Hello, please find attached my whole document. Sorry, it's a bit long! The first part is the identification of a gap, second part is applying theory. I used CFIR (or at least part of it) and diffusion of innovations.
Hi Kevin,
I think you are on the right track for your gap. I know your gap is a little different and does not fit perfectly into any of the theories we discussed in class. I think CFIR was a good choice and brought out some interesting ideas in regards to identifying areas to be addressed to close your gap. Since you are focusing on the organizational level I think resources honestly might be the biggest area to really focus in on as well as incentives. You may be able to address these two areas together in one recommendation for closing your gap. Think about why the lower performing centers might have issues with resources (understaffed, no time to call for follow-ups, other pressing issues unique to that clinic) and how maybe an incentive could help with this. I know this is a new area which you are currently collecting information on but see if you can focus your efforts down within the organizational level to see if there is any supporting evidence from similar situations out there that might help guide you and your recommendations for your gap. Well done though!
Hi Kevin,
This is a very well-thought analysis of the gap. It is nice that you went beyond (I found the positive deviant very interesting and applicable in many contexts) to do a thorough analysis.
It will be informing to learn what those high performing sites are doing differently, and equally important is learning what is keeping the low performance sites to do so. I found your theory of patient behavior really relevant, and was tilted more toward that. I might also be worth including a few patients in your research to find out what the demotivating factors are, and what can make them willing at going for colonoscopy after initial FIT.
The patient navigation is really well perceived in many other diseases (and even social needs and resources provisions) and settings. Worth a trial!
Kevin,
Great way to combine the two constructs: diffusion of ideas and CFIR. I think by looking at clinics that is structurally aligned to close the gap between FIT testing and colonoscopy you will be able to identify at the the provider and patient characteristics that lead to the appropriate referral of FIT testing. If there are multiple clinics identified, each with unique structural arrangements to facilitate FIT -> colonoscopy, then you may even be able to identify how incentives at the provider and individual level change/interface with the different clinic-wide structures.
My one consideration is that Kaiser is such a unique care network that I wonder how applicable these models will be to systems that are outside of the Kaiser network. Given the size of the Kaiser network, identifying the structural and individual-level (inner) processes will have a large impact, but may make assumptions about broader economic/political context that may be crucial to understanding the gap in FIT -> colonoscopy.
Looking forward to discussing this further in class!
Asa