not confident

Somewhat confident

Very confident

7j

B*, A*

Screening rate problem

Are there known unresolved problems with the EHR reported screening rate or screening data quality?

List

Yes

No

7k

B*, A*

Specify screening rate problem


If 7j is YES, specify the problem and any activities conducted this program year to address it.


Describe the issue and severity of known problems or rationale for low confidence in the validity of the EHR-reported screening rate. Specify any activities such as improvements made to data entry systems or to the screening rate measurement calculation.

Char

Free text

256 Char limit

7l

A*

Screening rate target

Indicates the screening rate target established for the subsequent annual screening rate reporting period. The number represents a percentage value (rate per 100).


Targets should be realistic and actionable.

Num

1-100

999 (No target set)

7m

B, A

Section 7 Comments

Optional comments for Section 7.

Char

Free text

200 Char limit



Section 8: MONITORING AND QUALITY IMPROVEMENT for BREAST CANCER SCREENING


8a

B*, A*

Clinic screening policy

Does the clinic have a written breast cancer screening policy or protocol in use?

A credible policy should include a defined set of guidelines and procedures in place and in use at the clinic or parent health system to support breast cancer screening; a team responsible for implementing the policy; and a quality assurance structure (e.g., professional screening guideline followed, such as USPSTF, process to assess patient screening history/risk/preference/insurance, process for scheduling screening or referral, steps/procedures/roles to implement the office policy).

List

Yes

No


8b

A*

Frequency of monitoring breast cancer screening rate

Indicates how often the clinic breast cancer screening rate is monitored and reviewed by clinic personnel.


Select the response that best matches monitoring frequency.

List

Monthly

Quarterly

Semi-annually

Annually

8c

A*

Frequency of implementation support to clinic

On-site or direct contacts (e.g., telephone) with the clinic to support and improve implementation activities for EBIs and breast cancer screening data quality. Support could be provided by a grantee or contracted agent. Example support activities include conducting a clinic workflow assessment; providing technical assistance on implementing an EBI; training staff to support an EBI; providing technical assistance to develop a breast cancer screening policy; or providing feedback to staff from monitoring or evaluating an EBI implementation.

Select the response that best matches delivery of implementation support.

List

Weekly

Monthly

Quarterly

Semi-annually

Annually

8d

A*

Validated cancer screening rate

Validated the breast cancer screening rate data using chart review or other methods during this PY.

List

Yes

No


8e

B*, A*


Clinic champion


Is there a known champion for breast cancer screening internal to this clinic or parent health system?


List

Yes

No


8f

B*, A*

BCCEDP clinical services

Does your program support/reimburse for breast cancer screening, diagnostics, and/or patient navigation services at this clinic? Funding could come from CDC, your state, or other sources.

List

Yes

No


8g

A

Section 8 Comments

Optional comments for Section 8.

Char

Free text

200 Char limit



Section 9: EVIDENCE-BASED INTERVENTIONS (EBIs)


For each EBI, report (baseline) implementation status, and (annually) whether NBCCEDP resources supported the EBI during the PY, if the EBI is in place and operational at the end of the PY (and if not in place were planning activities conducted), and if the EBI is sustainable.

EBI (Patient reminder system)

System in place to remind patients when they are due for breast cancer screening. Patient reminders are written (e.g., letter, postcard, email) or telephone messages (including automated messages).

9a1

B*

Patient reminder system

in place at baseline

Indicates whether the EBI is in place for breast cancer screening and operational (in use) in this clinic before your NBCCEDP begins implementation, regardless of the quality, reach, or current level of functionality. Any activities that were implemented as a part of a previous NBCCEDP funding cycle (DP12-1205) should be considered as operational prior to NBCCEDP DP17-1701 implementation.

List

Yes

No


9a2

A*

Were NBCCEDP resources used toward a patient reminder system during this PY?

Indicates whether NBCCEDP grantee resources (e.g., funds, staff time, materials, contracts) were used during this PY to contribute to planning, developing, implementing, monitoring/evaluating, or improving the EBI for breast cancer screening.

List

Yes

No


9a3

A*

Patient reminder system

in place at PY end

Indicates whether the EBI is in place for breast cancer screening and operational (in use) in this clinic at the end of the PY, regardless of the quality, reach, or current level of functionality.

List

Yes

No


9a4

A*

Patient reminder system modality

If in place (9a3 is Yes), indicates whether an average patient at this clinic received breast cancer screening reminders in more than one way (e.g., same patient received 3 reminders: one by letter, another by text message, and a third by telephone) or a reminder type multiple times (e.g., same patient received 2 different text message reminders or 2 different telephone messages) during this PY.

List

Yes

No

9a5

A*

Patient reminder dosage

If multi-modal (9a4 is Yes) for breast cancer screening, how many different ways or different times did a given patient receive breast cancer screening reminders?

List

2

3

4

5 or more

9a6

A*

Patient reminder system planning activities

If not in place (9a3 is No)were planning activities conducted this year for future implementation of the EBI for breast cancer screening?

List

Yes

No


9a7

A*

Patient reminder system sustainability

If in place (9a3 is Yes) for breast cancer screening, do you consider the EBI as fully integrated into health system and/or clinic operations and sustainable? [High quality implementation has been achieved and a supporting infrastructure is in place along with any financial support needed to maintain the EBI. The EBI has become an institutionalized component of the health system and/or clinic operations.]

List

Yes, with NBCCEDP resources

Yes, without NBCCEDP resources

No


EBI (Provider reminder system)

System in place to inform providers that a patient is due (or overdue) for breast cancer screening. The reminders can be provided in different ways, such as in patient charts or by e-mail.

9b1

B*

Provider reminder system

in place at baseline

Indicates whether the EBI is in place for breast cancer screening and operational (in use) in this clinic before your NBCCEDP begins implementation, regardless of the quality, reach, or current level of functionality. Any activities that were implemented as a part of a previous NBCCEDP funding cycle (DP12-1205) should be considered as operational prior to NBCCEDP DP17-1701 implementation.

List

Yes

No


9b2

A*

Were NBCCEDP resources used toward a provider reminder system during this PY?

Indicates whether NBCCEDP grantee resources (e.g., funds, staff time, materials, contracts) were used during this PY to contribute to planning, developing, implementing, monitoring/evaluating, or improving the EBI for breast cancer screening.

List

Yes

No


9b3

A*

Provider reminder system

in place at PY end

Indicates whether the EBI is in place for breast cancer screening and operational (in use) in this clinic at the end of the PY, regardless of the quality, reach, or current level of functionality.

List

Yes

No


9b4

A*

Provider reminder system modality

If in place (9b3 is Yes), indicates whether providers at this clinic typically received breast cancer screening reminders for a given patient in multiple ways during this PY (e.g., provider receives both an EHR pop-up message and a flagged patient chart for same patient).

List

Yes

No

9b5

A*

Provider reminder system dosage

If multi-modal (9b4 is Yes), on average, how many different ways did providers receive breast cancer screening reminders for a given patient?

List

2

3

4

5 or more

9b6

A*

Provider reminder system planning activities

If not in place (9b3 is No) were planning activities conducted this year for future implementation of the EBI for breast cancer screening?

List

Yes

No


9b7

A*

Provider reminder system sustainability

If in place (9b3 is Yes) for breast cancer screening, do you consider the EBI as fully integrated into health system and/or clinic operations and sustainable? [High quality implementation has been achieved and a supporting infrastructure is in place along with any financial support needed to maintain the EBI. The EBI has become an institutionalized component of the health system and/or clinic operations.]

List

Yes, with NBCCEDP resources

Yes, without NBCCEDP resources

No


EBI (Provider assessment and feedback)

System in place to both evaluate provider performance in delivering or offering breast cancer screening to patients (assessment) and present providers with information about their performance in providing breast cancer screening services (feedback).

9c1

B*

Provider assessment and feedback

in place at baseline

Indicates whether the EBI is in place for breast cancer screening and operational (in use) in this clinic before your NBCCEDP begins implementation, regardless of the quality, reach, or current level of functionality. Any activities that were implemented as a part of a previous NBCCEDP funding cycle (DP12-1205) should be considered as operational prior to NBCCEDP DP17-1701 implementation.

List

Yes

No


9c2

A*

Were NBCCEDP resources used toward provider assessment and feedback during this PY?

Indicates whether NBCCEDP grantee resources (e.g., funds, staff time, materials, contracts) were used during this PY to contribute to planning, developing, implementing, monitoring/evaluating, or improving the EBI for breast cancer screening.

List

Yes

No


9c3

A*

Provider assessment and feedback

in place at PY end

Indicates whether the EBI is in place for breast cancer screening and operational (in use) in this clinic at the end of the PY, regardless of the quality, reach, or current level of functionality.

List

Yes

No


9c4

A*

Provider assessment and feedback frequency

If in place (9c3 is Yes), indicates, on average, how often providers were given feedback on their performance in providing breast cancer screening services during this PY.

List

Weekly

Monthly

Quarterly

Annually

9c5

A*

Provider assessment and feedback planning activities

If not in place (9c3 is No) were planning activities conducted this year for future implementation of the EBI for breast cancer screening?

List

Yes

No


9c6

A*

Provider assessment and feedback sustainability

If in place (9c3 is Yes) for breast cancer screening, do you consider the EBI as fully integrated into health system and/or clinic operations and sustainable? [High quality implementation has been achieved and a supporting infrastructure is in place along with any financial support needed to maintain the EBI. The EBI has become an institutionalized component of the health system and/or clinic operations.]

List

Yes, with NBCCEDP resources

Yes, without NBCCEDP resources

No


EBI (Reducing structural barriers)

Clinic has assessed structural barriers to breast cancer screening that are relevant to the clinic patient population and has addressed these barriers through one or more interventions. Structural barriers are non-economic burdens or obstacles that make it difficult for people to access cancer screening. Do not include patient navigation or community health workers as "reducing structural barriers."

9d1

B*

Reducing structural barriers

in place at baseline

Indicates whether the EBI is in place for breast cancer screening and operational (in use) in this clinic before your NBCCEDP begins implementation, regardless of the quality, reach, or current level of functionality. Any activities that were implemented as a part of a previous NBCCEDP funding cycle (DP12-1205) should be considered as operational prior to NBCCEDP DP17-1701 implementation.

List

Yes

No


9d2

A*

Were NBCCEDP resources used toward reducing structural barriers during this PY?

Indicates whether NBCCEDP grantee resources (e.g., funds, staff time, materials, contracts) were used during this PY to contribute to planning, developing, implementing, monitoring/evaluating, or improving the EBI for breast cancer screening.

List

Yes

No


9d3

A*

Reducing structural barriers

in place at PY end

Indicates whether the EBI is in place for breast cancer screening and operational (in use) in this clinic at the end of the PY, regardless of the quality, reach, or current level of functionality.

List

Yes

No


9d4

A*

Reducing structural barriers modality

If in place (9d3 is Yes), indicates whether this clinic reduced structural barriers for patients in multiple ways during this PY (e.g., offered evening clinic hours, provided free screenings for some patients).

List

Yes

No

9d5

A*

Reducing structural barriers dosage

If multi-modal (9d4 is Yes), how many different ways did the clinic reduce structural barriers to breast cancer screening during this PY?

List

2

3

4

5 or more

9d6

A*

Reducing structural barriers planning activities

If not in place (9d3 is No)were planning activities conducted this year for future implementation of the EBI for breast cancer screening?

List

Yes

No


9d7

A*

Reducing structural barriers sustainability




If in place (9d3 is Yes) for breast cancer screening, do you consider the EBI as fully integrated into health system and/or clinic operations and sustainable? [High quality implementation has been achieved and a supporting infrastructure is in place along with any financial support needed to maintain the EBI. The EBI has become an institutionalized component of the health system and/or clinic operations.]


List

Yes, with NBCCEDP resources

Yes, without NBCCEDP resources
No


EBI (Small media)

Indicates whether small media are distributed to clinic patients. Small media are materials used to inform and motivate people to be screened for breast cancer, including videos and printed materials (e.g., letters, brochures, and newsletters).

9e1

B*

Small media

in place at baseline

Indicates whether the EBI is in place for breast cancer screening and operational (in use) in this clinic before your NBCCEDP begins implementation, regardless of the quality, reach, or current level of functionality. Any activities that were implemented as a part of a previous NBCCEDP funding cycle (DP12-1205) should be considered as operational prior to NBCCEDP DP17-1701 implementation.

List

Yes

No


9e2

A*

Were NBCCEDP resources used toward small media during this PY?

Indicates whether NBCCEDP grantee resources (e.g., funds, staff time, materials, contracts) were used during this PY to contribute to planning, developing, implementing, monitoring/evaluating, or improving the EBI for breast cancer screening.

List

Yes

No


9e3

A*

Small media

in place at PY end

Indicates whether the EBI is in place for breast cancer screening and operational (in use) in this clinic at the end of the PY, regardless of the quality, reach, or current level of functionality.

List

Yes

No


9e4

A*

Small media modality

If in place (9e3 is Yes), indicates whether a given patient received multiple forms of small media related to breast cancer screening (e.g., the same patient received a postcard, was exposed to posters in the office setting, received a clinic newsletter or brochure) during this PY.

List

Yes

No

9e5

A*

Small media dosage

If multi-modal (9e4 is Yes) how many different ways did a given patient likely receive small media about breast cancer screening?

List

2

3

4

5 or more

9e6

A*

Small media planning activities

If not in place (9e3 is No) were planning activities conducted this year for future implementation of the EBI for breast cancer screening?

List

Yes

No


9e7

A*

Small media sustainability

If in place (9e3 is Yes) for breast cancer screening, do you consider the EBI as fully integrated into health system and/or clinic operations and sustainable? [High quality implementation has been achieved and a supporting infrastructure is in place along with any financial support needed to maintain the EBI. The EBI has become an institutionalized component of the health system and/or clinic operations.]

List

Yes, with NBCCEDP resources

Yes, without NBCCEDP resources

No


EBI (Patient education for clinic patients)

Indicates whether activities are in place to provide group or individual education to clinic patients on indications for, benefits of, and ways to overcome barriers to breast cancer screening with the goal of informing, encouraging, and motivating participants to seek recommended screening. Patient education may include role modeling or other interactive learning formats.

9f1

B*

Patient education

in place at baseline

Indicates whether the EBI is in place for breast cancer screening and operational (in use) in this clinic before your NBCCEDP begins implementation, regardless of the quality, reach, or current level of functionality. Any activities that were implemented as a part of a previous NBCCEDP funding cycle (DP12-1205) should be considered as operational prior to NBCCEDP DP17-1701 implementation.

List

Yes

No


9f2

A*

Were NBCCEDP resources used toward patient education during this PY?

Indicates whether NBCCEDP grantee resources (e.g., funds, staff time, materials, contracts) were used during this PY to contribute to planning, developing, implementing, monitoring/evaluating, or improving the EBI for breast cancer screening.

List

Yes

No


9f3

A*

Patient education

in place at PY end

Indicates whether the EBI is in place for breast cancer screening and operational (in use) in this clinic at the end of the PY, regardless of the quality, reach, or current level of functionality.

List

Yes

No


9f4

A*

Patient education dosage

If in place (9f3 is Yes), indicates, on average, how many hours of breast cancer screening education were received by a given patient during this PY.

List

Less than 15 minutes

15 to 30 minutes

31 minutes to 1 hour

2 to 3 hours

More than 3 hours

9f5

A*

Patient education planning activities

If not in place (9f3 is No) were planning activities conducted this year for future implementation of the EBI for breast cancer screening?

List

Yes

No


9f6

A*

Patient education sustainability

If in place (9f3 is Yes) for breast cancer screening, do you consider the EBI as fully integrated into health system and/or clinic operations and sustainable? [High quality implementation has been achieved and a supporting infrastructure is in place along with any financial support needed to maintain the EBI. The EBI has become an institutionalized component of the health system and/or clinic operations.]

List

Yes, with NBCCEDP resources

Yes, without NBCCEDP resources

No


EBI (Reducing out of pocket costs)

Indicates whether a system is in place to reduce patient out-of-pocket costs to minimize or remove economic barriers that make it difficult for patients to access breast cancer screening services. Reducing costs may include vouchers or reimbursements for transportation/parking, reduction in co-pays, reimbursing for breast cancer screening and/or diagnostics, or adjustments in federal or state insurance coverage.

9g1

B*

Reducing out of pocket costs

in place at baseline

Indicates whether the EBI is in place for breast cancer screening and operational (in use) in this clinic before your NBCCEDP begins implementation, regardless of the quality, reach, or current level of functionality. Any activities that were implemented as a part of a previous NBCCEDP funding cycle (DP12-1205) should be considered as operational prior to NBCCEDP DP17-1701 implementation.


If BCCEDP resources are used to support/reimburse for breast cancer screening and/or diagnostics, then this EBI should be considered in place.

List

Yes

No


9g2

A*

Were NBCCEDP resources used toward reducing out of pocket costs during this PY?

Indicates whether NBCCEDP grantee resources (e.g., funds, staff time, materials, contracts) were used during this PY to contribute to planning, developing, implementing, monitoring/evaluating, or improving the EBI for breast cancer screening.

List

Yes

No


9g3

A*

Reducing out of pocket costs

in place at PY end

Indicates whether the EBI is in place for breast cancer screening and operational (in use) in this clinic at the end of the PY, regardless of the quality, reach, or current level of functionality.


If BCCEDP resources were used to support/reimburse for breast cancer screening and/or diagnostics, then this EBI should be considered in place.

List

Yes

No


9g4

A*

Reducing out of pocket costs modality

If in place (9g3 is Yes), indicates whether this clinic reduced out of pocket costs for patients in multiple ways during this PY.

List

Yes

No

9g5

A*

Reducing out of pocket costs dosage

If multi-modal (9g4 is Yes), on average, how many different ways did the clinic use to reduce out of pocket costs for patients?

List

2

3

4

5 or more

9g6

A*

Reducing out of pocket costs planning activities

If not in place (9g3 is No) were planning activities conducted this year for future implementation of the EBI for breast cancer screening?

List

Yes

No


9g7

A*

Reducing out of pocket costs sustainability

If in place (9g3 is Yes) for breast cancer screening, do you consider the EBI as fully integrated into health system and/or clinic operations and sustainable? [High quality implementation has been achieved and a supporting infrastructure is in place along with any financial support needed to maintain the EBI. The EBI has become an institutionalized component of the health system and/or clinic operations.]

List

Yes, with NBCCEDP resources

Yes, without NBCCEDP resources

No



Section 10: PROFESSIONAL DEVELOPMENT AND PROVIDER EDUCATION

Indicates whether activities are in place to provide professional development/provider education to health care providers in this clinic on breast cancer screening. Activities may include distribution of provider education materials, including screening guidelines and recommendations, and/or continuing medical education (CMEs) opportunities.

10a1

B*

Professional development/provider education in place at baseline

Indicates whether this activity is in place for breast cancer screening and operational (in use) in this clinic before your NBCCEDP begins implementation, regardless of the quality, reach, or current level of functionality. Any activities that were implemented as a part of a previous NBCCEDP funding cycle (DP12-1205) should be considered as operational prior to NBCCEDP DP17-1701 implementation.

List

Yes

No


10a2

A*

Were NBCCEDP resources used toward professional development/provider education activities during this PY?

Indicates whether NBCCEDP grantee resources (e.g., funds, staff time, materials, contracts) were used during this PY to contribute to planning, developing, implementing, monitoring/evaluating, or improving the activity for breast cancer screening.

List

Yes

No


10a3

A*

Professional development/provider education

in place at PY end

Indicates whether the activity is in place and operational (in use) in this clinic at the end of the PY, regardless of the quality, reach, or current level of functionality.

List

Yes

No


10a4

A*

Professional development/provider education dosage

If in place (10a3 is Yes), indicates on average, how many hours of breast cancer screening professional development training or education were received by a given provider during this PY.

List

Less than 15 minutes

15 to 30 minutes

31 minutes to 1 hour

2 to 3 hours

More than 3 hours

Section 11: COMMUNITY OUTREACH, EDUCATION, AND SUPPORT

(Community outreach, education, and support; Other CCL activities)

For each community outreach, education, and support activity, report (baseline) implementation status, and (annually) whether NBCCEDP resources supported the activity during the PY, if the activity is in place and operational at the end of the PY (and if not in place were planning activities conducted), and if the activity is sustainable.

Community outreach, education, and support

Indicates whether community outreach and education activities are in place with the goal of linking women in the community to breast cancer screening services at this clinic. An example is using community health workers (CHWs) for community outreach. CHWs are lay health educators with a deep understanding of the community and are often members of the community being served. CHWs work in community settings to educate people about cancer screening, promote cancer screening, and provide peer support to people referred to cancer screening.

11a1

B*

Community outreach activities

in place at baseline

Indicates whether this activity is in place for breast cancer screening and operational (in use) in this clinic before your NBCCEDP begins implementation, regardless of the quality, reach, or current level of functionality. Any activities that were implemented as a part of a previous NBCCEDP funding cycle (DP12-1205) should be considered as operational prior to NBCCEDP DP17-1701 implementation.

List

Yes

No


11a2

A*

Were NBCCEDP resources used toward community outreach activities during this PY?

Indicates whether NBCCEDP grantee resources (e.g., funds, staff time, materials, contracts) were used during this PY to contribute to planning, developing, implementing, monitoring/evaluating, or improving the activity for breast cancer screening.

List

Yes

No


11a3

A*

Community outreach activities

in place at PY end

Indicates whether the activity is in place for breast cancer screening and operational (in use) in this clinic at the end of the PY, regardless of the quality, reach, or current level of functionality.

List

Yes

No


11a4

A*

Community outreach activities dosage

If in place (11a3 is Yes), for persons in the clinic’s community who were exposed to outreach activities conducted by the clinic during this PY, indicates the amount of time a given person received those activities.

List

Less than 15 minutes

15 to 30 minutes

31 minutes to 1 hour

2 to 3 hours

More than 3 hours

11a5

A*

Community outreach planning activities

If not in place (11a3 is No) were planning activities conducted this year for future implementation of the activity for breast cancer screening?

List

Yes

No


11a6

A*

Community outreach sustainability

If in place (11a3 is Yes) for breast cancer screening, do you consider the activity as fully integrated into health system and/or clinic operations and sustainable? [High quality implementation has been achieved and a supporting infrastructure is in place along with any financial support needed to maintain the activity. The activity has become an institutionalized component of the health system and/or clinic operations.]

List

Yes, with NBCCEDP resources

Yes, without NBCCEDP resources

No


11a7

B*, A*

If community health workers (CHWs) used, # of FTE CHWs

The number of CHW full time equivalents (FTEs) employed at or by the clinic during the program year for breast cancer screening. For this number, please provide the total sum of whole and partial FTEs to the nearest tenths decimal place. For example, if 2 CHWs work a total of 50% time, then enter 0.50.

Num

00.0-999.0

Other community-clinical linkage (CCL) activities

Indicates whether other CCL activities are in place at or employed by the clinic to link priority population members in the community to breast cancer screening services at this clinic.

11b

B*, A*

Other community-clinical linkage (CCL) activities

Describe other activities this clinic is conducting to link women in the community to breast cancer screening services in this clinic.

Char

Free text

256 Char limit

Section 12: PATIENT NAVIGATION FOR SCREENING, DIAGNOSTICS, AND/OR TREATMENT INITIATION

For each patient navigation for screening, diagnostics, and/or treatment initiation activity, report (baseline) implementation status, and (annually) whether NBCCEDP resources supported the activity during the PY, if the activity is in place and operational at the end of the PY (and if not in place were planning activities conducted), and if the activity is sustainable.

Patient navigation for screening, diagnostics, and/or treatment initiation

Indicates whether patient navigation is in place at this clinic. Patient navigation involves assisting clients in overcoming individual barriers to breast cancer screening and typically includes assessment of patient barriers; patient education and support; resolution of patient barriers; patient tracking; and follow-up. Patient navigation should involve multiple contacts with a patient. Refer to the CDC Patient Navigation Policy for more guidance.

12a1

B*

Patient navigation

in place at baseline

Indicates whether patient navigation is in place for breast cancer screening and operational (in use) in this clinic before your NBCCEDP begins implementation, regardless of the quality, reach, or current level of functionality. Any activities that were implemented as a part of a previous NBCCEDP funding cycle (DP12-1205) should be considered as operational prior to NBCCEDP DP17-1701 implementation.

List

Yes

No


12a2

A*

Were NBCCEDP resources used toward patient navigation during this PY?

Indicates whether NBCCEDP grantee resources (e.g., funds, staff time, materials, contracts) were used during this PY to contribute to planning, developing, implementing, monitoring/evaluating, or improving patient navigation activities for breast cancer.

List

Yes

No


12a3

A*

Patient navigation in place at PY end

Indicates whether patient navigation for breast cancer is in place and operational (in use) in this clinic at the end of the PY, regardless of the quality, reach, or current level of functionality.

List

Yes

No


12a4

A*

Patient navigation dosage

If in place (12a3 is Yes), for persons at this clinic who received navigation this PY, indicates the average amount of navigation time she received to overcome breast cancer screening barriers.

List

Less than 15 minutes

15 to 30 minutes

31 minutes to 1 hour

2 to 3 hours

More than 3 hours

12a5

A*

Patient navigation planning activities

If not in place (12a3 is No) were planning activities conducted this year for future implementation of the patient navigation for breast cancer?

List

Yes

No


12a6

A*

Patient navigation sustainability

If in place (12a3 is Yes), do you consider patient navigation for breast cancer as fully integrated into health system and/or clinic operations and sustainable? [High quality implementation has been achieved and a supporting infrastructure is in place along with any financial support needed to maintain the activity. The activity has become an institutionalized component of the health system and/or clinic operations.]

List

Yes, with NBCCEDP resources

Yes, without NBCCEDP resources

No


12a7

B*, A*

If patient navigation in place, # of FTEs delivering patient navigation

The number of full time equivalents (FTEs) conducting patient navigation (e.g., navigators, nurse navigators, nurses, peer health advisors, health navigators) for breast cancer in this clinic. For this number, please provide the total sum of whole and partial FTEs to the nearest tenths decimal place. For example, if 2 patient navigators work a total of 50% time to delivery navigation for breast cancer, then enter 0.50.

Num

00.0-999.0

12a8

A

If patient navigation in place, # of clients navigated

Report the number of clients receiving navigation services for breast cancer during this program year.   

Num

1-99998

99999 (Unk)

Section 13: Other breast cancer-related strategies (Optionally report any in place at baseline, and report annually on up to 3 other strategies)

(e.g., clinic workflow assessment and data driven optimization; other data driven quality improvement strategies; 5 rights of clinical decision support [5 Rs], etc.)

13a1

B

HIT activities in place at baseline

Describe any activities in place to improve the use of health information technology (e.g., electronic medical records) for breast cancer screening in the clinic. Activities may include standardization of data fields used to document a patient’s breast cancer screening, linkage of data to mammography reports, etc.

Char

Free text

256 Char limit

13a2

B

Other breast cancer-related strategies in place at baseline

Any other activities or strategies that are in place to increase breast cancer screening in this clinic.

Char

Free text

256 Char limit


Other Breast Cancer Activity 1

13b1

A

Other breast cancer Activity 1

Description of other breast cancer activity or strategy (1).

Char

Free text

200 Char limit

13b2

A

Were NBCCEDP resources used towards Activity1 during this PY?

Indicates whether NBCCEDP grantee resources (e.g., funds, staff time, materials, contract) were used during this PY to contribute to planning, developing, implementing, monitoring/evaluating or improving the activity.

List

Yes

No



Other Breast Cancer Activity 2

13c1

A

Other breast cancer Activity 2

Description of other breast cancer activity or strategy (2).

Char

Free text

200 Char limit

13c2

A

Were NBCCEDP resources used towards Activity2 during this PY?

Indicates whether NBCCEDP grantee resources (e.g., funds, staff time, materials, contract) were used during this PY to contribute to planning, developing, implementing, monitoring/evaluating or improving the activity.

List

Yes

No



Other Breast Cancer Activity 3

13d1

A

Other breast cancer Activity 3

Description of other breast cancer activity or strategy (3).

Char

Free text

200 Char limit

13d2

A

Were NBCCEDP resources used towards Activity3 during this PY?

Indicates whether NBCCEDP grantee resources (e.g., funds, staff time, materials, contract) were used during this PY to contribute to planning, developing, implementing, monitoring/evaluating or improving the activity.

List

Yes

No



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