CRCCP Clinic-level Information Collection

Colorectal Cancer Control Program (CRCCP) Monitoring Activities

Att 5b - CRCCP Clinic Data Definitions

CRCCP Clinic-level Information Collection

OMB: 0920-1074

Document [docx]
Download: docx | pdf

Shape2

CRCCP NOFO 2020-2002

OMB # 0920-1074

Expiration Date: XX/XX/XXXX

Version date:


Attachment 5b:

Colorectal Cancer Control Program (CRCCP)

Clinic Data Dictionary























Public reporting burden of this collection of information is estimated to average 50 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 30333; ATTN: PRA (XXXX-XXXX).





CRCCP Clinic Data Dictionary (NOFO DP20-2002)

Contents


Part I: Partner and Record Identifiers


Shape1

CRCCP DP20-2002

Program Years (PY)



Start Date

end date

PY 1

July 1, 2020

June 30, 2021

PY 2

July 1, 2021

June 30, 2022

PY 3

July 1, 2022

June 30, 2023

PY 4

July 1, 2023

June 30, 2024

PY 5

July 1, 2024

June 30, 2025


Part II: Baseline and Annual Record Data Items

Section 1. Baseline and Annual Clinic CRCCP Activity and Status

Section 2. Baseline and Annual Health System and Clinic Characteristics and Clinic Patient Population

Section 3. Baseline and Annual CRC Screening Rates and Practices

  • Screening Rate Status

  • Chart Review (CR) Screening Rates

  • Electronic Health Records (EHR) Screening Rates

  • CRC Screening Practices and Outcomes

Section 4. Baseline and Annual Monitoring and Quality Improvement Activities

Section 5. Baseline and Annual Evidence-based Interventions (EBIs) and Other Clinic Activities

  • 5-1: EBI-Patient Reminder System

  • 5-2: EBI-Provider Reminder System

  • 5-3: EBI-Provider Assessment and Feedback

  • 5-4: EBI-Reducing Structural Barriers

  • 5-5: Small Media

  • 5-6: Patient Navigation

Section 6. Annual Implementation Factors

Section 7. Other Baseline and Annual Colorectal Cancer Activities and Comments



Data Collection Notes:

  • Baseline data are required for all clinics participating in CRCCP- NOFO DP20-2002.

  • For clinics enrolled during the previous CRCCP funding period (NOFO DP15-1502) and still active, awardees must re-submit baseline data using the clinic's NOFO DP15-1502 program year 5 reported screening rates as the current baseline screening rates.

  • For new clinics, baseline data are reported when new clinics are enrolled to participate in CRCCP activities and reflect activities prior to CRCCP activity implementation (Item B1-1: Clinic CRCCP Activities Start Date).



Part I. Partner and Record Identifiers

Identifying information for the partner clinic and health system.

Item #

Item Type

Collected

CRCCP Data Item

Indication/ Definition

Field Type

Response Options

P1

R

B

Grantee code

Baseline Record:

Two-character Grantee Code (assigned by CDC)


Annual Record:

N/A


List

TBD- 2-digit code

P2

R


B

Clinic Enrollment NOFO

Baseline Record:

Indicates the NOFO during which the clinic was first enrolled into CRCCP.


Identifies the clinic as new to CRCCP and newly enrolled during NOFO DP20-2002 or if the clinic was recruited prior to this funding cycle and is continuing from NOFO DP15-1502 and if so, its status at the end of DP15-1502.


  • DP20-2002: Clinic is new to CRCCP (did not participate in NOFO DP151502.

  • DP15-1502 never terminated: Clinic is continuing on from NOFO DP15-1502 (never terminated)

  • DP15-1502 previously terminated: Clinic enrolled during NOFO DP15-1502 but ended CRCCP participation during that NOFO and is being re-enrolled into CRCCP as part of DP20-2002.


If unknown, select DP20-2002.



Annual Record:

N/A


List

  • DP20-2002

  • DP15-1502 never terminated

  • DP15-1502 previously terminated

P3

R

 B

CRCCP Partner Entity

Baseline Record:

Indicates the organizational level of the partner entity working with the grantee to implement CRC EBIs and associated population used for calculating screening rates.


Clinic partnerships are the preferred action. When reporting clinic-level data, the clinic/grantee must report clinic-specific screening rates and population counts (not health system rates and counts).


To report Health System-level data, you must have approval from CDC's Evaluation Team before enrolling the Health System.


In addition, four criteria must be met:

  1. All Clinics within the health system must be participating in CRCCP.

  2. The same EBIs must be implemented uniformly across ALL clinics within the health system

  3. The reported screening rate and population counts must be Health System-wide for ALL eligible patients at all clinics within the health system.

  4. Data for any individual clinic within the health system must not be reported separately. Thus, you will have only one record reported for the entire health system in CBARS. Within the record, information at the health system level will be reported for both the Health System and the individual Clinic fields. Contact CDC’s evaluation team for help with reporting these data.


Annual Record:

N/A


List

  • Clinic

  • Health System

  • Other (specify below)

P3a

R

B

Other Partner Entity specify

Baseline Record:

If other partner, provide description


Annual Record:

N/A


Char

Free text

200 Char limit

P4

R

B

Partner Type

Baseline Record:

Organizational classification of partner clinic/health system.


  • 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.


Annual Record:

N/A


List

  • CHC/FQHC

  • Health system/Hospital owned

  • Private/Physician owned

  • Health department

  • Tribal health

  • Primary Care Facility (non-CHC/FQHC)

  • Other

P5

R

B

Initial Partner Agreement

Baseline Record:

The initial type of formal agreement the grantee made with the partner health system and/or clinic for CRCCP activities.


Annual Record:

N/A


List

  • MOU/MOA

  • Contract

  • Other

  • None

P6

R

B

Date of Initial Partner Agreement

Baseline Record:

The original date the formal agreement was finalized between the grantee and partner clinic or health system for CRCCP activities.


Annual Record:

N/A


Date

MM/DD/YYYY

HS1

R

B

Health system name

Baseline Record:

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


Annual Record:

N/A


Char

Free text

100 Char limit

HS2

R

B

Health system ID

Baseline Record:

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 health system was recruited during NOFO DP15-1502, continue to use the existing three-digit health system ID that was assigned during NOFO DP15-1502

  • If this is a clinic where CDC’s NBCCEDP breast and/or cervical cancer activities are also being implemented, we encourage using the same three-digit health system identification code assigned by the NBCCEDP staff. Contact the NBCCEDP staff in your state for a list of clinics participating in the NBCCEDP.


Annual Record:

N/A

Num

001-999

HS3

R

B

HS Street

Baseline Record:

Street address for the partner health system. If the street address is more than two lines, use a comma for separation.


Annual Record:

N/A


Char

Free text

100 Char limit

HS4

R

B

HS City

Baseline Record:

City of the partner health system.


Annual Record:

N/A


Char

Free text

50 Char limit

HS5

R

B

HS State

Baseline Record:

Two-letter state or territory postal code for the partner health system.


Annual Record:

N/A


List

Various

HS6

R

B

HS zip code

Baseline Record:

5-digit zip code for the partner health system.


Annual Record:

N/A


Num

00001-99999

HS7

R

B

HS County

Baseline Record:

County where the primary administrative office of the health system is located


Annual Record:

N/A


Char

Free text

100 char limit

CL1

R

B

Clinic name

Baseline Record:

Name of the partner health clinic (intervention site).

  • If the partner is a health system (item P3 is “Health System”) then re-enter the Health System information as the clinic name


Annual Record:

N/A


Char

Free text

100 Char limit

CL2

R

B

Clinic ID

Baseline Record:

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


  • If this clinic was recruited during NOFO DP15-1502, continue to use the existing 3-digit clinic ID that was assigned during NOFO DP15-1502

  • If this is a clinic where CDC’s NBCCEDP breast and/or cervical cancer activities are also being implemented, we encourage using the same three-digit clinic identification code assigned by the NBCCEDP staff. Contact the NBCCEDP staff in your state for a list of clinics participating in the NBCCEDP.



Annual Record:

N/A


Num

001-999

CL3

R

B

Clinic Street

Baseline Record:

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

  • If the partner is a health system (item P3 is “Health System”) then re-enter the Health System information as the clinic name


Annual Record:

N/A


Char

Free text

100 Char limit

CL4

R

B

Clinic City

Baseline Record:

City of the partner clinic.

  • If the partner is a health system (item P3 is “Health System”) then re-enter the Health System information as the clinic name

Annual Record:

N/A

Char

Free text

50 Char limit

CL5

R

B

Clinic State

Baseline Record:

Two-letter state or territory postal code for the partner clinic.

  • If the partner is a health system (item P3 is “Health System”) then re-enter the Health System information as the clinic name


Annual Record:

N/A


List

Various

CL6

R

B

Clinic zip code

Baseline Record:

5-digit zip code for the partner clinic.

  • If the partner is a health system (item P3 is “Health System”) then re-enter the Health System information as the clinic name


Annual Record:

N/A


Num

00001-99999

CL7

R

B

Clinic County

Baseline Record:

County where the clinic is located

  • If the partner is a health system (item P3 is “Health System”) then re-enter the Health System information as the clinic name


Annual Record:

N/A


Char

Free text

100 char limit

P7

O

B

Part 1 Comments

Optional comments for Part 1.

Char

Free text

200 Char limit





Part II. Baseline and Annual Record Data Items



Section 1. Baseline and Annual Clinic CRCCP Activity and Status

If the partner is a health system (P3=” Health System”) then clinic data reported must represent the entire Health System


Item #

Item Type

Collected

CRCCP Data Item

Indication/ Definition

Field Type

Response Options

B1-1

R

B

Clinic CRCCP Activities Start Date

Baseline Record:

Indicates the date the clinic (or health system if reporting health system-level data) began actively implementing CRCCP [NOFO DP20-2002] activities.


Enter the date that the clinic started implementing CRCCP program activities to increase clinic-level colorectal cancer screening rates. Activities can include:

  • Enhancing existing EBIs

  • Implementing new CRCCP EBI activities

  • Conducting quality improvement activities to increase CRC screening rates such as:

    • Improving the quality of EHR screening data to produce an accurate CRC screening rate, integrate patient and provider reminder systems, or produce feedback reports;

    • Process mapping to identify areas where CRC screening can best be promoted or implemented;

    • Other activities that improve service delivery in ways to increase CRC screening.


  • Note: For clinics enrolled during the previous CRCCP funding period (NOFO DP15-1502), grantees must re-submit baseline data using the clinic's NOFO DP15-1502, PY5 screening rates for NOFO 20-2002 baseline screening rates. In such cases, the same 12-month screening rate measurement period and the same screening rate measure (e.g., UDS) must be used for reporting under DP20-2002.


For active clinics continuing from NOFO DP15-1502, (item P2, Clinic Enrollment NOFO is “DP15-1502 not terminated”) the clinic CRCCP activities start date will be automatically entered by CBARS as 07/01/2020.


Annual Record:

N/A


Date

MM/DD/YYYY

B1-2

Comp

B

Baseline PY

Baseline Record:

Baseline PY (based on activities start date)
- auto-calculated based on start date (item, B1-1)


Annual Record:

N/A


List

  • CRCCP 2020-2002-py1

  • CRCCP 2020-2002-py2

  • CRCCP 2020-2002-py3

  • CRCCP 2020-2002-py4

  • CRCCP 2020-2002-py5

A1-1

Comp

A

Annual Report Period

Baseline Record:

N/A


Annual Record:

Indicates the reporting period represented in the data submission


  • Annual data are reported at the end of each CRCCP program year (PY) and reflect activities conducted during that completed program year. Select the PY that matches the data that are being reported.

  • Screening rates reported at baseline and annually use a consistent 12-month measurement period that may be different from the CRCCP PY.


List

  • CRCCP 2020-2002-py1

  • CRCCP 2020-2002-py2

  • CRCCP 2020-2002-py3

  • CRCCP 2020-2002-py4

  • CRCCP 2020-2002-py5

A1-2

R

A

Annual Partner Status

Baseline Record:

N/A


Annual Record:

Indicates the status of CRCCP supported colorectal cancer EBI implementation and screening rate monitoring activities at this clinic during the program year. Select only one response.

  • Active: Grantee actively worked with the clinic to 1) plan and/or implement CRCCP colorectal cancer EBI activities and 2) monitor the colorectal cancer screening rate. If any CRCCP activities were planned or conducted at any point during the PY with support from the grantee, enter “Active”.

  • Monitoring: Grantee did not provide CRCCP colorectal cancer EBI planning or implementation support (no active technical assistance provided) to the clinic during the PY but continued to monitor its screening rate and EBI implementation.

  • Suspended: Partnership with the clinic was temporarily stopped for the PY with no CRCCP EBI colorectal cancer planning or implementation or screening rate monitoring activities conducted during any time of this PY, but the clinic intends to resume CRCCP EBI activities at some time before the end of the current cooperative agreement.

    • Note: If any CRCCP activities were conducted during the PY, enter “Active” and submit a full annual record for this PY. Only use the response “Suspended” if CRCCP implementation was halted for the full year.

  • Terminated: Partnership with the clinic has ended with no CRCCP colorectal cancer EBI implementation or screening rate monitoring activities conducted during the PY or planned through the end of the cooperative agreement.

    • Note: If any CRCCP activities were conducted during the PY, enter “Active” and submit a full annual record for this PY. Only use the response “Terminated” if CRCCP implementation was terminated for the full year.


If active or monitoring, skip to Section 2

*Full annual record required for active or monitoring


List

Select one

Select one:

  • Active

  • Monitoring

  • Suspended

  • Terminated

A1-2a

R

A

Suspension/Termination date

Baseline Record:

N/A


Annual Record:

Indicates the date when the clinic partnership for CRCCP colorectal cancer EBI activities and screening rate monitoring activities were suspended or terminated. If the day is unknown use “15”

Date

MM/DD/YYYY

A1-2b

R

A

Reason for suspension or termination

Baseline Record:

N/A


Annual Record:

Reason(s) that CRCCP colorectal cancer EBI planning or implementation and screening rate monitoring activities have been suspended or terminated at the clinic.

Select all that apply.



List-

Select all that apply

Select all that apply:

  • Clinic implementation completed- no longer monitoring screening rates

  • Clinic non-performance

  • Clinic does not have resources/ capacity to participate

  • Clinic EHR problems or unable to collect clinic data

  • Clinic merged with another clinic

  • Clinic closed

  • Other

A1-2c

 R

A

Other reason for suspension or termination

Baseline Record:

N/A


Annual Record:

If item A1-2b is other, please specify


*End of record for partnership status (item A1-2) = suspended or terminated.


Char

Free text

200 char limit

COV-1

R

B&A

COVID-19 clinic closure or hours reduced

Baseline Record:

Indicates whether the clinic closed for an extended period (a full week or more) or reduced hours because of COVID-19 at any time during the year prior to CRCCP activity implementation (Item B1-1: Clinic CRCCP Activities Start Date).


Response option notes:

  • Closed= the clinic was completely closed to patients for an extended period of time (at least a full week or more) because of COVID-19.

  • Hours reduced= the clinic was partially closed to patients for a set number of days per week or a set number of hours per day because of COVID-19.


If closed, specify # of weeks in item COV-2 and impact in COV-4 and COV5

If reduced hours, specify amount in item COV-3 and impact in COV-4 and COV5

If no, skip to COV-4.


Annual Record:

Indicates whether the clinic closed for an extended period (a full week or more) or reduced hours because of COVID-19 at any time during the program year (July1- June 30).


Response option notes:

  • Closed= the clinic was completely closed to patients for an extended period of time (at least a full week or more) because of COVID-19.

  • Hours reduced= the clinic was partially closed to patients for a set number of days per week or a set number of hours per day because of COVID-19.


If closed, specify # of weeks in item COV-2 and impact in COV-4 and COV5

If reduced hours, specify amount in item COV-3 and impact in COV-4 and COV5

If no, skip to COV-4.

List – select one only


Select one:


  • Yes, closed

  • Yes, reduced hours

  • No, clinic did not close or reduce hours


COV-2

R

B&A

COVID-19 closure amount

Baseline Record:

Indicates the number of weeks, in total, the clinic was closed because of COVID-19 at any time during the year prior to CRCCP activity implementation (Item B1-1: Clinic CRCCP Activities Start Date).


Annual Record:

Indicates the number of weeks, in total, the clinic was closed because of COVID-19 at any time during the program year (July1- June 30).


_# of weeks


COV-3

R

B&A

COVID-19 Hours reduced

Baseline Record:

Indicates the amount of time, in total, the clinic reduced hours because of COVID-19 at any time during the year prior to CRCCP activity implementation (Item B1-1: Clinic CRCCP Activities Start Date).

  • If the clinic reduced hours for a set amount of hours per day, provide the number of hours reduced for the entire week and the total number of weeks in which the reduction occurred during the year prior to CRCCP implementation.

  • If the clinic reduced hours by closing for a set number of days per week, provide the number of days closed each week and the total number of weeks in which the reduction in days occurred during the year prior to CRCCP implementation.


Annual Record:

Indicates the amount of time, in total, the clinic reduced hours because of COVID-19 at any time during the program year (July1- June 30).

  • If the clinic reduced hours for a set amount of hours per day, provide the number of hours reduced for the entire week and the total number of weeks in which the reduction occurred during the program year.

  • If the clinic reduced hours by closing for a set number of days per week, provide the number of days closed each week and the total number of weeks in which the reduction in days occurred during the program year.


_#__ hours each week for __#__weeks


_#__ days per week for __#__weeks



COV-4

R

B&A

COVID-19 screening/diagnostic impact

Baseline:

Indicates whether COVID-19 negatively impacted the clinic’s delivery of colorectal cancer screening and diagnostic services during the year prior to CRCCP activity implementation (Item B1-1: Clinic CRCCP Activities Start Date).

  • If yes, indicate how the clinic was impacted in items COV-4a through COV-4h

  • If no, skip to COV-5


Annual:

Indicates whether COVID-19 negatively impacted the clinic’s delivery of colorectal cancer screening and diagnostic services during the program year (July 1- June 30).

  • If yes, indicate how the clinic was impacted in items COV-4a through COV-4h

  • If no, skip to COV-5

List


  • Yes

  • No

COV-4a

R

B&A

COVID-19 sick visits

Clinic visits were restricted to sick patients, with limited or no preventive care available

List

  • Yes No

COV-4b

R

B&A

COVID-19 high risk visits

Clinic visits were limited to patients at high risk for colorectal cancer or with symptoms for colorectal cancer

List

  • Yes No

COV-4c

R

B&A

COVID-19 telemed visits

Clinic visits were telehealth/telemedicine only

List

  • Yes No

COV-4d

R

B&A

COVID-19 no referrals for screening colo

Clinic could not refer average risk patients for screening colonoscopies due to limited availability of endoscopic services

List

  • Yes No

COV-4e

R

B&A

COVID-19 no referrals for follow-up colo

Clinic could not refer patients with positive or abnormal fecal test results for follow-up colonoscopies due to limited availability of endoscopic services

List

  • Yes No

COV-4f

R

B&A

COVID-19 pts cancelled

Patients cancelled or did not schedule appointments (e.g., due to COVID concerns)

List

  • Yes No

COV-4g

R

B&A

COVID-19 pts fearful

Patients fearful of getting COVID-19

List

  • Yes No

COV-4h

R

B&A

COVID-19 other

Other

List

  • Yes No

COV-4i

R

B&A

COVID-19 other specify

Other, specify

Char

Free text

200 char limit

COV-5

R

B&A

COVID-19 EBI impact

Baseline:

Indicates whether COVID-19 negatively impacted the clinic’s the implementation of evidence-based interventions (EBIs) or Patient Navigation activities for colorectal cancer screening during the year prior to CRCCP activity implementation (Item B1-1: Clinic CRCCP Activities Start Date). (e.g., implementation of some or all EBIs were suspended)

  • If yes, indicate all activities negatively impacted by COVID-19 in COV-5a through COV5-e

  • If no, skip to COV-6


Annual:

Indicates whether COVID-19 negatively impacted the clinic’s the implementation of evidence-based interventions (EBIs) or Patient Navigation activities for colorectal cancer screening during the program year (July 1-June 30). (e.g., implementation of some or all EBIs were suspended)

  • If yes, indicate all activities negatively impacted by COVID-19 in COV-5a through COV=5e

  • If no, skip to COV-6

List



Yes No

COV-5a

R

B&A

COVID-19 PTR impact

Baseline:

Indicates whether COVID-19 negatively impacted the clinic’s the implementation of Patient Reminder activities for colorectal cancer screening during the year prior to CRCCP activity implementation (Item B1-1: Clinic CRCCP Activities Start Date).

Annual:

Indicates whether COVID-19 negatively impacted the clinic’s the implementation of Patient Reminder activities for colorectal cancer screening during the program year (July 1-June 30).

List


  • Yes

  • No


COV-5b

R

B&A

COVID-19 PVR impact

Baseline:

Indicates whether COVID-19 negatively impacted the clinic’s the implementation of Provider Reminder activities for colorectal cancer screening during the year prior to CRCCP activity implementation (Item B1-1: Clinic CRCCP Activities Start Date).

Annual:

Indicates whether COVID-19 negatively impacted the clinic’s the implementation of Provider Reminder activities for colorectal cancer screening during the program year (July 1-June 30).

List


  • Yes

  • No


COV-5c

R

B&A

COVID-19 PAF impact

Baseline:

Indicates whether COVID-19 negatively impacted the clinic’s the implementation of Provider Assessment and Feedback activities for colorectal cancer screening during the year prior to CRCCP activity implementation (Item B1-1: Clinic CRCCP Activities Start Date).

Annual:

Indicates whether COVID-19 negatively impacted the clinic’s the implementation of Provider Assessment and Feedback activities for colorectal cancer screening during the program year (July 1-June 30).

List


  • Yes

  • No


COV-5d

R

B&A

COVID-19 RSB impact

Baseline:

Indicates whether COVID-19 negatively impacted the clinic’s the implementation of Reducing Structural Barriers activities for colorectal cancer screening during the year prior to CRCCP activity implementation (Item B1-1: Clinic CRCCP Activities Start Date).

Annual:

Indicates whether COVID-19 negatively impacted the clinic’s the implementation of Reducing Structural Barriers activities for colorectal cancer screening during the program year (July 1-June 30).

List


  • Yes

  • No


COV-5e

R

B&A

COVID-19 PN impact

Baseline:

Indicates whether COVID-19 negatively impacted the clinic’s the implementation of Patient Navigation activities for colorectal cancer screening during the year prior to CRCCP activity implementation (Item B1-1: Clinic CRCCP Activities Start Date).

Annual:

Indicates whether COVID-19 negatively impacted the clinic’s the implementation of Patient Navigation activities for colorectal cancer screening during the program year (July 1-June 30).

List


  • Yes

  • No


COV-6

O

B&A

COVID-19 Comments

Optional comments for COVID-19 Section


Char

Free text

200 char limit



Section 2. Baseline and Annual Health System and Clinic Characteristics and Clinic Patient Population

If the partner is a health system (P3=” Health System”) then clinic data reported must represent the entire Health System


Item #

Item Type

Collected

CRCCP Data Item

Indication/ Definition

Field Type

Response Options

B2-1
A2-1

R

B, A

Total # of primary care clinics in health system

Baseline Record:

The total number of primary health care clinics that operate under the partner health system, including those serving specific populations such as pediatric clinics, prior to beginning CRCCP activities (item B1-1: Clinic CRCCP Activities Start Date). A clinic is defined as a location where primary care services are delivered. Clinics may also be referred to as "sites" or “practices”.


Annual Record:

The total number of primary health care clinics that operated under the partner health system, including those serving specific populations such as pediatric clinics during the program year (July 1-June 30). 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


B2-2
A2-2

R

B, A

Total # of primary care providers in health system

Baseline Record:

Total number of primary care providers who are delivering services for the parent health system prior to beginning CRCCP activities (item B1-1: Clinic CRCCP Activities Start Date).


  • Primary care providers include physicians (e.g., internists, family practice, OB/GYN, attending physicians, fellows and residents), nurses, nurse practitioners, and physician assistants.

  • Do not include specialty providers in this number.

  • Report on individuals, not full-time equivalents (FTEs).


Annual Record:

Total number of primary care providers who were delivering services for the parent health system during the program year (July 1-June 30).

  • Primary care providers include physicians (e.g., internists, family practice, OB/GYN, attending physicians, fellows and residents) nurses, nurse practitioners, and physician assistants.

  • Do not include specialty providers in this number.

  • Report on individuals, not full-time equivalents (FTEs).

Num

1-99999


B2-3
A2-3

R

B, A

# of primary care providers at clinic

Baseline Record:

Indicates the total number of primary care providers who were delivering primary care services at the clinic prior to CRCCP activity implementation (Item B1-1: Clinic CRCCP Activities Start Date).


  • Primary care providers include physicians (e.g., internists, family practice, OB/GYN attending physicians, fellows and residents), nurses, nurse practitioners, and physician assistants.

  • Do not include specialty providers in this number.

  • Report on individuals, not full-time equivalents (FTEs).

  • If the partner is a health system (P3=” Health System”) then re-enter the number of primary care providers at the Health System



Annual Record:

Indicates the total number of primary care providers who were delivering primary care services at the clinic during the program year (July 1-June 30).


  • Primary care providers include physicians (e.g., internists, family practice, OB/GYN attending physicians, fellows and residents), nurses, nurse practitioners, and physician assistants.

  • Do not include specialty providers in this number.

  • Report on individuals, not full-time equivalents (FTEs).

  • If the partner is a health system (P3=” Health System”) then re-enter the number of primary care providers at the Health System


Num

1-99999


B2-4
A2-4

R

B, A

Total # of clinic patients

Baseline Record:

The total number of clinic patients who had at least one medical visit to the clinic in the year prior to starting CRCCP.

  • If the partner is a health system (P3=” Health System”) then re-enter the number of clinic patients at the Health System


Annual Record:

The total number of clinic patients who had at least one medical visit to the clinic in the last complete program year (July 1-June 30).

  • If the partner is a health system (P3=” Health System”) then re-enter the number of clinic patients at the Health System.


Num

1-9999999

B2-5
A2-5

R

B, A

Total # of clinic patients, age 50-75

Baseline Record:

The total number of clinic patients aged 50-75 who had at least one medical visit to the clinic in the year prior to starting CRCCP.

  • If unavailable, it is acceptable to report on a similar age range used by the clinic for measuring screening rates (e.g. ages 51-74 used by FQHCs/CHCs for UDS screening rate).


Annual Record:

The total number of clinic patients aged 50-75 who had at least one medical visit to the clinic in the last complete program year (July 1- June 30).


  • If unavailable, it is acceptable to report on a similar age range used by the clinic for measuring screening rates (e.g. ages 51-74 used by FQHCs/CHCs for UDS screening rate).


Num

1-9999999

B2-5a

O

B

% of patients, age 50-75, women

Baseline Record:

Indicates the percent of the total number of clinic patients aged 50-75 who had at least one medical visit to the clinic in the year prior to starting CRCCP (item B2-5) who are women.

  • Report as a whole number 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 50-75.


Annual Record:

N/A

Num

00-100

B2-5b
A2-5b

R

B, A

% of patients, age 50-75, uninsured

Baseline Record:

Indicates the percent of the total number of clinic patients aged 50-75 who had at least one medical visit to the clinic in the year prior to starting CRCCP (item B2-5) who did not have any form of public or private health insurance.

  • Report as a whole number percent. For example, enter 67 for 67%, not 0.67.

  • It is acceptable to report the percent based on the total clinic population if unknown for those age 50-75.


Annual Record:

The percent of the "Total # of clinic patients, 50-75 who had at least one medical visit to the clinic in the last complete program year (July 1- June 30) (item A2-5) who did not have any form of public or private health insurance.

  • Report as a whole number percent. For example, enter 67 for 67%, not 0.67.

  • It is acceptable to report the percent based on the total clinic population if unknown for those age 50-75.


Num

00-100

B2-5c

O

B

% of patients, age 50-75, Hispanic

Baseline Record:

Indicates the percent of the total number of clinic patients aged 50-75 who had at least one medical visit to the clinic in the year prior to starting CRCCP (item B2-5) 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 as a whole number 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 50-75.


Annual Record:

N/A

Num

00-100

B2-5d

O

B

% of patients, age 50-75, White

Baseline Record:

Indicates the percent of the total number of clinic patients aged 50-75 who had at least one medical visit to the clinic in the year prior to starting CRCCP (item B2-5) who are White/Caucasian (i.e., persons having origins in any of the original peoples of Europe, the Middle East, or North Africa.)


  • Report as a whole number 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 50-75.


Annual Record:

N/A

Num

00-100

B2-5e

O

B

% of patients, age 50-75, Black or African American

Baseline Record:

Indicates the percent of the total number of clinic patients aged 50-75 who had at least one medical visit to the clinic in the year prior to starting CRCCP (item B2-5) who are Black or African American (i.e., persons having origins in any of the black racial groups of Africa).


  • Report as a whole number 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 50-75.


Annual Record:

N/A

Num

00-100

B2-5f

O

B

% of patients, age 50-75, Asian

Baseline Record:

Indicates the percent of the total number of clinic patients aged 50-75 who had at least one medical visit to the clinic in the year prior to starting CRCCP (item B2-5) 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 as a whole number 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 50-75.


Annual Record:

N/A

Num

00-100

B2-5g

O

B

% of patients, age 50-75, Native Hawaiian or other Pacific Islander

Baseline Record:

Indicates the percent of the total number of clinic patients aged 50-75 who had at least one medical visit to the clinic in the year prior to starting CRCCP (item B2-5) 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 as a whole number 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 50-75.


Annual Record:

N/A

Num

00-100

B2-5h

O

B

% of patients, age 50-75, American Indian or Alaskan Native

Baseline Record:

Indicates the percent of the total number of clinic patients aged 50-75 who had at least one medical visit to the clinic in the year prior to starting CRCCP (item B2-5) 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 as a whole number 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 50-75.


Annual Record:

N/A

Num

00-100

B2-5i

O

B

% of patients, age 50-75, More than one race

Baseline Record:

Indicates the percent of the total number of clinic patients aged 50-75 who had at least one medical visit to the clinic in the year prior to starting CRCCP (item B2-5) who are of more than one race (i.e., persons having origins in two or more of the federally designated racial categories).


  • Report as a whole number 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 50-75.


Annual Record:

N/A

Num

00-100

B2-6
A2-6

R

B, A

Name of primary EHR vendor at clinic

Baseline Record:

Indicates the primary EHR used at the clinic that was in use prior to CRCCP activity implementation (Item B1-1: Clinic CRCCP Activities Start).



Annual Record:

Indicates the primary EHR that was in use at the clinic during the program year (July 1-June 30).

List

  • Allscripts

  • Athenahealth

  • Cerner

  • eClinicalWorks

  • Epic

  • GE Healthcare

  • Greenway Health

  • Kareo

  • McKesson

  • Meditech

  • NextGen (Quality Systems, Inc.)

  • Practice Fusion

  • Other

  • None

B2-6a
A2-6a

R

B, A

Other EHR, specify

Baseline Record:

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


Annual Record:

Name of the 'other' electronic health record vendor(s) used by the clinic during the program year (July 1-June 30).

Char

Free text

100 Char limit

B2-7

A2-7

R

B, A

Primary EHR home

Level of EHR implementation and functionality: EHR system unique to the clinic versus health-system wide EHR system shared by all clinics.


Baseline Record:

Indicates the breadth and functionality of the clinic EHR system that was in use prior to CRCCP activity implementation (Item B1-1: Clinic CRCCP Activities Start).


Annual Record:

Indicates the breadth and functionality of the primary EHR system that was in use at the clinic during the program year (July 1-June 30).


List

Select one

Select one:

  • EHR specific to the clinic

  • Health system wide EHR

  • Other: _____________


B2-7a

A2-7a

R

B, A

Other EHR home specify

Specify other EHR home

Char

Free text

100 Char limit

B2-8

R

B

Newly screening or opened

Baseline Record:

Identifies clinics that have recently started providing colorectal cancer screening services and/or are newly opened prior to time of the Clinic CRCCP Activities Start Date (item B1-1).


  • Recently started providing colorectal cancer screening services: clinic has started providing colorectal cancer screening within 1 year of the Clinic CRCCP Colorectal Activities Start Date (item B1-1).

  • Newly opened clinic: clinic has been in operation for less than 1 year at the time of Clinic CRCCP Colorectal Activities Start Date (itemB1-1).

If yes (<1 year), do not report baseline screening rates or baseline screening practices and outcomes (items


Annual Record:

N/A


List

  • Yes (< 1 year)

  • No (1 or more years)

B2-9
A2-9

O

B, A

Section 2 Comments

Optional comments for section 2

Char

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200 char limit






Section 3. Baseline and Annual CRC Screening Rates and Practices

If the partner is a health system (P3=” Health System”) then clinic data reported must represent the entire Health System


Item #

Item Type

Collected

CRCCP Data Item

Indication/ Definition

Field Type

Response Options

B3-1
A3-1

R

B, A

Rate Status

Baseline Record:

Indicates the availability of baseline CRC screening rate data and associated information on data sources/approach for calculating the screening rates are available.


  • If “Chart review rate only” skip to B3-4a and skip EHR section.

  • If “EHR rate only” skip to B3-5a (skip CR section).

  • If “Both Chart Review rate and EHR rate”, skip to B3-4a and complete both the CR section (B3-4a to B3-4l) and the EHR rate section (B3-5a to B3-5l).

  • If “No, not yet available” go to B3-1a and enter date available and then skip to B3-6 CRC Screening Practices and Outcomes.

  • If “No, cannot obtain” skip to B3-6 CRC Screening Practices and Outcomes.

  • If “No, Newly opened/screening clinic” skip to Section 4, item B4-1.

*Clinics that have recently started colorectal cancer screening and/or are newly opened (item 3p) will not report a baseline screening rate or answer the remaining Section 3 questions.


Annual Record:

Indicates the availability of annual CRC screening rate data and associated information on data sources/approach for calculating the screening rates are available.


  • If “Yes, chart review rate only” skip to A3-4a and skip EHR section.

  • If “Yes, EHR rate only” skip to A3-5a (skip CR section).

  • If “Yes, both Chart Review rate and EHR rate”, skip to A3-4a and complete both the CR section (A3-4a to A3-4l) and the EHR rate section (A3-5a to A3-5l).

  • If “No. not yet available” go to A3-1a and enter date available and then skip to B3-6 CRC Screening Practices and Outcomes.

  • If “No, cannot obtain” skip to A3-6 CRC Screening Practices and Outcomes.


List

Select one

Baseline

Select one:

  • Chart Review rate only

  • EHR rate only

  • Both Chart Review and EHR Rate

  • No, not yet available

  • No, cannot obtain

  • No, Newly opened/screening clinic



Annual

Select one:

  • Yes, Chart Review rate only

  • Yes, EHR rate only

  • Yes, Both Chart Review and EHR Rate

  • No, not yet available

  • No, cannot obtain


B3-1a
A3-1a

R

B, A

Screening rate date available

Baseline Record:

If a baseline screening rate is not yet available, provide the approximate date that the screening rate will be available.

skip to B3-6


Annual Record:

If an annual screening rate cannot be obtained or is not yet available when submitting the annual clinic data, provide the approximate date that the screening rate will be available.

skip to A3-6

Date

MM/DD/YYYY

B3-2
A3-2

R

B, A

Start date of 12-month measurement SR period

Baseline Record:

The start date of the 12-month screening rate measurement period used to calculate the clinic’s baseline CRC screening rate. The 12-month measurement period does not need to coincide with the program year. Any 12-month period may be used as the measurement period.


  • The measurement period for the baseline screening rate should be the most recent 12-month measurement period prior to implementation of CRCCP activities (Item B1-1: Clinic CRCCP Activities Start Date).

  • Note that the date that implementation activities started (Item BC1-1: Clinic CRCCP Activities Start Date) must be after the end of the baseline 12-month measurement period.


This same 12-month measurement period must be used for reporting subsequent annual colorectal cancer screening rates for this clinic.


Annual Record:

The start date of the annual colorectal cancer screening rate 12-month measurement period.

  • The 12-month measurement period for all annual records for this clinic should be consistent over time and match that used for the baseline screening rate.

  • Measurement periods, starting with the baseline measurement period, should represent consecutive years. For example, if the baseline measurement period was 01/01/2019- 12/31/2019, then the first annual screening rate measurement period should be 01/01/2020 - 12/31/2020.


The first annual measurement period (year 1 for the clinic) should include the date that implementation activities started (Item BC1-1: Clinic CRCCP Activities Start Date).


Date

MM/DD/YYYY

B3-3
A3-3

comp

B, A

End date of 12-month measurement period

Baseline Record:

This date will be automatically calculated from the 12-month start date.


Indicates the end date of the 12-month measurement period used to calculate the clinic’s baseline CRC screening rate.


  • The measurement period for the baseline screening rate should be the most recent 12-month measurement period available prior to implementation of CRCCP activities (Item BC1-1: Clinic CRCCP Activities Start Date).

  • This same 12-month measurement period must be used for reporting subsequent annual colorectal cancer screening rates for this clinic.


Annual Record:

Indicates the end date of the annual colorectal cancer screening rate 12-month measurement period.

  • The 12-month measurement period for all annual records for this clinic should be consistent over time and match that used for the baseline screening rate.

  • Measurement periods, starting with the baseline measurement period, should represent consecutive years. For example, if the baseline measurement period was 01/01/2019 - 12/31/2019, then the first annual screening rate measurement period should be 01/01/2020 - 12/31/2020.


Date

MM/DD/YYYY

Chart Review (CR) Screening Rates ***This section should be skipped at baseline for clinics that are newly screening or newly opened***

B3-4a
A3-4a

comp

B, A

CR Screening rate (%)

Baseline Record:

This rate will be automatically computed by the data system using the numerator and denominator reported below.


*Clinics that have recently started colorectal cancer screening and/or are newly opened (item 3p) will not report a baseline screening rate.


Annual Record:

This rate will be automatically computed by the data system using the numerator and denominator reported below.

Num

00-100

B3-4b
A3-4b

R

B, A

CR Numerator screening rate numerator

Baseline Record:

Numerator is dependent on the measure used (e.g., UDS, HEDIS). Please see Appendix 3 in CDC Guidance for Measuring Breast, Cervical, and Colorectal Cancer Screening Rates in Health System Clinics.


Annual Record:

Numerator is dependent on the measure used (e.g., UDS, HEDIS). Please see Appendix 3 in CDC Guidance for Measuring Breast, Cervical, and Colorectal Cancer Screening Rates in Health System Clinics.

Num

0-9999999

B3-4c
A3-4c

R

B, A

CR screening rate denominator

Baseline Record:

Denominator is dependent on the measure used (e.g., UDS, HEDIS). Please see Appendix 3 in CDC Guidance for Measuring Breast, Cervical, and Colorectal Cancer Screening Rates in Health System Clinics.


Annual Record:

Denominator is dependent on the measure used (e.g., UDS, HEDIS). Please see Appendix 3 in CDC Guidance for Measuring Breast, Cervical, and Colorectal Cancer Screening Rates in Health System Clinics.

Num

1-9999999

B3-4d
A3-4d

R

B, A

Measure used

Baseline Record:

Indicates the measure that was used to calculate the numerator and denominator for the clinic’s colorectal cancer screening rate.


  • If an existing measure (e.g., UDS, 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 must be used for reporting subsequent annual colorectal cancer screening rates for this clinic.


Annual Record:

If an existing measure (e.g. UDS, 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 must be used for reporting subsequent annual colorectal cancer screening rates for this clinic.

List

Select one:

  • GPRA

  • HEDIS

  • NQF

  • UDS

  • Other

B3-4e
A3-4e

Comp

B, A

% of charts reviewed to calculate screening rate

Baseline Record:

Indicates the percent of medical charts that were reviewed for adults, ages 50-75, who had at least one medical visit during the reporting year and who have not previously had colorectal cancer or had a total colectomy. A minimum of 10% or 100 charts should be reviewed. If using the UDS measure, a minimum of 70 charts should be reviewed. See CDC Guidance for Measuring Breast, Cervical, and Colorectal Cancer Screening Rates in Health System Clinics.


Field will be auto-calculated using the provided screening rate denominator (item B3-4c) and the total # of clinic patients, age 50-75 (item B2-5) reported for this program year.


Annual Record:

Indicates the percent of medical charts that were reviewed for adults, ages 50-75, who had at least one medical visit during the reporting year and who have not previously had colorectal cancer or had a total colectomy. A minimum of 10% or 100 charts should be reviewed. If using the UDS measure, a minimum of 70 charts should be reviewed. See CDC Guidance for Measuring Breast, Cervical, and Colorectal Cancer Screening Rates in Health System Clinics.


Field will be auto-calculated using the provided screening rate denominator (item A3-4c) and the total # of clinic patients, age 50-75 (item A2-5) reported for this program year.


Num

00-100

B3-4f
A3-4f

R

B, A

Sampling Method

Baseline and Annual Records:

Indicates if records were 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 for the measure used. 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

  • Unknown

B3-4g
A3-4g

R

B, A

CR screening rate confidence

Baseline and Annual Records:

Indicates the grantee's confidence in the accuracy of the CR-calculated screening rate.


Accuracy of CR-calculated screening rates can vary depending on how charts are sampled and the information available in the charts.

List

  • Not confident

  • Somewhat confident

  • Very confident

B3-4h
A3-4h

R

B, A

CR Screening rate problem

Baseline and Annual Records:

Indicates if there are known unresolved problems with the CR reported screening rate or screening data quality.


List

  • Yes

  • No

  • Unknown

B3-4i
A3-4i

R

B, A

Specify CR- screening rate problem

Baseline Record:

If B3-4h 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 accuracy of the CR-reported screening rate.


Annual Record:

If A3-4h 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 CR-reported screening rate.

Char

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256 Char limit

B3-4j
A3-4j

N/A

 

N/A for CR

 

 

 

B3-4k
A3-4k

R

B, A

CR Screening rate target

Baseline Record:

Indicates the clinic-level colorectal cancer screening rate target established by the clinic for its first CRCCP annual clinic record.


  • Enter the targeted clinic-level colorectal cancer screening rate (i.e., the screening rate you want to achieve) for the clinic’s first annual record, i.e. the colorectal cancer screening rate for the next 12-month measurement period after the baseline screening rate measurement period.

  • Do not enter the expected additional % increase.

  • Targets should be:

    • Clinic-level targets. Do not report targets for the health system unless the partner is the health system (item P3= Health System).

    • Unique to each clinic.

    • Ambitious but realistic and achievable.


Annual Record:

Indicates the clinic-level colorectal cancer screening rate target established by the clinic for the next subsequent CRCCP annual clinic record.

  • Enter the targeted clinic-level colorectal cancer screening rate (i.e., the screening rate you want to achieve) for the next annual record, i.e. the colorectal cancer screening rate for the next 12-month measurement period.

  • Do not enter the expected additional % increase.

  • Targets should be:

    • Clinic-level targets. Do not report targets for the health system unless the partner is the health system (item P3= Health System).

    • Unique to each clinic.

    • Ambitious but realistic and achievable

Num

1-100

999 (no target set)

B3-4l
A3-4l

O

B, A

Comments for CR rates

Optional Comments for CR rates.

Char

Free text

200 char limit

EHR Screening Rates ***This section should be skipped at baseline for clinics that are newly screening or newly opened***

B3-5a
A3-5a

comp

B, A

EHR Screening rate (%)

Baseline Record:

This rate will be automatically computed by the data system using the numerator and denominator reported below.


*Clinics that have recently started colorectal cancer screening and/or are newly opened (item 3p) will not report a baseline screening rate.


Annual Record:

This rate will be automatically computed by the data system using the numerator and denominator reported below.


Num

00-100

B3-5b
A3-5b

R

B, A

EHR screening rate numerator

Baseline and Annual Records:

Numerator is dependent on the measure used (e.g., UDS, HEDIS). Please see Appendix 3 in CDC Guidance for Measuring Breast, Cervical, and Colorectal Cancer Screening Rates in Health System Clinics.

Num

0-9999999

B3-5c
A3-5c

R

B, A

EHR screening rate denominator

Baseline and Annual Records:

Denominator is dependent on the measure used (e.g., UDS, HEDIS). Please see Appendix 3 in CDC Guidance for Measuring Breast, Cervical, and Colorectal Cancer Screening Rates in Health System Clinics.

Num

1-9999999

B3-5d
A3-5d

R

B, A

EHR Measure used

Baseline and Annual Records:

Indicates the measure that was used to calculate the numerator and denominator for the clinic’s colorectal cancer screening rate.


  • If an existing measure (e.g. UDS, HEDIS, GPRA) was not used, the CDC Guidance for Measuring Breast, Cervical, and Colorectal Cancer Screening Rates in Health System Clinics (Appendix 3) provides information on calculating a NQF-endorsed measure. If this is used, "NQF" should be selected.

The same measure reported at baseline must be used for reporting subsequent annual colorectal cancer screening rates for this clinic.


List

Select one

Select one:

  • GPRA

  • HEDIS

  • NQF

  • UDS

  • Other

B3-5e
A3-5e

N/A

N/A

N/A for EHR

N/A for EHR

N/A for EHR

N/A for EHR

B3-5f
A3-5f

N/A

N/A

N/A for EHR

N/A for EHR

N/A for EHR

N/A for EHR

B3-5g
A3-5g

R

B, A

EHR screening rate confidence

Baseline and Annual Records:

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

B3-5h
A3-5h

R

B, A

EHR Screening rate problem

Baseline and Annual Records:

Indicates if there are known unresolved problems with the EHR reported screening rate or screening data quality.

List

  • Yes

  • No

B3-5i
A3-5i

R

B, A

Specify EHR screening rate problem

Baseline Record:

If item B3-5h 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 accuracy of the EHR-reported screening rate. Specify any activities to address the problem(s) such as improvements made to data entry systems or to the screening rate measurement calculation.


Annual Record:

If A3-5h 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

B3-5j
A3-5j

R

B, A

EHR rate reporting source

Baseline and Annual Records:

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



List

Select one

Select one:

  • HCCN data warehouse

  • Clinic EHR

  • Health system EHR

  • EHR Vendor

  • Other

B3-5k
A3-5k

R

B, A

EHR screening rate target

Baseline Record:

Indicates the clinic-level colorectal cancer screening rate target established by the clinic for its first CRCCP annual clinic record.

  • Enter the targeted clinic-level colorectal cancer screening rate (i.e., the screening rate you want to achieve) for the clinic’s first annual record, i.e. the colorectal cancer screening rate for the next 12-month measurement period after the baseline screening rate measurement period.

  • Do not enter the expected additional % increase.

  • Targets should be:

    • Clinic-level targets. Do no report targets for the health system unless the partner is the health system (item P3).

    • Unique to each clinic.

    • Ambitious but realistic and achievable


Annual Record:

Indicates the clinic-level colorectal cancer screening rate target established by the clinic for its next subsequent CRCCP annual clinic record.

  • Enter the targeted clinic-level colorectal cancer screening rate (i.e., the screening rate you want to achieve) for the next annual record, i.e. the colorectal cancer screening rate for the next 12-month measurement period.

  • Do not enter the expected additional % increase.

  • Targets should be:

    • Clinic-level targets. Do no report targets for the health system unless the partner is the health system (item P3).

    • Unique to each clinic.

    • Ambitious but realistic and achievable


Num

1-100

999 (no target set)

B3-5l
A3-5l

O

B, A

Comments for EHR rates

Optional comments for EHR rates

Char

Free text

200 char limit

CRC Screening Practices and Outcomes

Information regarding clinic’s practices and outcomes of CRC screening. Items include primary test type, FIT/FOBT return rate, colonoscopy follow-up rates, and colonoscopies paid for with CDC funds.

***This section should be skipped at baseline for clinics that are newly screening or newly opened***

B3-6
A3-6

R

B, A

CRC Screening methods

Baseline Record:

Indicates all methods used by the clinic for colorectal cancer screening during the year prior to CRCCP activity implementation (Item B1-1: Clinic CRCCP Activities Start Date). Colonoscopy includes referral for screening colonoscopy.


Annual Record:

Indicates all methods used by the clinic for colorectal cancer screening during the annual program year (July 1- June 30). Colonoscopy includes referral for screening colonoscopy.

List

Select all that apply

Select all that apply:

  • FIT

  • FIT-DNA (Cologuard)

  • FOBT

  • Colonoscopy:

  • Other: ___________

B3-6a
A3-6a

R

B, A

Other CRC Screening methods

Specify “other” screening tests used

Char

Free text

200 char limit

B3-7
A3-7

R

B, A

Primary CRC screening method

Baseline Record:

Indicates the colorectal cancer screening method most frequently used by the clinic during the year prior to CRCCP activity implementation (Item B1-1: Clinic CRCCP Activities Start Date). Colonoscopy includes referral for screening colonoscopy.


Annual Record:

Indicates the colorectal cancer screening method most frequently used during the program year (July 1-June 30). Colonoscopy includes referral for screening colonoscopy.

List

Select one

Select one:

  • FIT

  • FIT-DNA (Cologuard)

  • FOBT

  • Colonoscopy:

  • Other: ___________

B3-7a
A3-7a

R

B, A

Other primary CRC screening method

Specify “other” primary CRC screening method

Char

Free text

  • 200 char limit

B3-8
A3-8

R

B, A

Free fecal testing kits

Baseline Record:

Indicates whether the clinic provided free fecal testing kits (FIT, FIT-DNA (Cologuard), or FOBT) to any of their patients during the year prior to CRCCP activity implementation (Item BC1-1: Clinic CRCCP Activities Start Date).


This includes kits that may be made available by the laboratory and distributed at no cost to patients by the clinic.


Annual Record:

Indicates whether the clinic provided free fecal testing kits (FIT, FIT-DNA (Cologuard), or FOBT) to any of their patients during the program year (July 1-June 30).


This includes kits that may be made available by the laboratory and distributed at no cost to patients used by the clinic.


List

  • Yes

  • No

  • Unknown

B3-9
A3-9

Comp

B, A

Fecal Kit return rate

Baseline Record:

Percentage of patients receiving a fecal testing kit (FIT, FIT-DNA (Cologuard), or FOBT) during the year prior to CRCCP activity implementation (Item BC1-1: Clinic CRCCP Activities Start Date) and returned it for processing. Includes all fecal kits regardless of cost/payor.

  • This rate will be automatically computed by the data system using the numerator (item B3-9b) and denominator (item B3-9a) reported.

  • If data are not available at the time of submission, please provide the anticipated date of availability below (item B3-9c).


Annual Record:

Percentage of patients receiving a fecal testing kit (FIT, FIT-DNA (Cologuard), or FOBT) during the program year (July 1-June 30)., who returned it for processing. Includes all fecal kits regardless of cost/payor.

  • This rate will be automatically computed by the data system using the numerator (item A3-9b) and denominator (item A3-9a) reported below.

  • If data are not available at the time of annual data submission, please provide the anticipated date of availability below (item A3-9c).


Num

00-100

B3-9a
A3-9a

R

B, A

# of patients given fecal kits

Baseline Record:

The total number of patients, age 50-75, given a fecal testing kit (FIT, FIT-DNA (Cologuard), or FOBT) during the year prior to CRCCP activity implementation (Item B1-1: Clinic CRCCP Activities Start Date).


Includes all fecal kits regardless of cost/payor.


Do not include mailed kits that were returned to sender.


Annual Record:

The total number of patients, age 50-75, given a fecal testing kit (FIT, FIT-DNA (Cologuard), or FOBT) during the program year (July 1-June 30).


Includes all fecal kits regardless of cost/payor.


*Do not include mailed kits that were returned to sender.

Num

00-100,000

B3-9b
A3-9b

R

B, A

# of patients returning fecal kits

Baseline Record:

The total number of patients, age 50-75, given a FIT/FIT-DNA (Cologuard)/FOBT kit during the year prior to CRCCP activity implementation (item B3-9a) that returned the kit for processing within 6 months of distribution.


Annual Record:

The total number of patients, age 50-75, given fecal testing kit (FIT, FIT-DNA (Cologuard), or FOBT) during the July 1-June 30 program year (item A3-9a), that returned the kit for processing within 6 months of distribution.

Num

00-100,000

B3-9C
A3-9C

R

B, A

Fecal kit return date available

Baseline Record:

If fecal kit return rate data are not available at the time of baseline data submission, provide an anticipated date of availability.


Annual Record:

If fecal kit return rate data are not available at the time of annual data submission, provide an anticipated date of availability.

Date

mm/dd/yyyy

B3-10
A3-10

comp

B, A

Colonoscopy completion rate

Baseline Record:

Percent of patients referred for colonoscopy during the year prior to CRCCP activity implementation (Item B1-1: Clinic CRCCP Activities Start Date) regardless of reason, (e.g., screening colonoscopy or a colonoscopy as follow-up to positive fecal test), who complete the procedure and have a final result.


  • This rate will be automatically computed by the data system using the numerator (item B3-10b) and denominator (item B3-10a) reported below.

  • If data are not available at the time of submission, please provide the anticipated date of availability below (item B3-10c).


Annual Record:

Percent of patients referred for colonoscopy during the program year (July 1-June 30), regardless of reason (e.g., screening colonoscopy or a colonoscopy as follow-up to positive fecal test), who complete the procedure and have a final result.

  • This rate will be automatically computed by the data system using the numerator (item A3-10b) and denominator (item A3-10a) reported below.

  • If data are not available at the time of submission, please provide the anticipated date of availability below (item A3-10c).

Num

00-100

B3-10a
A3-10a

R

B, A

# patients referred for colonoscopy

Baseline Record:

The total number of patients, age 50-75, referred for colonoscopy, regardless of reason, during the year prior to CRCCP activity implementation (Item B1-1: Clinic CRCCP Activities Start Date).


Annual Record:

The total number of patients, age 50-75, referred for colonoscopy, regardless of reason (e.g., screening colonoscopy or a colonoscopy as follow-up to positive fecal test), during the program year (July 1-June 30).

Num

00-100,000

B3-10b
A3-10b

R

B, A

# patients completing colonoscopy

Baseline Record:

The total number of patients, age 50-75, referred for colonoscopy during the year prior to CRCCP activity implementation (item B3-10a), who completed the procedure with a final result within 12 months of their colonoscopy referral date.


Annual Record:

The total number of patients, age 50-75, referred for colonoscopy during the July 1-June 30 program year (item A3-10a), who completed the procedure with a final result within 12 months of their colonoscopy referral date.

Num

00-100,000

B3-10c
A3-10c

R

B, A

Colonoscopy completion rate date available

Baseline Record:

If Colonoscopy completion rate data are not available at the time of baseline data submission, provide an anticipated date of availability.


Annual Record:

If Colonoscopy completion rate data are not available at the time of annual data submission, provide an anticipated date of availability

Date

mm/dd/yyyy

B3-11
A3-11

comp

B, A

Follow-up colonoscopy completion rate

Baseline Record:

Percentage of patients with a positive or abnormal CRC screening test, who were referred for a follow-up colonoscopy during the year prior to CRCCP activity implementation (Item B1-1: Clinic CRCCP Activities Start Date).and completed the procedure and have a final result.

  • This rate will be automatically computed by the data system using the numerator (item B3-11b) and denominator (item B3-11a) reported below.

  • If data are not available at the time of submission, please provide the anticipated date of availability below (item B3-11c).

  • CRC screening tests include FIT, FOBT, FIT-DNA, sigmoidoscopy, CT colonography.


Annual Record:

Percentage of patients with a positive or abnormal CRC screening test, who are referred for a follow-up colonoscopy during the program year (July 1-June 30), and complete the procedure with a final result.

  • This rate will be automatically computed by the data system using the numerator (item A3-11b) and denominator (item A3-11a) reported below.

  • If data are not available at the time of submission, please provide the anticipated date of availability below (item A3-11c).

  • CRC screening tests include FIT, FOBT, FIT-DNA, sigmoidoscopy, CT colonography.

Num

00-100

B3-11a
A3-11a

R

B, A

# patients referred for follow-up colonoscopy

Baseline Record:

The total number of patients, age 50-75, with a positive or abnormal CRC screening test, who were referred for a follow-up colonoscopy during the year prior to CRCCP activity implementation (Item BC1-1: Clinic CRCCP Activities Start Date).


*based on the date of colonoscopy referral. CRC screening tests include FIT, FOBT, FIT-DNA, sigmoidoscopy, CT colonography.


Annual Record:

The total number of patients, age 50-75, with a positive or abnormal CRC screening test results, referred for a follow-up colonoscopy during the program year (July 1-June 30).


*Based on the date of colonoscopy referral.

CRC screening tests include FIT, FOBT, FIT-DNA, sigmoidoscopy, CT colonography.

Num

00-100,000

B3-11b
A3-11b

R

B, A

# patients completing follow-up colonoscopy

Baseline Record:

The total number of patients, age 50-75, with a positive or abnormal CRC screening test, who were referred for follow-up colonoscopy during: during the year prior to CRCCP activity implementation (Item B3-11a) and completed the procedure with a final result within 6 months of their follow-up colonoscopy referral date*.


*based on the date of colonoscopy referral.

CRC screening tests include FIT, FOBT, FIT-DNA, sigmoidoscopy, CT colonography.


Annual Record:

The total number of patients, age 50-75, with a positive or abnormal CRC screening test, who were referred for a follow-up colonoscopy during the July 1-June 30 program year (item A3-11a) and completed the procedure with a final result within 6 months of their follow-up colonoscopy referral date*.


*Based on the date of colonoscopy referral. CRC screening tests include FIT, FOBT, FIT-DNA, sigmoidoscopy, CT colonography.


Num

00-100,000

B3-11c
A3-11c

R

B, A

Follow-up colonoscopy completion rate date available

Baseline Record:

If the follow-up colonoscopy rate data are not available at the time of baseline data submission, provide an anticipated date of availability.


Annual Record:

If the follow-up colonoscopy rate data are not available at the time of annual data submission, provide an anticipated date of availability.

Date

mm/dd/yyyy

A3-12

R

A

# patients with CDC-paid follow-up colonoscopy

Baseline Record:

N/A


Annual Record:

The total number of patients who had a follow-up colonoscopy for a positive or abnormal CRC screening test, that was partially or fully funded with CDC funds, during the program year (July 1- June 30).


* Based on the date of colonoscopy and not when the patient was referred or the date the colonoscopy report was received.

Num

00-100,000

A3-12a

R

A

# patients with normal colonoscopy results

Baseline Record:

N/A


Annual Record:

Total number of patients who had a follow-up colonoscopy for a positive or abnormal CRC screening test, that was partially or fully funded with CDC funds during July 1- June 30 program year (item A3-12) with normal results.

Num

00-100,000

A3-12b

R

A

# patients with adenomatous polyps

Baseline Record:

N/A


Annual Record:

Total number of patients who had a follow-up colonoscopy for a positive or abnormal CRC screening test, that was partially or fully funded with CDC funds, during the July 1- June 30 program year (item A3-12), with adenomatous polyps removed

Num

00-100,000

A3-12c

R

A

# patients with abnormal findings

Baseline Record:

N/A


Annual Record:

The total number of patients who had a follow-up colonoscopy for a positive or abnormal CRC screening test, that was partially or fully funded with CDC funds, during the July 1- June 30 program year (item A3-12), with other abnormal findings (other than adenomatous polyps).

Num

00-100,000

A3-12d

R

A

# patients diagnosed with CRC

Baseline Record:

N/A


Annual Record:

The total number of patients who had a follow-up colonoscopy for a positive or abnormal CRC screening test, that was partially or fully funded with CDC funds, during the July 1- June 30 program year (item A3-12), who were diagnosed with colorectal cancer

Num

00-100,000

B3-13
A3-13

O

B, A

Section 3 Comments

Optional Comments for Section 3.

Char

Free text

200 char limit





Section 4: Baseline and Annual Monitoring and Quality Improvement Activities

Information on the clinic’s practices, policies, and support received to improve implementation of EBIs and/or monitoring of CRC screening rates


Item #

Item Type

Collected

CRCCP Data Item

Indication/ Definition

Field Type

Response Options

B4-1
A4-1

R

B, A

Clinic colorectal cancer screening policy

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 colorectal 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).


Baseline Record:

Indicates if the clinic had a written colorectal cancer screening policy or protocol in use prior to implementation of CRCCP activities (item B1-1: Clinic CRCCP Activities Start Date).


Annual Record:

Indicates if the clinic had a written colorectal cancer screening policy or protocol in use during the program year.

List

  • Yes

  • No


B4-2
A4-2

R

B, A

Clinic colorectal cancer champion

Baseline Record:

Indicates if there was a known champion for colorectal cancer screening internal to this clinic or parent health system prior to implementation of CRCCP activities (Item B1-1: Clinic CRCCP Activities Start Date)


Annual Record:

Indicates if there was a known champion or champions for colorectal cancer screening internal to this clinic or parent health system for at least 6 months during this program year (July 1- June 30).

List

  • Yes

  • No


B4-3
A4-3

R

B, A

Utilizing health IT to improve data collection and quality

Baseline Record:

Indicates if the clinic was using health information technology (health IT) to improve collection, accuracy and validity of colorectal cancer screening data prior to CRCCP activity implementation (Item BC1-1: Clinic CRCCP Activities Start Date).

  • Activities may include standardization of data definitions used to document a patient’s colorectal cancer screening, linkage of data to screening reports, EHR improvements and enhancements, provider training on proper EHR data entry and use, etc.


Annual Record:

Clinic used health information technology (health IT) to improve collection, accuracy, and validity of colorectal cancer screening data during the program year (July 1- June 30).

  • Activities may include standardization of data definitions used to document a patient’s colorectal cancer screening, linkage of data to screening reports, EHR improvements and enhancements, provider training on proper EHR data entry and use, etc.

List

  • Yes

  • No


B4-4
A4-4

R

B, A

Utilizing health IT tools for monitoring program performance

Baseline Record:

Indicates if the clinic was using health IT to perform data analytics and reporting to monitor and improve their colorectal cancer screening program and rates prior to CRCCP activity implementation (Item B1-1: Clinic CRCCP Activities Start Date).

  • Examples include: EHR overlays, Population Health Management software, data visualization software and programs.


Annual Record:

Clinic used health information technology (health IT) tools to perform data analytics and reporting to monitor and improve their colorectal cancer screening program and rates during the program year (July 1- June 30).

  • Examples include: EHR overlays, Population Health Management software, data visualization software and programs.


List

  • Yes

  • No


B4-5
A4-5

R

B, A

QA/QI support

Baseline Record:

Indicates whether the clinic had a quality assurance/quality improvement specialist or team in place that addressed colorectal cancer screening prior to CRCCP activity implementation (Item B1-1: Clinic CRCCP Activities Start Date).

  • The person or team could work at the health system level and provide QA/QI support to the clinic.


Annual Record:

Indicates whether the clinic had a quality assurance/quality improvement specialist or team in place that addressed colorectal cancer screening during the program year (July 1- June 30).

  • The person or team could work at the health system level and provide QA/QI support to the clinic.

List

  • Yes

  • No


A4-6

R

A

Process Improvements

Baseline Record:

N/A


Annual Record:

Indicates whether process improvements were made at the clinic during the program year (July 1- June 30) to facilitate increased colorectal cancer screening of patients. Examples include process mapping to identify points to improve screening, daily huddles or other daily processes to identify persons due for screening and use of QI processes to improve screening.


List

  • Yes

  • No


A4-7

R

A

Frequency of monitoring colorectal cancer screening rate

Baseline Record:

N/A


Annual Record:

Indicates how often the clinic colorectal cancer screening rate was monitored and reviewed by clinic personnel during the program year (July 1- June 30).


Select the response that best matches monitoring frequency during this program year.

List

Select One

Select one:


  • Monthly

  • Quarterly

  • Semi-annually

  • Annually

A4-8

R

A

Validated screening rate

Baseline Record:

N/A


Annual Record:

Indicates if the clinic-level colorectal cancer screening rate data were validated using chart review or other methods during this program year (July 1- June 30).

List

  • Yes

  • No


A4-8a

R

A

Validation method

Baseline Record:

N/A


Annual Record:

If the clinic-level colorectal cancer screening rate data were validated using chart review or other methods during this program year (July 1- June 30), indicate the method(s) used to conduct the validation.

List

Select all that apply

Select all that apply:


  • Manual Chart Review

  • EHR system or algorithm validation

  • Other validation method

A4-8b

R

A

Other Validation Method Specify

Specify other validation method

Char

Free text

200 char limit

A4-9

R

A

Health Center Controlled Network

Baseline Record:

N/A


Annual Record:

For Community Health Centers/FQHCs only, indicates whether the clinic received technical assistance from a Health Center Controlled Network to implement EBIs or improve use of the clinic’s EHR to better measure and monitor CRC screening rates during the program year (July 1- June 30).

List

  • Yes

  • No


A4-10

R

A

Annual Partner Agreement type

Baseline Record:

N/A


Annual Record:

The type of formal agreement the grantee had in place with the partner health system and/or clinic for CRCCP activities at the end of the program year (July 1- June 30).

List

Select one:


  • MOU/MOA

  • Contract

  • Other

  • None

A4-11

R

A

Frequency of implementation support to clinic

Baseline Record:

N/A


Annual Record:

Indicates the frequency of on-site or direct contacts (e.g., telephone) with the clinic to support and improve implementation activities for EBIs/SAs and colorectal cancer screening data quality during this program year (PY).


  • Support could be provided by a grantee or contracted agent.

  • Examples of support activities include conducting a clinic workflow assessment, providing technical assistance to improve HIT, providing technical assistance on implementing an EBI/SA, training staff to support an EBI/SA, providing technical assistance to develop a colorectal cancer screening policy, providing support to a champion, or providing feedback to staff from monitoring or evaluating an EBI/SA implementation.

  • Select the response that best matches delivery of implementation support during this program year (July 1- June 30).

List

Select one:


  • Weekly

  • Monthly

  • Quarterly

  • Semi-annually

  • Annually

A4-12

R

A

CRCCP financial resources

Baseline Record:

N/A


Annual Record:

Indicates whether the grantee or a subcontractor of the grantee provided financial resources to this clinic and/or its parent health system during the program year (July 1- June 30) to support CRCCP activities. Funding could come from CDC, your state, or other sources.

If no, skip to A4-13.

List

Select one

Select One:

  • Yes, to the clinic

  • Yes, to the parent health system

  • No

A4-12a

R

A

Amount of CRCCP financial resources

Baseline Record:

N/A


Annual Record:

If CRCCP financial resources were provided (item AC4-11 is Yes), indicate the total amount of financial resources provided to the clinic during this program year (PY).

  • Pro-rate funding, if needed, to associate with the PY. Do NOT include in-kind resources.

  • If financial resources were provided to the parent health system (item AC4-11 is “Yes, to the parent health system”) rather than directly to the clinic, and you do not know how much of those funds were used for this specific clinic, please divide the amount given to the health system by the number of clinics in that health system that were enrolled in the CRCCP program during the program year (July 1- June 30).


Num

Dollar amount 1-900000,

999999 (UNK)

B4-6

A4-13

O

B, A

Section 4 Comments

Optional comments for section 4.

Char

Free text

200 char limit





Section 5: Baseline and Annual Evidence-based Interventions (EBIs) and Other Clinic Activities

Information on implementation status and sustainability of activities, put in place by the grantee or clinic, to improve colorectal cancer screening.
Annually: report 1) whether CRCCP resources were used to support the activity during the
program year (July 1- June 30) , 2) if the activity was in place and operational at the end of the PY, 3) if not in place, were planning activities conducted for future implementation, and 4) if the activity is considered sustainable.


Section 5-1: EBI-Patient Reminder System

Indicates the clinic’s use of system(s) to remind patients when they are due for colorectal cancer screening. Patient reminders can be written (letter, postcard, email, text) or telephone messages (including automated messages).


Item #

Item Type

Collected

CRCCP Data Item

Indication/ Definition

Field Type

Response Options

A5-1a

R

A

CRCCP resources used toward a patient reminder system

Baseline Record:

N/A


Annual Record:

Indicates whether CRCCP grantee resources (e.g. funds, staff time, materials, contract) were used during this program year (July 1- June 30) to contribute to planning, developing, implementing, monitoring/evaluating or improving a patient reminder system for colorectal cancer screening.

List

  • Yes

  • No


B5-1b
A5-1b

R

B, A

Patient reminder system in place

Baseline Record:

Indicates whether a patient reminder system for colorectal cancer screening was in place and operational (in use) in this clinic prior to CRCCP activity implementation (Item B1-1: Clinic CRCCP Activities Start Date), regardless of the quality, reach, or level of functionality.


Annual Record:

Indicates whether a patient reminder system for colorectal cancer screening was in place and operational (in use) in this clinic at the end of the program year (July 1- June 30), regardless of the quality, reach, or current level of functionality.

  • If patient reminders were newly implemented during this program year, select “Yes, newly in place”.

  • If patient reminders were in place prior to this program year, select “Yes, continuing”


If yes, newly in place skip to A5-1e

If yes, continuing, skip to A5-1d

If no, answer A5-1c and then skip to A5-2a


List

Baseline Record:

  • Yes

  • No



Annual Record:

  • Yes, newly in place

  • Yes, continuing

  • No




A5-1c

R

A

Patient reminder system planning activities

Baseline Record:

N/A


Annual Record:

If a patient reminder system was not in place (A5-1b is No), indicates whether planning activities were conducted this program year (July 1- June 30) for future implementation of a colorectal cancer screening patient reminder system.

Skip to A5-2a.

 List

  • Yes

  • No


A5-1d

R

A

Patient reminder system enhancements

Baseline: N/A


Annual:

If a patient reminder system was in place prior to this program year and continuing (A5-1b is Yes, continuing), indicates whether the clinic made changes to enhance or improve implementation of patient reminders during the program year (July 1- June 30).

List

  • Yes

  • No


A5-1e

R

A

Patient reminders sent multiple ways

Baseline Record:

N/A


Annual Record:

If a patient reminder system was in place (A5-1b is “Yes, newly in place” or “Yes, continuing”), indicates whether an average patient at this clinic received colorectal cancer screening reminders in more than one way (e.g., same patient received reminders in 3 different ways: one by letter, another by text message, and a third by telephone) during this program year (July 1- June 30).

List

  • Yes

  • No


A5-1f

R

A

Maximum number and/or frequency of patient reminders

Baseline Record:

N/A


Annual Record:

If a patient reminder system was in place (A5-1b is “Yes, newly in place” or “Yes, continuing”), indicates the maximum number of different ways and times (activity conducted more than one time during the year) that a given patient could have received colorectal cancer screening reminders during this program year (July 1- June 30) (e.g., same patient received a total of 4 reminders – 2 by phone, 1 by text, 1 by mail).


List

Select one:


Select one:


  • 1

  • 2

  • 3

  • 4

  • 5 or more

A5-1g

R

A

Patient reminder system sustainability

Baseline Record:

N/A


Annual Record:

If a patient reminder system was in place at the end of the program year (July 1- June 30) (A5-1b is “Yes, newly in place” or “Yes, continuing”), indicates whether the colorectal cancer screening patient reminder system is considered to be fully integrated into health system and/or clinic operations and is sustainable without CRCCP resources.


[The patient reminder system has become an institutionalized component of the health system and/or clinic operations.]

List

  • Yes

  • No




Section 5-2: EBI -Provider Reminder System

Indicates the clinic’s use of system(s) to inform providers that a patient is due (or overdue) for screening. The reminders can be provided in different ways, such as placing reminders in patient charts, EHR alerts, e-mails to the provider, etc.


Item #

Item Type

Collected

CRCCP Data Item

Indication/ Definition

Field Type

Response Options

A5-2a

R

A

CRCCP resources used toward a provider reminder system

Baseline Record:

N/A


Annual Record:

Indicates whether CRCCP grantee resources (e.g. funds, staff time, materials, contract) were used during this program year (July 1- June 30) to contribute to planning, developing, implementing, monitoring/evaluating or improving a provider reminder system that addresses colorectal cancer screening.

List

  • Yes

  • No

B5-2b
A5-2b

R

B, A

Provider reminder system in place

Baseline Record:

Indicates whether a provider reminder system that addresses colorectal cancer screening was in place and operational (in use) in this clinic prior to CRCCP activity implementation (Item BC1-1: Clinic CRCCP Activities Start Date), regardless of the quality, reach, or level of functionality.


Annual Record:

Indicates whether a provider reminder system that addresses colorectal cancer screening was in place and operational (in use) in this clinic at the end of the program year (July 1- June 30), regardless of the quality, reach, or current level of functionality.

  • If provider reminders were newly implemented during this program year, select “Yes, newly in place”.

  • If provider reminders were in place prior to this program year, select “Yes, continuing”


If yes, newly in place skip to A5-2e

If yes, continuing, skip to A5-2d

If no, answer A5-2c and then skip to A5-3a


List

Baseline Record:

  • Yes

  • No




Annual Record:

  • Yes, newly in place

  • Yes, continuing

  • No


A5-2c

R

A

Provider reminder system planning activities

Baseline Record:

N/A


Annual Record:

If a provider reminder system is not in place (A5-2b is No), indicates whether planning activities were conducted this program year (July 1- June 30) for future implementation of a provider reminder system for colorectal cancer screening.

Skip to A5-3a.

List

  • Yes

  • No

A5-2d

R

A

Provider reminder system enhancements

Baseline: N/A


Annual:

If a provider reminder system was in place prior to this program year and continuing (A5-2b is Yes, continuing), indicates whether the clinic made changes to enhance or improve implementation of patient reminders during the program year (July 1- June 30).

List

  • Yes

  • No


A5-2e

R

A

Provider reminders sent multiple ways

Baseline Record:

N/A

Annual Record:

If a provider reminder system was in place at the end of the program year (July 1- June 30) (A5-2b is “Yes, newly in place” or “Yes, continuing”), indicates whether providers at this clinic typically received colorectal cancer screening reminders for a given patient in more than one way (e.g., provider receives both an EHR pop-up message and a flagged patient chart for the same patient) during this program year.


List

  • Yes

  • No

A5-2f

R

A

Maximum number and/or frequency of provider reminders

Baseline Record:

N/A


Annual Record:

If a provider reminder system was in place at the end of the program year (July 1- June 30) (A5-2b is “Yes, newly in place” or “Yes, continuing”), indicates the maximum number of different ways and times (activity conducted more than one time during the year) that a given provider could have received colorectal cancer screening reminders for an individual patient during this program year (e.g., the provider received a total of 3 reminders for a given patient – 1 pop-up reminder in the patients electronic medical record, 1 reminder flagged in the patient chart, and 1 reminder via a list each day of patients due for screening) .

List

Select one


Select one:


  • 1

  • 2

  • 3

  • 4

  • 5 or more

A5-2g

R

A

Provider reminder system sustainability

Baseline Record:

N/A


Annual Record:

If a provider reminder system was in place at the end of the program year (July 1- June 30) (A5-2b is “Yes, newly in place” or “Yes, continuing”), indicates whether the provider reminder system is considered to be fully integrated into health system and/or clinic operations and is sustainable without CRCCP resources.


[The provider reminder system has become an institutionalized component of the health system and/or clinic operations.]


List

  • Yes

  • No


Section 5-3: EBI -Provider Assessment and Feedback

Indicates the clinic’s use of system(s) to evaluate provider performance in delivering or offering screening to clients (assessment) and/or present providers, either individually or as a group, with information about their performance in providing screening services (feedback).


Item #

Item Type

Collected at

CRCCP Data Item

Indication/ Definition

Field Type

Response Options

A5-3a

R

A

CRCCP resources used toward provider assessment and feedback

Baseline Record:

N/A


Annual Record:

Indicates whether CRCCP grantee resources (e.g. funds, staff time, materials, contract) were used during this program year (July 1- June 30) to contribute to planning, developing, implementing, monitoring/evaluating or improving provider assessment and feedback.


List

  • Yes

  • No

B5-3b
A5-3b

R

B, A

Provider assessment and feedback in place

Baseline Record:

Indicates whether provider assessment and feedback processes for colorectal cancer screening were in place and operational (in use) in this clinic before your CRCCP begins implementation (item B1-1), regardless of the quality, reach, or current level of functionality.


Annual Record:

Indicates whether provider assessment and feedback processes for colorectal cancer screening were in place and operational (in use) in this clinic at the end of the program year (July 1- June 30), regardless of the quality, reach, or current level of functionality.

  • If provider assessment and feedback processes were newly implemented during this program year, select “Yes, newly in place”.

  • If provider assessment and feedback processes were in place prior to this program year, select “Yes, continuing”


If yes, newly in place skip to A5-3e

If yes, continuing, skip to A5-3d

If no, answer A5-3c and then skip to A5-4a


List

Baseline Record:

  • Yes

  • No



Annual Record:

  • Yes, newly in place

  • Yes, continuing

  • No


A5-3c

R

A

Provider assessment and feedback planning activities

Baseline Record:

N/A


Annual Record:

If provider assessment and feedback were not in place and operational (A5-3b is No), indicates whether planning activities were conducted this program year for future implementation of provider assessment and feedback for colorectal cancer screening.

Skip to A5-4a.

List

  • Yes

  • No

A5-3d

R

A

Provider assessment and feedback enhancements

Baseline: N/A


Annual:

If a provider reminder system was in place prior to this program year and continuing (A5-3b is Yes, continuing), indicates whether the clinic made changes to enhance or improve implementation of patient reminders during the program year (July 1- June 30).

List

  • Yes

  • No


A5-3f

R

A

Provider assessment and feedback frequency

Baseline Record:

N/A


Annual Record:

If provider assessment and feedback were in place and operational at the end of the program year (July 1- June 30) (A5-3b is “Yes, newly in place” or “Yes, continuing”), indicates, on average, how often providers, either individually or as a group, were given feedback on their performance in providing colorectal cancer screening services during this program year.

List

Select one


Select one:


  • Weekly

  • Monthly

  • Quarterly

  • Annually

A5-3g

R

A

Provider assessment and feedback sustainability

Baseline Record:

N/A


Annual Record:

If provider assessment and feedback were in place and operational at the end of the program year (July 1- June 30) (A5-3b is “Yes, newly in place” or “Yes, continuing”), indicates whether provider assessment and feedback is considered to be fully integrated into health system and/or clinic operations and is sustainable without CRCCP resources.


[Provider assessment and feedback has become an institutionalized component of the health system and/or clinic operations.]


List

  • Yes

  • No



Section 5-4: EBI -Reducing Structural Barriers

Indicates the clinic’s use of one or more interventions to address structural barriers to colorectal cancer screening. 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."


Item #

Item Type

Collected

CRCCP Data Item

Indication/ Definition

Field Type

Response Options

A5-4a

R

A

CRCCP resources used toward reducing structural barriers

Baseline Record:

N/A


Annual Record:

Indicates whether CRCCP grantee resources (e.g. funds, staff time, materials, contract) were used during this program year (July 1- June 30) to contribute to planning, developing, implementing, monitoring/evaluating or improving reducing structural barriers.


List

  • Yes

  • No

B5-4b
A5-4b

R

B, A

Reducing structural barriers in place

Baseline Record:

Indicates whether activities for reducing structural barriers to colorectal cancer screening was in place and operational (in use) in this clinic before your CRCCP begins implementation, regardless of the quality, reach, or current level of functionality.


Annual Record:

Indicates whether activities for reducing structural barriers to colorectal cancer screening were in place and operational (in use) in this clinic at the end of the program year (July 1- June 30), regardless of the quality, reach, or current level of functionality.

  • If activities for reducing structural barriers were newly implemented during this program year, select “Yes, newly in place”.

  • If activities for reducing structural barriers were in place prior to this program year, select “Yes, continuing”


If yes, newly in place skip to A5-4e

If yes, continuing, skip to A5-4d

If no, answer A5-4c and then skip to A5-5a

List

Baseline Record:

  • Yes

  • No



Annual Record:

  • Yes, newly in place

  • Yes, continuing

  • No


A5-4c

R

A

Reducing structural barriers planning activities

Baseline Record:

N/A


Annual Record:

If reducing structural barriers was not in place at the end of the program year (July 1- June 30) (A5-4b is No), indicates whether planning activities were conducted this program year for future implementation of reducing structural barriers for colorectal cancer screening.

Skip to A5-5a.

List

  • Yes

  • No

A5-4d

R

A

Reducing structural barriers enhancements

Baseline: N/A


Annual:

If reducing structural barriers was in place prior to this program year and continuing (A5-4b is “Yes, continuing”), indicates whether the clinic made changes to enhance or improve implementation of patient reminders during the program year (July 1- June 30).

List

  • Yes

  • No


A5-4e

R

A

Reducing structural barriers more than one way

Baseline Record:

N/A


Annual Record:

If reducing structural barriers was in place at the end of the program year (July 1- June 30) (A5-4b is “Yes, newly in place” or “Yes, continuing”), indicates whether this clinic reduced structural barriers for patients in multiple ways (e.g., offered evening clinic hours, offered assistance in scheduling appointments, provided free screenings for some patients) during this program year.

List

  • Yes

  • No

A5-4f

R

A

Maximum ways reducing structural barriers

Baseline Record:

N/A


Annual Record:

If reducing structural barriers was in place at the end of the program year (July 1- June 30) (A5-4b is “Yes, newly in place” or “Yes, continuing”), indicates the maximum number of different ways the clinic reduced structural barriers to colorectal cancer screening during this program year.

List

Select one


Select one:


  • 1

  • 2

  • 3

  • 4

  • 5 or more

A5-4g

R

A

Reducing structural barriers sustainability

Baseline Record:

N/A


Annual Record:

If reducing structural barriers was in place at the end of the program year (July 1- June 30) (A5-4b is “Yes, newly in place” or “Yes, continuing”), indicates whether reducing structural barriers is considered to be fully integrated into health system and/or clinic operations and is sustainable without CRCCP resources.


[ Reducing structural barriers has become an institutionalized component of the health system and/or clinic operations.]

List

  • Yes

  • No



Section 5-5: Small Media

Indicates the clinic’s use of small media to improve colorectal cancer screening. Small media are materials used to inform and motivate people to be screened for cancer, including videos and printed materials (e.g., letters, brochures, and newsletters).


Item #

Item Type

Collected

CRCCP Data Item

Indication/ Definition

Field Type

Response Options

A5-5a

R

A

CRCCP resources used toward small media

Baseline Record:

N/A


Annual Record:

Indicates whether CRCCP grantee resources (e.g. funds, staff time, materials, contract) were used during this program year (July 1- June 30) to contribute to planning, developing, implementing, monitoring/evaluating or improving small media to improve colorectal cancer screening.

List

  • Yes

  • No

B5-5b
A5-5b

R

B, A

Small media in place

Baseline Record:

Indicates whether use of small media to improve colorectal cancer screening was in place and operational (in use) in this clinic before your CRCCP begins implementation, regardless of the quality, reach, or current level of functionality.


Annual Record:

Indicates whether use of small media to improve colorectal cancer screening were in place and operational (in use) in this clinic at the end of the program year (July 1- June 30), regardless of the quality, reach, or current level of functionality.

  • If activities for reducing structural barriers were newly implemented during this program year, select “Yes, newly in place”.

  • If activities for reducing structural barriers were in place prior to this program year, select “Yes, continuing”.


If yes, newly in place skip to A5-5e

If yes, continuing, skip to A5-5d

If no, answer A5-5c and then skip to A5-6a

List

Baseline Record:

  • Yes

  • No



Annual Record:

  • Yes, newly in place

  • Yes, continuing

  • No


A5-5c

R

A

Small media planning activities

Baseline Record:

N/A


Annual Record:

If small media to improve colorectal cancer screening was not in place at the end of the program year (July 1- June 30) (A5-5b is No), indicates whether planning activities were conducted this year for future implementation of small media.

Skip to A5-6a

List

  • Yes

  • No

A5-5d

R

A

Small media enhancements

Baseline: N/A


Annual:

If reducing structural barriers was in place prior to this program year and continuing (A5-5b is “Yes, continuing”), indicates whether the clinic made changes to enhance or improve implementation of patient reminders during the program year (July 1- June 30).

List

  • Yes

  • No


A5-5e

R

A

Maximum number of ways and times small media delivered

Baseline Record:

N/A


Annual Record:

If small media was in place at the end of the program year (July 1- June 30) (A5-5b is “Yes, newly in place” or “Yes, continuing”), indicates the maximum number of different ways and times (activity conducted more than one time during the year) a given patient could have received small media about colorectal cancer screening during this PY.

List

Select one


Select one:


  • 1

  • 2

  • 3

  • 4

  • 5 or more

A5-5f

R

A

Small media sustainability

Baseline Record:

N/A


Annual Record:

If small media was in place at the end of the program year (July 1- June 30) (A5-5b is “Yes, newly in place” or “Yes, continuing”), indicates whether small media is considered to be fully integrated into health system and/or clinic operations and sustainable.


[ Small media has become an institutionalized component of the health system and/or clinic operations.]


List

  • Yes

  • No


Section 5-6: Patient Navigation

Indicates whether patient navigators (PNs) are in place at or employed by the clinic. PNs typically assist clients in overcoming individual barriers to cancer screening. Patient navigation includes assessment of client barriers, client education and support, resolution of client barriers, client tracking and follow-up. Patient navigation should involve multiple contacts with a client.


Item #

Item Type

Collected

CRCCP Data Item

 Indication/ Definition

Field Type

Response Options

A5-6a

R

A

CRCCP resources used toward patient navigation

Baseline Record:

N/A


Annual Record:

Indicates whether CRCCP grantee resources (e.g. funds, staff time, materials, contract) were used during this program year (July 1- June 30) to contribute to planning, developing, implementing, monitoring/evaluating or improving patient navigation to support colorectal cancer screening (including completion of follow-up colonoscopies).

List

  • Yes

  • No

B5-6b
A5-6b

R

B, A

Patient navigation in place

Baseline Record:

Indicates whether patient navigation to support colorectal cancer screening (including completion of follow-up colonoscopies) was in place and operational (in use) in this clinic before your CRCCP begins implementation (itemB1-1), regardless of the quality, reach, or current level of functionality.


Annual Record:

Indicates whether patient navigation to support colorectal cancer screening (including completion of follow-up colonoscopies) was in place and operational (in use) in this clinic at the end of the program year (July 1- June 30), regardless of the quality, reach, or current level of functionality.


If yes, newly in place skip to A5-6d

If yes, continuing, skip to A5-6d

If no, answer A5-6c and then skip to A6-1.

List

Baseline Record:

  • Yes

  • No



Annual Record:

  • Yes, newly in place

  • Yes, continuing

  • No

A5-6c

R

A

Patient navigation planning

Baseline Record:

N/A


Annual Record:

If patient navigation was not in place at the end of the program year (July 1- June 30) (A5-6b is “No”), indicates whether planning activities were conducted this program year for future implementation of patient navigation for colorectal cancer screening.

skip to A6-1.

List

  • Yes

  • No

A5-6d

R

B&A

Patient Navigation Purpose

Baseline Record:

Indicates the focus of patient navigation in this clinic before your CRCCP begins implementation (item B1-1),


Annual Record:

Indicates whether patient navigation supported colorectal cancer screening, follow-up colonoscopies or both in this clinic at the end of the program year (July 1- June 30).


If A5-6b is yes, newly in place skip to A5-6f

List

Select one:

  • CRC screening

  • Follow-up colonoscopies

  • Both




A5-6e

R

A

Patient Navigation Enhancements

Baseline: N/A


Annual:

If patient navigation was in place and continuing (A5-6b is “Yes, continuing”), indicates whether the clinic made changes to enhance or improve implementation of patient navigation during the program year (July 1- June 30).

List

  • Yes

  • No


A5-6f

R

A

Average amount of patient navigation time

Baseline Record:

N/A


Annual Record:

For persons at this clinic who received navigation this program year (July 1- June 30), indicates the average amount of navigation time a patient received to overcome colorectal cancer screening barriers during this PY.


If detailed monitoring data are not available, an estimate of the average time is sufficient.

List

Select one


Select one:


  • Less than 15 minutes

  • >15 to 30 minutes

  • >30 minutes to 1 hour

  • >1 to 2 hours

  • >2 to 3 hours

  • More than 3 hours

A5-6g

R

A

Patient navigators for EBIs

Baseline Record:

N/A


Annual Record: Indicates whether patient navigator(s) at this clinic assisted or facilitated implementation of any of the following 4 EBIs: patient reminders, provider reminders, provider assessment and feedback, or reducing structural barriers.

List

  • Yes

  • No

A5-6h

R

A

Patient navigation sustainability

Baseline Record:

N/A


Annual Record:

If patient navigation was in place at the end of the program year (July 1- June 30) (A5-6b is “Yes, newly in place” or “Yes, continuing”), indicates whether patient navigation for colorectal cancer screening is considered to be fully integrated into health system and/or clinic operations and is sustainable without CRCCP resources.


[Patient navigation has become an institutionalized component of the health system and/or clinic operations.]

List

Yes
No

B5-6h

A5-6h

R

A, B

Number of FTEs delivering patient navigation

Baseline Record:

If patient navigation was in place at baseline (item B5-6b=Yes), indicates the number of full-time equivalents (FTEs) conducting patient navigation (e.g., navigators, nurse navigators, nurses, peer health advisors, health navigators) for colorectal cancer in this clinic during this program year.


Annual Record:

If patient navigation was in place at the end of the program year (July 1- June 30) (item A5-6b is “Yes, newly in place” or “Yes, continuing”), indicates the number of full-time equivalents (FTEs) conducting patient navigation (e.g., navigators, nurse navigators, nurses, peer health advisors, health navigators) for colorectal cancer in this clinic during this program year.


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 deliver navigation for colorectal cancer, then enter 0.5.


Num

00.0-999.0

A5-6i

R

A

Number of patients navigated

Baseline Record:

N/A


Annual Record:

If patient navigation was in place at the end of the program year (July 1- June 30) (A5-6b is Yes), indicates the number of patients s receiving navigation services for colorectal cancer screening (including follow-up colonoscopies) during this program year.   

Num

1-99998


99999 (Unk)

B5-7

A5-7

O

A, B

Section 5 Comments

Optional comments for Section 5.

Char

Free text

200 Char limit





Section 6. Annual Implementation Factors

  • The following variables address factors affecting implementation of the evidence-based interventions or EBIs. EBIs include patient reminders, provider reminders, reducing structural barriers, and provider assessment and feedback.

  • A representative of the clinic should provide the responses for these fields based on his or her experience during the program year.


Item #

Item Type

 Collected

CRCCP Data Item

Definition

Field Type

Response Options

A6-1

R

A

Complexity

Baseline Record:

N/A


Annual Record:

EBIs’ individual process steps and/or EBIs as a whole are difficult to implement 


Evidence-based interventions or EBIs to increase colorectal cancer screening include patient reminders, provider reminders, reducing structural barriers, and provider assessment and feedback.

List

Select one


Select one:

  • Strongly Disagree

  • Disagree

  • Neither Agree nor Disagree

  • Agree

  • Strongly Agree

  • Don’t know/Not Applicable

A6-2

R

A

Adaptability

Baseline Record:

N/A


Annual Record:

The EBIs are flexible and the process steps for implementing them can be tailored to fit our clinic workflow.


Evidence-based interventions or EBIs to increase colorectal cancer screening include patient reminders, provider reminders, reducing structural barriers, and provider assessment and feedback.

List

Select one


Select one:

  • Strongly Disagree

  • Disagree

  • Neither Agree nor Disagree

  • Agree

  • Strongly Agree

  • Don’t know/Not Applicable

A6-3

R

A

Cost-substantial resources

Baseline Record:

N/A


Annual Record:

The EBIs require substantial resources to implement. 


Evidence-based interventions or EBIs to increase colorectal cancer screening include patient reminders, provider reminders, reducing structural barriers, and provider assessment and feedback.

List

Select one


Select one:

  • Strongly Disagree

  • Disagree

  • Neither Agree nor Disagree

  • Agree

  • Strongly Agree

Don’t know/Not Applicable

A6-4

R

A

Cost- worthwhile

Baseline Record:

N/A


Annual Record:

The EBIs are a worthwhile investment for systems change to increase colorectal cancer screening rates 


Evidence-based interventions or EBIs to increase colorectal cancer screening include patient reminders, provider reminders, reducing structural barriers, and provider assessment and feedback.

List

Select one


Select one:

  • Strongly Disagree

  • Disagree

  • Neither Agree nor Disagree

  • Agree

  • Strongly Agree

Don’t know/Not Applicable

A6-5

R

A

Patient Needs/ Resources

Baseline Record:

N/A


Annual Record:

The EBIs and support strategies take into consideration the needs and preferences of the patients at this clinic. 


Evidence-based interventions or EBIs to increase colorectal cancer screening include patient reminders, provider reminders, reducing structural barriers, and provider assessment and feedback.

List

Select one


Select one:

  • Strongly Disagree

  • Disagree

  • Neither Agree nor Disagree

  • Agree

  • Strongly Agree

Don’t know/Not Applicable

A6-6

R

A

External Policy

Baseline Record:

N/A


Annual Record:

The requirement to report colorectal cancer screening data to an outside organization (e.g., HRSA, CMS, NCQS) is an important motivator to increase screening among our patients

List

Select one


Select one:

  • Strongly Disagree

  • Disagree

  • Neither Agree nor Disagree

  • Agree

  • Strongly Agree

  • Don’t know/Not Applicable

A6-7

R

A

Incentives

Baseline Record:

N/A


Annual Record:

Financial rewards received by your health system/clinic for meeting certain requirements or colorectal cancer screening thresholds provide incentive to improve colorectal cancer screening, (e.g., quality improvement awards)

List

Select one


Select one:

  • Strongly Disagree

  • Disagree

  • Neither Agree nor Disagree

  • Agree

  • Strongly Agree

  • Don’t know/Not Applicable

A6-8

R

A

Conform

Baseline Record:

N/A


Annual Record:

The EBIs to increase colorectal cancer screening are consistent with the opinions of clinical experts and staff in this setting. 


Evidence-based interventions or EBIs to increase colorectal cancer screening include patient reminders, provider reminders, reducing structural barriers, and provider assessment and feedback.

List

Select one


Select one:

  • Strongly Disagree

  • Disagree

  • Neither Agree nor Disagree

  • Agree

  • Strongly Agree

  • Don’t know/Not Applicable

A6-9

R

A

Innovate and experiment

Baseline Record:

N/A


Annual Record:

Staff members are willing to innovate and experiment to improve procedures to increase colorectal cancer screening 

List

Select one


Select one:

  • Strongly Disagree

  • Disagree

  • Neither Agree nor Disagree

  • Agree

  • Strongly Agree

  • Don’t know/Not Applicable

A6-10

R

A

Priority

Baseline Record:

N/A


Annual Record:

Clinic leadership have set a high priority on the success of the colorectal cancer screening interventions relative to other quality improvement activities  

List

Select one


Select one:

  • Strongly Disagree

  • Disagree

  • Neither Agree nor Disagree

  • Agree

  • Strongly Agree

  • Don’t know/Not Applicable

A6-11

R

A

Staff- time and resources

Baseline Record:

N/A


Annual Record:

The clinic leadership/clinic managers make sure that staff have the time and resources necessary to implement the EBIs to increase colorectal cancer screening.


Evidence-based interventions or EBIs to increase colorectal cancer screening include patient reminders, provider reminders, reducing structural barriers, and provider assessment and feedback.

List

Select one


Select one:

  • Strongly Disagree

  • Disagree

  • Neither Agree nor Disagree

  • Agree

  • Strongly Agree

Don’t know/Not Applicable

A6-12

R

A

Staff- training

Baseline Record:

N/A


Annual Record:

Clinic staff get the support in terms of the training needed to implement the EBIs to increase colorectal cancer screening. 


Evidence-based interventions or EBIs to increase colorectal cancer screening include patient reminders, provider reminders, reducing structural barriers, and provider assessment and feedback.

List

Select one


Select one:

  • Strongly Disagree

  • Disagree

  • Neither Agree nor Disagree

  • Agree

  • Strongly Agree

  • Don’t know/Not Applicable

A6-13

R

A

Appropriate Set

Baseline Record:

N/A


Annual Record:

The EBIs implemented at your clinic are an appropriate set of interventions to increase colorectal cancer screening. 


Evidence-based interventions or EBIs to increase colorectal cancer screening include patient reminders, provider reminders, reducing structural barriers, and provider assessment and feedback.

List

Select one


Select one:

  • Strongly Disagree

  • Disagree

  • Neither Agree nor Disagree

  • Agree

  • Strongly Agree

  • Don’t know/Not Applicable

A6-14

R

A

Champion designated

Baseline Record:

N/A


Annual Record:

Senior leadership/clinical management have designated a champion(s) for implementing the EBIs to increase colorectal cancer screening. 


Evidence-based interventions or EBIs to increase colorectal cancer screening include patient reminders, provider reminders, reducing structural barriers, and provider assessment and feedback.

List

Select one


Select one:

  • Strongly Disagree

  • Disagree

  • Neither Agree nor Disagree

  • Agree

  • Strongly Agree

  • Don’t know/Not Applicable

A6-15

R

A

Champion responsibility

Baseline Record:

N/A


Annual Record:

The clinic champion(s) accepts responsibility for implementing the EBIs to increase colorectal cancer screening


Evidence-based interventions or EBIs to increase colorectal cancer screening include patient reminders, provider reminders, reducing structural barriers, and provider assessment and feedback.

List

Select one


Select one:

  • Strongly Disagree

  • Disagree

  • Neither Agree nor Disagree

  • Agree

  • Strongly Agree

  • Don’t know/Not Applicable

A6-16

R

A

Team debrief

Baseline Record:

N/A


Annual Record:

Progress of the implementation of the EBIs are reviewed through regular debriefings with clinic staff. 


Evidence-based interventions or EBIs to increase colorectal cancer screening include patient reminders, provider reminders, reducing structural barriers, and provider assessment and feedback.

List

Select one


Select one:

  • Strongly Disagree

  • Disagree

  • Neither Agree nor Disagree

  • Agree

  • Strongly Agree

  • Don’t know/Not Applicable



Section 7: Other Baseline and Annual Colorectal Cancer Activities and Comments

Indicates whether other/additional colorectal cancer-related strategies are used in the clinic to improve screening levels such as clinic workflow assessment and data driven optimization, other data driven quality improvement strategies, 5 rights of clinical decision support (5 R’s), etc.


Item #

Item Type

Collected

CRCCP Data Item

 

Field Type

Response Options

B7-1
A7-1

O

B, A

Other Colorectal Cancer Activity 1

Baseline and Annual Records:

Description of other CRC activity or strategy #1.

Char

Free text

200 Char limit

A7-1a

O

A

CRCCP resources used toward Activity1

Baseline Record:

N/A


Annual Record:

Indicates whether CRCCP resources were used during the program year to support activity #1

List

  • Yes

  • No

B7-2
A7-2

O

B, A

Other Colorectal Cancer Activity 2

Baseline and Annual Records:

Description of other CRC activity or strategy #2.

Char

Free text

200 Char limit

A7-2a

O

A

CRCCP resources used toward Activity2

Baseline Record:

N/A


Annual Record:

Indicates whether CRCCP resources were used during the program year to support activity #2.

List

  • Yes

  • No

B7-3
A7-3

O

B, A

Other Colorectal Cancer Activity 3

Baseline and Annual Records:

Description of other CRC activity or strategy #3.


Char

Free text

200 Char limit

A7-3a

O

A

CRCCP resources used toward Activity3

Baseline Record:

N/A


Annual Record:

Indicates whether CRCCP resources were used during the program year to support activity #3.

List

  • Yes

  • No

B7-4
A7-4

0

B, A

Section 7 Comments

Optional comments for Section 7.

Char

Free text

200 Char limit



File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorMichele Beckman
File Modified0000-00-00
File Created2021-01-13

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