Hi guys, this is still a little long, I apologize! However, I tried to start focusing in on what I hope to do.
Hi Kevin,
No need to apologize; more is better in this context. You conducted a really thorough analysis and you seem to have a clear vision of your intervention. Patient navigation programs have shown effectiveness in many domains in medicine and I think it can work in you particular area.
You mentioned that you will be looking at differences in leadership support in sites, and I am curious how you intend to do that. What are the measures you will be using? I am also curious if you have data on patients who are more likely to have their colonoscopy right after their FIT and if there is a difference between the patients who don't come back.
Really strong project! Well done!
Hi Kevin,
I agree with Kadia, this really sounds like a strong project with a clear plan and aim! You mentioned that follow-up colonoscopy rates have increased at Kaiser Permanente since the early 2000s, so I was wondering if there are already specific guidelines concerning management of follow-up colonoscopies after positive FIT tests in this integrated health system? As you had mentioned in section, KP already has quite high follow-up rates compared to other health systems or other countries, and it would be interesting to see how your finding can be translated to other settings, where the follow-up rates are currently still much lower!
Hi Kevin,
Well done on this assignment. I really like the way your DAG is organized. It definitely helps me to see where you are thinking of applying specific parts of your intervention. I know you have concerns about generalizability but I think by addressing the organizational level there will not be a huge issue with this since other organizations generally have similar programs/procedures set up. I am also very interested in patients attitudes to FIT testing and their outlook on the significance of a positive test. Maybe there is a way to ask the staff about patient attitudes and beliefs? Or to assess the information they provide patients? Maybe some clinics provide detailed education pamphlets on positive FIT tests while others do not? Just something to think about.
This is coming along nicely.
There is a class on organizational sociology that will provide a lot of insights here.
One possibility is to approach the "high performing" facilities with a blank slate and see what you can learn.
A little advanced thinking about things like organizational culture, leadership and managerial processes at these units might position you well to dive into the qualitative data.
There is for example an instrument of management capability developed by someone at Stanford Business School. I'll have to dig this up - let me know if you are interested in it.
Another random scale for ability to take up evidence (maybe this one applies more after the recent JAMA paper by your colleagues) that may or may not fit your context.
- Aarons, Gregory A. "Mental health provider attitudes toward adoption of evidence-based practice: The Evidence-Based Practice Attitude Scale (EBPAS)." Mental health services research 6.2 (2004): 61-74.