Attachment D1: Data Collection Instrument: MS Word version
Form Approved
OMB No. 0920-XXXX
Expiration Date: XX/XX/20XX
Annual Survey of the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) Grantees’ Program Implementation
The Centers for Disease Control and Prevention (CDC), Division of Cancer Prevention and Control (DCPC) is assessing how states, tribes, tribal organizations and territorial health departments implement the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) during DP12-1205. This survey asks about your program implementation during DP12-1205 program year 2, the time period July 1, 2013 through June 30, 2014.
The aims of this data collection are to better understand how you are implementing your BCCEDP programs within an evolving healthcare context and to collect information about your training and technical assistance needs. Topics covered include: respondent information, program activities, clinical service delivery, non-screening partnerships, data use, training and technical assistance and program management. Your feedback is extremely important. Your responses to the questions are voluntary and will be kept in a secure manner. Results will be incorporated into individual and summary grantee reports for you and other stakeholders.
Given the evolving health care context, we expect that grantees will make changes in the types of activities implemented over the course of the 5-year program period. We do NOT expect that any program will be doing all of the activities asked about in this data collection.
It should take approximately 40 minutes to complete the survey in one sitting.
Thank you for your participation.
Public reporting burden of this collection of information is estimated to average 40 minutes per response including the time for reviewing the instructions and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road, NE, MS D-74, Atlanta, GA 30333. ATTN: PRA(0920-XXXX)
INSTRUCTIONS/DEFINITIONS
WHO SHOULD COMPLETE THIS DATA COLLECTION? The person responsible for the day-to-day management of the program and/or with the most program knowledge should complete this data collection.
WHAT TIME PERIOD IS BEING ASSESSED? We are collecting information about the implementation of your DP1205 BCCEDP, program year 2 (PY2). Unless instructed otherwise, all responses should reflect implementation of your BCCEDP in PY2 ONLY, July 1, 2013 – June 30, 2014.
WHAT DO WE MEAN BY ‘YOUR BCCEDP PROGRAM’? The term ‘BCCEDP program’ refers to all those involved in the implementation of your program/program activities, including you, your contractors, and your other partners, regardless of funding source (e.g., CDC funds, State funds, Komen funds) .
WHAT DO WE MEAN BY ‘YOU AND YOUR BCCEDP STAFF’?
‘You and your BCCEDP staff’ include those people working within your organization (e.g., State health department, tribal program) that work with the BCCEDP program, regardless of funding source (e.g., CDC funds, State funds, Komen funds).
WHAT DO WE MEAN BY ‘BCCEDP CLINICS’?
‘BCCEDP clinics’ are sites where BCCEDP-funded clinical services are provided.
[Note: ‘BCCEDP-funded’ includes all funding sources supporting your BCCEDP program such as CDC funds, State funds, and/or Komen funds.]
WHAT DO WE MEAN BY ‘NON-BCCEDP CLINICS’?
‘Non-BCCEDP clinics’ are those sites where BCCEDP-funded clinical services are NOT provided, but where other BCCEDP-funded activities (e.g., patient navigation, client reminders) may take place.
[Note: ‘BCCEDP-funded’ includes all funding sources supporting your BCCEDP program such as CDC funds, State funds, and/or Komen funds.]
WHAT
DO WE MEAN BY ‘BCCEDP CLIENTS’?
‘BCCEDP clients’ include all persons who receive BCCEDP-funded clinical screening and diagnostic services. [Note: ‘BCCEDP-funded’ includes all funding sources supporting your BCCEDP program such as CDC funds, State funds, and/or Komen funds.]
WHAT ARE PROCESS AND OUTCOME EVALUATION?
Process evaluation involves collecting and analyzing information about how program activities were implemented (e.g., number of clients assessed by a patient navigator).
Outcome evaluation examines whether expected outcomes were achieved (e.g., changes in clinic-level screening rates).
SECTION 1: RESPONDENT INFORMATION
With which BCCEDP program are you affiliated? [Dropdown list of all BCCEDP grantees]
Check appropriate GRANTEE NAME
What is your current position with the BCCEDP program? (Check all that apply)
Program director (the primary contact for the BCCEDP cooperative agreement)
Program manager/coordinator (the day-to-day manager for the BCCEDP)
Other (please specify):__________________
How long have you worked with the BCCEDP program in your state/tribe/territory/jurisdiction/ organization?
< 1 year
1-2 years
3-5 years
6-10 years
11+ years
SECTION 2: PROGRAM ACTIVITIES
In the following sections, you will be asked questions about your BCCEDP’s implementation of specific program activities in program year 2 (PY2). Subsections A-C apply to provider-oriented activities; D-J address client-oriented activities.
PROVIDER REMINDERS
A provider reminder is used to inform a health care provider that a specific client is due or overdue for a cancer screening test. The reminder to a provider can be made in different ways such as in client charts, in client electronic medical records, or by e-mail.
During PY2, did one or more of your BCCEDP clinics utilize a provider reminder system?
Yes
No – skip to Section B
During PY2, did your BCCEDP program a) conduct or b) provide funding or technical assistance to support implementation of provider reminder system(s) (Check all that apply)
Yes, in BCCEDP clinics
Yes, in non-BCCEDP clinics
No -- skip to question 2.A.4.
What activities did your BCCEDP program conduct to implement a provider reminder system? (Check all that apply)
We sent reminders directly
We provided funding to others to implement
We provided technical assistance to support others to implement
Other: _____________
During PY2, what types of clinics (BCCEDP and/or Non-BCCEDP) implemented provider reminder systems? (Check all that apply)
Federally Qualified Health Centers or Community Health Centers
Indian Health Service hospital or clinic or other tribal health organizations
Health care systems or clinics associated with insurers (e.g., hospital, VA, Kaiser)
Individual offices or clinics
Local health department clinics
Other (please specify):______________________
During PY2, did your BCCEDP program evaluate provider reminder systems? (Check all that apply)
Yes, we conducted process evaluation of provider reminder systems (e.g., percentage of patients due for screening that are referred for mammogram by their provider)
Yes, we conducted outcome evaluation of provider reminder systems (e.g., changes in clinic-level screening rates)
No, we did not evaluate provider reminder systems in PY2
PROVIDER ASSESSMENT AND FEEDBACK
Provider assessment and feedback interventions evaluate provider performance (assessment) in delivering cancer screening to clients and then present providers with information about their performance (feedback), sometimes comparing it with a goal or standard.
1. During PY2, did your BCCEDP program use some or all of CDC’s 11 core performance indicators to produce provider or clinic-level feedback reports for BCCEDP clinics?
Yes
No -- skip to question 2.B.8.
2. During PY2, did your feedback reports include benchmarks or targets (e.g., 90% of abnormal breast screens with diagnostic evaluation completed) for CDC’s core performance indicators?
Yes
No
3. During PY2, did the feedback reports include comparisons between BCCEDP clinics or individual providers on specific indicators?
Yes
No
4. During PY2, did the feedback reports include data other than some or all of the CDC’s 11 core performance indicators?
Yes
No
5. During PY2, how frequently did your BCCEDP program distribute these feedback reports to BCCEDP clinics?
1-2 times
More than 2 times
6. How long has your BCCEDP program been producing and distributing these feedback reports to BCCEDP clinics?
1-2 years
3-5 years
>5 years
7. During PY2, were data from the feedback reports or other data about provider performance used to inform funding allocations for contracts with BCCEDP clinics?
Yes
No
8. During PY2, did your BCCEDP program a) conduct or b) provide funding or technical assistance to support implementation of provider assessment and feedback reports in non-BCCEDP clinics?
Yes
No –
[if Yes to 2.B.1. and No to 2.B.8., skip to 2.B.10; if No to 2.B.1. and No to 2.B.8, skip to Section 2.C]
9. What activities did your BCCEDP program conduct in relation to provider assessment and feedback? (Check all that apply)
We provided funding to others to implement
We provided technical assistance to support others to implement
Other: _____________
10. During PY2, what types of clinics (BCCEDP and/or Non-BCCEDP) received assessment and feedback reports? (Check all that apply)
Federally Qualified Health Centers or Community Health Centers
Indian Health Service hospital or clinic or other tribal health organizations
Health care systems or clinics associated with insurers (e.g., hospital, VA, Kaiser)
Individual offices or clinics
Local health department clinics
Other (please specify):______________________
11. During PY2, did your BCCEDP program evaluate provider assessment and feedback activities? (Check all that apply)
Yes, we conducted process evaluation of provider assessment and feedback (e.g., number of providers or clinics receiving assessment and feedback reports for a given time period)
Yes, we conducted outcome evaluation of provider assessment and feedback (e.g., changes in clinic-level screening rates)
No, we did not evaluate provider assessment and feedback activities in PY2
PROFESSIONAL DEVELOPMENT/PROVIDER EDUCATION
Professional development and/or provider educational activities are designed to improve the knowledge, attitudes, cancer screening care, and counseling behaviors of healthcare providers and can be applied in a range of settings (e.g., pharmacies, physician offices, medical schools).
1. During PY2, did your BCCEDP program provide professional development/provider education (e.g., training sessions with CME credits, provider tool kits, academic detailing)? By “provide” we mean providing funding or technical assistance to support implementation of these activities, or delivering these activities directly. (Check all that apply)
Yes, for providers in BCCEDP clinics
Yes, for providers in non-BCCEDP clinics
No – skip to section 2.D
2. How did your BCCEDP program implement professional development/provider education (Check all that apply)
We provided professional development activities directly
We provided funding to others to implement
We provided technical assistance to support others to implement
Other: _____________
3. During PY2, which providers received professional development/provider education? (Check all that apply)
Providers in Federally Qualified Health Centers or Community Health Centers
Providers in the Indian Health Service hospital or clinic or other tribal health organizations
Providers in health care systems or associated with insurers (e.g., hospital, VA, Kaiser)
Providers in individual offices or clinics
Local health department clinics
Other (please specify):______________________
4. During PY2, did your BCCEDP program evaluate professional development/provider education activities? (Check all that apply)
Yes, we conducted process evaluation of professional development/provider education (e.g., number of providers receiving CMEs for a given time period)
Yes, we conducted outcome evaluation of professional development/provider education (e.g., changes in provider practices such as providers adherence to clinical guidelines)
No, we did not evaluate provider assessment and feedback activities in PY2
Now we will ask you about client-oriented activities
CLIENT REMINDERS
Client (or patient) reminders are written, electronic or telephone messages advising people that they are due for cancer screening.
During PY2, did BCCEDP clients receive client reminders either directly from your BCCEDP program or from BCCEDP clinics?
Yes
No – skip to section 2.E
During PY2, did your BCCEDP program a) conduct or b) provide funding or technical assistance to support the implementation of client reminder systems? (Check all that apply)
Yes, in BCCEDP clinics
Yes, in non-BCCEDP clinics
No – –[if No to both 2.D.1 and 2.D.2, skip to section 2.E, If Yes to 2.D.1 and No to 2.D.2, proceed to 2.D.4]
What activities did your BCCEDP program conduct to implement a client reminder system? (Check all that apply)
We sent reminders directly
We provided funding to others to implement
We provided technical assistance to support others to implement
Other: _____________
During PY2, who received client reminders? (Check all that apply)
Clients who receive healthcare through Federally Qualified Health Centers or Community Health Clinics
Clients who receive healthcare through clinics of the Indian Health Service hospital or clinic or other tribal health organizations
Clients who receive healthcare through health care systems or insurers (e.g., hospital, VA, Kaiser)
Clients who receive healthcare through individual physician offices/provider groups, including local health department clinics
Enrollees of Medicaid
Enrollees of Medicare
Other (please specify):________________________
5. During PY2, did your BCCEDP program evaluate client reminder systems? (Check all that apply)
Yes, we conducted process evaluation of client reminder systems (e.g., number of clinics using client reminder systems)
Yes, we conducted outcome evaluation of client reminder systems, (e.g., changes in clinic-level screening rates)
No, we did not evaluate client reminder systems in PY2
SMALL MEDIA
Small media include videos and printed materials such as letters, brochures, and newsletters that can be used to inform and motivate people to be screened for cancer. Small media materials can provide information tailored to specific individuals or targeted to general audiences.
1. During PY2, did your BCCEDP program use small media materials (e.g., educational brochures, targeted emails or social media with a screening promotion message)? (Check all that apply)
Yes, for clients in BCCEDP clinics
Yes, for clients in non-BCCEDP clinics
No – skip to section 2.F
2. During PY2, who received small media materials through the efforts of your BCCEDP program? (Check all that apply)
Clients who receive healthcare through Federally Qualified Health Centers or Community Health Clinics
Clients who receive healthcare through hospitals or clinics of the Indian Health Service or other tribal health organizations
Clients who receive healthcare through health care systems or insurers (e.g., hospital, VA, Kaiser)
Clients who receive healthcare through individual physician offices/provider groups, including local health department clinics
Enrollees of Medicaid
Enrollees of Medicare
Community members/the general public (e.g., religious organizations, workplaces, community-based organizations)
Other (please specify):________________________
3. During PY2, did your BCCEDP program distribute small media materials in conjunction with any of the following activities? (Check all that apply)
Patient navigation/case management (e.g., a navigator gives a patient an educational brochure in addition to addressing other barriers)
Client reminders (e.g., a postcard sent to a client to remind them that they are due for screening also includes a general educational message about screening)
One-on-one education (e.g., a community health worker gives a brochure to a community member during outreach)
Group education (e.g., a health educator distributes brochures as part of an educational session)
Small media materials are disseminated as a stand-alone intervention
4. During PY2, did your BCCEDP program evaluate small media activities? (Check all that apply)
Yes, we conducted process evaluation of our small media activities (e.g., number of events where small media materials were distributed)
Yes, we conducted outcome evaluation of small media activities, (e.g., changes in intention to be screened for breast cancer)
No, we did not evaluate small media activities in PY2
MASS MEDIA
Mass media—including television, radio, newspapers, magazines, and billboards—are used to communicate educational and motivational information about cancer screening.
During PY2, did your BCCEDP program produce or support a mass media campaign? By “produce or support” we mean providing funding or technical assistance to support production and placement of mass media, or producing these media activities directly.
Yes
No -- skip to Section 2.G.
During PY2, what types of mass media were produced by or produced on behalf of your BCCEDP program? (Check all that apply)
Television
Radio
Digital media (e.g., social media campaign, advertising on the internet)
Newspaper/Magazines
Billboards, Transit signs
Other: __________________
3. During PY2, did your BCCEDP program evaluate your mass media campaign/activities? (Check all that apply)
Yes, we conducted process evaluation of our mass media campaign/activities (e.g., number of times media spot ran on TV during a given time period)
Yes, we conducted outcome evaluation of mass media campaign/activities, (e.g., changes in intention to be screened for breast cancer among specified population)
No, we did not evaluate mass media campaign/activities in PY2
REDUCING STRUCTURAL BARRIERS
Structural barriers are non-economic obstacles that make it difficult for people to access cancer screening (e.g., inconvenient hours or days of clinical service, transportation costs, unpaid sick leave). Interventions are designed to reduce these barriers in order to facilitate access to cancer screening services.
During PY2, did your BCCEDP program implement strategies to reduce structural barriers? (Check all that apply)
Yes, for BCCEDP clients only
Yes, for all clients in BCCEDP clinics, including non-BCCEDP clients
Yes, for clients in non-BCCEDP clinics
No – skip to section 2.H.
During PY2, what strategies did your BCCEDP program implement to reduce structural barriers? (Check all that apply)
Reducing time or distance between service delivery setting and priority populations
Modifying hours of clinical service to better meet client needs
Offering services in alternative or non-clinical settings (e.g., mobile mammography, sites with accommodations for those with disabilities)
Eliminating or simplifying administrative procedures and other obstacles
Paying or reimbursing for a patient navigator/case manager
Paying or reimbursing for a community health worker
Referring or assisting women with insurance enrollment (e.g., Medicaid/Medicare, private insurance, IHS, state-funded insurance, Insurance Marketplace)
Other (please specify) ___________
During PY2, did your BCCEDP program evaluate your efforts to reduce structural barriers? (Check all that apply)
Yes, we conducted process evaluation of our efforts to reduce structural barriers (e.g., number of clinics where Saturday hours were added)
Yes, we conducted outcome evaluation of our efforts to reduce structural barriers, (e.g., changes in clinic-level screening rates for breast cancer)
No, we did not evaluate our efforts to reduce structural barriers in PY2
COMMUNITY HEALTH WORKERS
Community health workers (CHWs) are lay health educators with a deep understanding of the community and are often from the community being served. CHWs work in community settings, in collaboration with a health promotion program, clinic, or hospital, to educate women about cancer screening, promote cancer screening, and provide peer support to women referred to cancer screening (sometimes referred to as Community Health Representatives, or promotoras).
1. During PY2, did your BCCEDP program include Community Health Workers (CHWs)?
Yes
No – skip to 2.H.4.
2. During PY2, what activities were typically conducted by the CHWs paid for or employed by your BCCEDP program? (Check all that apply)
Conduct outreach to community organizations/community members
Recruit “hard-to-reach” women for screening
Conduct in-reach to recruit women for screening or re-screening
Provide one-on-one education
Provide group education
Conduct peer counseling and support
Connect women to a health care facility
Refer or assist women with insurance enrollment (e.g., Medicaid, Medicare, private insurance, IHS, state-funded insurance, Insurance Marketplace)
Assist women to address barriers to screening (e.g., transportation, language services)
Other (please specify):_____________
3. During PY2, did your BCCEDP program evaluate these CHW activities? (Check all that apply)
Yes, we conducted process evaluation of our CHW activities (e.g., geographic reach of CHWs, number/FTEs of CHWs conducting activities)
Yes, we conducted outcome evaluation of our CHW activities, (e.g., percent of women reached by CHWs who complete screening)
No, we did not evaluate our CHW activities in PY2
4. During PY2, did your BCCEDP program provide training for CHWs? We are NOT asking about ad hoc technical assistance for CHWs that you might provide during the year. Note: we will ask about training for patient navigators and case managers separately, in the next section. (Check all that apply)
Yes, our BCCEDP provided CHW classroom training
Yes, our BCCEDP provided online training for CHWs
Yes, our BCCEDP provided guidance manual/training document for CHWs
Yes, our BCCEDP paid for CHWs to attend training offered by others
Yes, other: _______
No, we did not provide training for CHWs in PY2
PATIENT NAVIGATION AND CASE MANAGEMENT
Patient navigators/case managers typically assist clients to overcome their individual barriers to cancer screening. Some BCCEDP programs use patient navigators/case managers to assist women through both cancer screening and diagnostic testing while other programs only use patient navigators/case managers to assist women through diagnostic testing, and if diagnosed with cancer, into cancer treatment.
The next set of questions asks about the use of patient navigators or case managers for cancer SCREENING. Questions about use of patient navigators/case managers for diagnostic testing will be asked later.
1. During PY2, did your BCCEDP program use patient navigators/case managers to assist clients through cancer SCREENING? (Check all that apply)
Yes, for BCCEDP clients
Yes, for non-BCCEDP clients in BCCEDP clinics
Yes, for non-BCCEDP clients in non-BCCEDP clinics
No – skip to question 2.I.3
2. During PY2, what activities were typically delivered by patient navigators/case managers who assisted clients through cancer SCREENING? (Check all that apply)
Assess client barriers to cancer screening
Educate clients about screening test procedures
Provide peer support/counseling
Assist to schedule appointments for screening
Arrange/provide transportation, translation (language), child or elder care services
Make reminder calls for screening appointments
Track/follow-up clients to ensure screening is complete and patient receives results
Make recommendations to clinics/health systems on procedural or other changes that support client adherence to screening
Collect and report data about navigator/case manager service delivery
Conduct clinic in-reach or client outreach to recruit women for screening
Addressing socio-cultural barriers/issues
Refer or assist women with insurance enrollment (e.g., Medicaid/Medicare, private insurance, IHS, state-funded insurance, Insurance Marketplace)
Explain test results
Other (please specify):_________________________________
The next set of questions asks about the use of patient navigators or case managers for DIAGNOSTIC TESTING.
3. During PY2, did your BCCEDP program use patient navigators/case managers to assist clients through DIAGNOSTIC TESTING? (Check all that apply)
Yes, for BCCEDP clients
Yes, for non-BCCEDP clients in BCCEDP clinics
Yes, for non-BCCEDP clients in non-BCCEDP clinics
No – [if No to 2.I.1. and 2.I.3., skip to Section 2.J.; if No to 2.I.3. only, skip to 2.I.5]
4. During PY2, what activities were typically delivered by patient navigators/case managers who assisted clients with abnormal screening results through DIAGNOSTIC TESTING? (Check all that apply)
Assess client barriers to diagnostic testing
Educate clients about diagnostic testing procedures
Provide peer support/counseling
Assist to schedule appointments for diagnostic testing
Arrange/provide transportation, translation (language), child or elder care services
Make reminder calls for diagnostic testing appointments
Track/follow-up clients to ensure diagnostic testing is complete and patient receives results
Assist clients diagnosed with cancer to get into cancer treatment
Make recommendations to clinics/health systems on procedural or other changes that support client adherence to diagnostic testing
Collect and report data about navigator/case manager service delivery
Addressing socio-cultural barriers/issues
Refer or assist women with insurance enrollment (e.g., Medicaid/Medicare, private insurance, IHS, state-funded insurance, Insurance Marketplace)
Explain test results
Other (please specify):_________________________________
The next set of questions asks about evaluation and training for patient navigators or case managers.
5. During PY2, did your BCCEDP program provide training for patient navigators/case managers? We are not asking about ad hoc technical assistance that you might provide during the year. (Check all that apply)
Yes, our BCCEDP program provided PN/case management training class(es)
Yes, our BCCEDP program provided online training for PN/case managers
Yes, our BCCEDP program provided guidance manual/training document for PN/case managers
Yes, our BCCEDP program paid for PN/case management training offered by others (e.g., Harold Freeman Institute)
Yes, other: ______
No, we did not provide training for PN/case managers in PY2 -- skip to section 2.J.7
6. What topics were addressed in the training? (Check all that apply)
Assessing client barriers
Screening guidelines for breast and cervical cancer
Educating clients on breast and cervical cancer information
Motivating clients to be screened
Addressing structural barriers (e.g., transportation, language translation)
Ensuring cultural competency
Conducting patient tracking and follow-up
Providing peer support/counseling
Setting appropriate boundaries with clients
Collecting/reporting data for patient navigation/case management
Supporting health systems change strategies
Understanding health reform issues
Referring or assisting women with insurance enrollment (e.g., Medicaid/Medicare, private insurance, IHS, state-funded insurance, Insurance Marketplace)
Other (please specify):_________________
7. During PY2, did your BCCEDP program evaluate your patient navigation/case management activities? (Check all that apply)
Yes, we conducted process evaluation of our patient navigation/case management activities (e.g., number of women who were formally assessed by patient navigators/case managers)
Yes, we conducted outcome evaluation of our patient navigation/case management activities, (e.g., percent of women served by patient navigators/case managers who completed screening)
No, we did not evaluate our patient navigation/case management activities in PY2
8. During PY2, how did your BCCEDP program pay for patient navigation/case management services for BCCEDP clients? (Check all that apply)
Reimbursement to providers/clinics or other contractors for FTE support
Reimbursement to providers/clinics on a per-patient navigation/case management basis
Grantee staff served as patient navigators/case managers
In-kind support from a community partner/program
Other (specify): _____________________
9. In the table below, please enter the requested information about patient navigators/case managers that worked with clients during PY2.
|
If no navigators or case managers were part of your BCCEDP program, enter ‘0’. If you do not know the number of people or FTEs, enter ‘9999.’ |
Number of patient navigators/case managers working with clients in PY2, regardless of whether BCCEDP funds were used to pay for clinical services |
|
Number of FTE patient navigators/case managers working with clients in PY2, regardless of whether BCCEDP funds were used to pay for clinical services (e.g., you could have three people working 20 hrs/week representing total of 1.5 FTEs) |
|
10. During PY2, did any of your patient navigators/case managers collect and report non-clinical data to you about navigation services delivered (e.g., number of clients receiving navigation/case management, number of clients assessed for barriers, number and types of patient navigation contacts per client, percentage of clients navigated that completed screening).
Yes
No – Skip to question 2.I.12
11. During PY2, did your BCCEDP program use some type of patient navigation data system to collect non-clinical data about navigation services delivered?
Yes
No
12. During PY2, did your BCCEDP program collect clinical MDE data for non-BCCEDP clients who received navigation/case management?
Yes
No
13. During PY2, did your BCCEDP encounter challenges related to accessing clinical screening data for non-BCCEDP clients who received navigation/case management?
Yes
No – Skip to Section 2.J
14. What types of challenges have you experienced? _______________
J. FACILITATING ENROLLMENT IN INSURANCE PROGRAMS FOR CANCER SCREENING
During PY2, did your BCCEDP program facilitate women’s enrollment in insurance coverage for breast and cervical cancer screening services? This question is NOT referring to enrolling BCCEDP clients in Medicaid following a cancer diagnosis (commonly referred to as the “Treatment Act”). (Check all that apply)
Yes, our BCCEDP facilitated enrollment in Medicaid
Yes, our BCCEDP facilitated enrollment in Medicare
Yes, our BCCEDP facilitated enrollment in IHS
Yes, our BCCEDP facilitated enrollment in State-based insurance
Yes, our BCCEDP facilitated enrollment in Insurance marketplace
Yes, our BCCEDP facilitated enrollment in private insurance plans
Yes, our BCCEDP facilitated enrollment, but I do not know the specific insurance sources
No (skip to question 2.J.3)
During PY2, what activities did your BCCEDP program conduct in order to facilitate women’s enrollment in insurance coverage? (Check all that apply)
Provided women information about sources of insurance coverage and related contact information (e.g., website for the Insurance Marketplace, Medicaid enrollment office phone number)
Conducted assessments of women to see if they met eligibility criteria for insurance coverage through specific sources such as Medicaid, Medicare, IHS, State-based Insurance, Insurance Marketplace
Provided assistance to women to help them complete insurance enrollment processes
Tracked and followed-up with women to see if they successfully enrolled in insurance coverage
Referred women to a partner organization for Marketplace or insurance information
Referred women to a trained/certified insurance navigator for assistance
Other:
For how many women did your BCCEDP program facilitate enrollment into insurance coverage during PY2? (enter 99999 if unknown) _____
SECTION 3: Clinical Service Delivery
The following questions apply specifically to delivering breast and cervical cancer screening and diagnostic clinical services to BCCEDP clients.
A. Client eligibility criteria for screening
Please describe who was eligible to receive breast and cervical cancer clinical services in your BCCEDP program, based on your program’s general eligibility requirements, including Federal Poverty Level, insurance status, residency/citizenship/affiliation, and age.
During PY2, what Federal Poverty Level (FPL) was used to determine eligibility for clients receiving BCCEDP-funded clinical services? (Check only one)
250% FPL
200% FPL
Other (please specify): _____%
During PY2, did your BCCEDP program require clients to provide any type of documentation (e.g., pay stubs) to determine financial eligibility based on FPL?
Yes
No – Skip to question 3.A.4
What type of documentation did your BCCEDP accept as proof of financial eligibility? (Check any that apply)
Pay stubs
Tax forms (W-2)
Proof of self-employment income
Proof of eligibility for other social services (e.g. WIC, TANF, Unemployment)
Signed affidavit
Other: ______________
During PY2, were under-insured women eligible to receive clinical services through your BCCEDP? (i.e., under-insured are clients who are insured but cannot afford their insurance co-pay or deductible or whose insurance plan does not cover cancer screening)
No
Yes, to screening services only
Yes, to diagnostic services only
Yes, both screening and diagnostic
During PY2, among under-insured women, what costs did your BCCEDP program reimburse? (Check all that apply)
Co-pays
Deductibles
All clinical costs
Other (please specify): _____________________
During PY2, did your program apply any eligibility criteria, in addition to meeting income and age requirements, for under-insured women to receive BCCEDP-funded clinical services?
Yes - please describe: __________________________
No
During PY2, did your BCCEDP program track the insurance status of clients?
Yes – in a data collection system
Yes – manually or paper form only
No – skip to question 3.A.9
During PY2, what percentage of women receiving clinical services through your BCCEDP program were under-insured? (enter 999 if unknown) __________
During PY2, at what age were average risk women eligible for screening in your program? (Do not report exceptions for special circumstances, e.g., younger women if symptomatic, higher risk, or rarely/never screened; enter 99 if you do not provide the specific testing):
Minimum age for clinical breast exam: ____
Minimum age for mammography screening: _____
Minimum age for Pap test: _____
Minimum age for Pap with HPV co-testing: _____
During PY2, which of these criteria related to residency or tribal affiliation did your BCCEDP program use/apply to determine eligibility? (Check all that apply)
Woman must live in our state or territory
Woman must live in our state or a bordering state
Woman must be affiliated with a specific tribe/tribal organization
Other, please specify:__________________
We did not use any of these criteria in PY2
During PY2, did you change your BCCEDP program eligibility criteria from the previous year, PY1? (Do not report on temporary changes needed to adjust screening budgets)
Yes
No - skip to question 3.A.14
Which BCCEDP program eligibility criteria were changed during PY2? (Check all that apply)
Federal poverty level
Insurance status
Minimum age, clinical breast exam
Minimum age, mammogram
Minimum age, Pap test (excluding a change from age 18 to 21 per clinical guidelines)
Minimum age, Pap with HPV co-testing
Residency/Tribal affiliation
Other (please specify)____________
Why did your BCCEDP program change your program eligibility criteria in PY2? (Check all that apply)
In response to new clinical guidelines
To reduce or narrow the number of women eligible for the program
To expand the number of women eligible for the program
Due to a change in state/tribe/territory/jurisdiction regulation
Because of implementation of health reform
Other (please specify):__________________
During PY2, did you observe an increase from previous years in the number of women referred to your BCCEDP program for clinical diagnostic services only?
Yes
No – Skip to question 3.A.16
How has this affected your BCCEDP program? [Open ended, limit # characters]
During PY2, what strategies did your BCCEDP program use to identify and recruit new women to your BCCEDP program for screening? [Open ended, limit # characters]
Does your BCCEDP program continue to provide any services to women who have received BCCEDP screenings in the past, but have since transitioned to Medicare?
Yes
No – Skip to Section 3.B
What types of services does your BCCEDP provide to BCCEDP clients who have transitioned to Medicare? (check all that apply)
Client reminders sent from provider
Client reminders sent from our BCCEDP program directly
Patient navigation/case management services
Other _______________________
B. BREAST AND CERVICAL CANCER PREVENTION AND TREATMENT ACT OF 2000
(Tribes, Tribal Associations and Territories will not be shown this section)
1. During PY2, did your State Medicaid program discontinue implementation of the Medicaid Treatment Act?
Yes
No – skip to question 3.B.3.
2. Have you established a process to ensure women diagnosed with cancer through your BCCEDP have access to cancer treatment?
Yes
No
3. During PY2, did your BCCEDP program consult with your state Medicaid office about the Medicaid Treatment Act (not about individual cases)?
Yes
No
C. BCCEDP Clinic Service Reimbursement Model
1. During PY2, which payment reimbursement model best describes how your BCCEDP program paid for screening and diagnostic clinical services? (Check all that apply)
Our organization provides clinical services directly (e.g., some tribal programs)
Fee for service (Provider bills and is reimbursed for services/procedures performed; may be managed internally by the grantee or externally by contractor, third party payer, etc.)
Capitated payment (A uniform reimbursement rate per woman served is established for a specified group of screening and/or diagnostic services.)
Bundled payment (Reimbursement rates are established according to tiered case outcomes and are reimbursed retrospectively)
Employed/Contracted Service Provider (Grantee uses BCCEDP funds to employ or contract with service providers for screening and/or diagnostic services; uses other vendor for cytology, radiology, etc.)
Other payment model (please specify): _________________
2. During PY2, did your BCCEDP program use performance-based contracting for reimbursing for clinical services (i.e., contract reimbursement contingent upon meeting performance targets or benchmarks)?
Yes
No
D. BCCEDP PROVIDER SITES
1. In the table below, please enter the number of individual primary care sites that delivered BCCEDP screening services in PY2 according to the type of provider setting. Please provide the number of sites or clinics, not the number of contracts. Do not include specialty clinics (e.g., imaging centers, labs).
|
Number of individual BCCEDP clinic sites that delivered BCCEDP screening services in PY2
If no sites of this type participated, enter ‘0’. If this type of site participated, but you do not know the number of sites, enter ‘9999’. |
Federally Qualified Health Centers or Community Health Centers |
|
Indian Health Service or other tribal health organization sites or clinics |
|
Individual offices or clinics, including local health departments, not including FQHCs |
|
Health care systems, hospitals, or clinics associated with an insurer (e.g. VA, Kaiser) |
|
Other: _______________ |
|
For the remainder of the data collection, the questions will focus on the staff members within your organization who work with the BCCEDP program.
SECTION 4: NON-SCREENING PARTNERSHIPS
1. During PY2, which of the following agencies or types of organizations did you and your BCCEDP staff collaborate with on BCCEDP-related program efforts, other than for direct screening services? (Check all that apply)
Federally Qualified Health Centers (FQHC)
Community Health Centers (Not FQHC)
Hospitals, health systems or insurers in your state/area
State Medicaid
Medicare
Indian Health Service (IHS) or other tribal organizations
Local health departments
Nonprofit and/or advocacy organizations (e.g., ACS, Komen, a homeless coalition)
Employers/worksites in your state/area
Accountable Care Organizations
Cancer Coalition
Faith-based organizations in your state/area
State Primary Care Associations (or similar)
Universities
Consulates of Mexico
Consumer programs with in-person assistance for insurance enrollment
Area Health Education Centers (AHEC)
Other (please specify):__________________________
IF THE RESPONDENT SELECTED FQHC, COMMUNITY HEALTH CENTERS, HOSPITALS/HEALTH SYSTEMS/INSURERS, STATE MEDICAID, MEDICARE, IHS, EMPLOYERS/WORKSITES, ACCOUNTABLE CARE ORGANIZATIONS, STATE PRIMARY CARE ASSOCIATIONS, ABOVE, ASK THE FOLLOWING QUESTIONS FOR EACH:
2. Was the partnership with Federally Qualified Health Centers (FQHC) a new partnership category in PY2?
Yes (skip to question 4)
No
3. Did your BCCEDP program expand the number of partners with Federally Qualified Health Centers (FQHC)?
Yes
No
4. Was the partnership with Federally Qualified Health Centers (FQHC) formalized through a written agreement during PY2 (e.g., memoranda of understanding, memoranda of agreement, contract, grant)? Respond “yes” if you collaborated with one or more partners of this type and at least one partnership was formalized in PY2.
Yes, the partnership was formalized during PY2
No, the partnership was formalized prior to PY2
No, the partnership is not formalized
5. In general, what activities did you conduct with Federally Qualified Health Centers (FQHC) during PY2? (Check all that apply)
Implementing evidence-based interventions recommended by The Community Guide (i.e., small media, client reminders, provider reminders, removing structural barriers, provider assessment/feedback)
Conducting mass media
Conducting quality improvement/quality assurance activities (that are not an evidence based intervention)
Conducting activities to improve the use of data (e.g., assess screening rates, measure screening quality)
Facilitating insurance enrollment or 3rd party funding
Promoting organizational change (e.g., establishing absentee policy so that workers can take leave for screening appointments)
Conducting worksite wellness programs
Conducting special events (e.g. breast cancer awareness month activities)
Conducting activities related to health reform, including related planning
Conducting targeted outreach and recruitment for hard to reach women
Conducting professional development or provider education
Conducting CHW activities
Conducting patient navigation/case management services
Establishing data sharing agreements
Other (please specify): _____________________
6. Was the partnership with Community Health Centers (Not FQHC) a new partnership category in PY2?
Yes (skip to question 8)
No
7. Did your BCCEDP program expand the number of partnerships with Community Health Centers (Not FQHC) in PY2?
Yes
No
8. Was the partnership with Community Health Centers (Not FQHC) formalized through a written agreement during PY2 (e.g., memoranda of understanding, memoranda of agreement, contract, grant)? Respond “yes” if you collaborated with one or more partners of this type and at least one partnership was formalized in PY2.
Yes, the partnership was formalized during PY2
No, the partnership was formalized prior to PY2
No, the partnership is not formalized
9. In general, what activities did you conduct with Community Health Centers (Not FQHC) during PY2? (Check all that apply)
Implementing evidence-based interventions recommended by The Community Guide (i.e., small media, client reminders, provider reminders, removing structural barriers, provider assessment/feedback)
Conducting mass media
Conducting quality improvement/quality assurance activities (that are not an evidence based intervention)
Conducting activities to improve the use of data (e.g., assess screening rates, measure screening quality)
Facilitating insurance enrollment or 3rd party funding
Promoting organizational change (e.g., establishing absentee policy so that workers can take leave for screening appointments)
Conducting worksite wellness programs
Conducting special events (e.g. breast cancer awareness month activities)
Conducting activities related to health reform, including related planning
Conducting targeted outreach and recruitment for hard to reach women
Conducting professional development or provider education
Conducting CHW activities
Conducting patient navigation/case management services
Establishing data sharing agreements
Other (please specify): _____________________
10. Was the partnership with Hospitals, health systems or insurers in your state/area a new partnership category in PY2?
Yes (skip to question 12)
No
11. Did your BCCEDP program expand the number of partners within Hospitals, health systems or insurers in your state/area in PY2?
Yes
No
12. Was the partnership with Hospitals, health systems or insurers in your state/area formalized through a written agreement during PY2 (e.g., memoranda of understanding, memoranda of agreement, contract, grant)? Respond “yes” if you collaborated with one or more partners of this type and at least one partnership was formalized in PY2.
Yes, the partnership was formalized during PY2
No, the partnership was formalized prior to PY2
No, the partnership is not formalized
13. In general, what activities did you conduct with Hospitals, health systems or insurers in your state/area during PY2? (Check all that apply)
Implementing evidence-based interventions recommended by The Community Guide (i.e., small media, client reminders, provider reminders, removing structural barriers, provider assessment/feedback)
Conducting mass media
Conducting quality improvement/quality assurance activities (that are not an evidence based intervention)
Conducting activities to improve the use of data (e.g., assess screening rates, measure screening quality)
Facilitating insurance enrollment or 3rd party funding
Promoting organizational change (e.g., establishing absentee policy so that workers can take leave for screening appointments)
Conducting worksite wellness programs
Conducting special events (e.g. breast cancer awareness month activities)
Conducting activities related to health reform, including related planning
Conducting targeted outreach and recruitment for hard to reach women
Conducting professional development or provider education
Conducting CHW activities
Conducting patient navigation/case management services
Establishing data sharing agreements
Other (please specify): _____________________
14. Was the partnership with State Medicaid a new partnership category in PY2?
Yes (skip to question 16)
No
15. Did your BCCEDP program expand the number of partners within State Medicaid in PY2?
Yes
No
16. Was the partnership with State Medicaid formalized through a written agreement during PY2 (e.g., memoranda of understanding, memoranda of agreement, contract, grant)? Respond “yes” if you collaborated with one or more partners of this type and at least one partnership was formalized in PY2.
Yes, the partnership was formalized during PY2
No, the partnership was formalized prior to PY2
No, the partnership is not formalized
17. In general, what activities did you conduct with State Medicaid during PY2? (Check all that apply)
Implementing evidence-based interventions recommended by The Community Guide (i.e., small media, client reminders, provider reminders, removing structural barriers, provider assessment/feedback)
Conducting mass media
Conducting quality improvement/quality assurance activities (that are not an evidence based intervention)
Conducting activities to improve the use of data (e.g., assess screening rates, measure screening quality)
Facilitating insurance enrollment or 3rd party funding
Promoting organizational change (e.g., establishing absentee policy so that workers can take leave for screening appointments)
Conducting worksite wellness programs
Conducting special events (e.g. breast cancer awareness month activities)
Conducting activities related to health reform, including related planning
Conducting targeted outreach and recruitment for hard to reach women
Conducting professional development or provider education
Conducting CHW activities
Conducting patient navigation/case management services
Establishing data sharing agreements
Other (please specify): _____________________
18. Was the partnership with Medicare a new partnership category in PY2?
Yes (skip to question 20)
No
19. Did your BCCEDP program expand the number of partners within Medicare in PY2?
Yes
No
20. Was the partnership with Medicare formalized through a written agreement during PY2 (e.g., memoranda of understanding, memoranda of agreement, contract, grant)? Respond “yes” if you collaborated with one or more partners of this type and at least one partnership was formalized in PY2.
Yes, the partnership was formalized during PY2
No, the partnership was formalized prior to PY2
No, the partnership is not formalized
21. In general, what activities did you conduct with Medicare during PY2? (Check all that apply)
Implementing evidence-based interventions recommended by The Community Guide (i.e., small media, client reminders, provider reminders, removing structural barriers, provider assessment/feedback)
Conducting mass media
Conducting quality improvement/quality assurance activities (that are not an evidence based intervention)
Conducting activities to improve the use of data (e.g., assess screening rates, measure screening quality)
Facilitating insurance enrollment or 3rd party funding
Promoting organizational change (e.g., establishing absentee policy so that workers can take leave for screening appointments)
Conducting worksite wellness programs
Conducting special events (e.g. breast cancer awareness month activities)
Conducting activities related to health reform, including related planning
Conducting targeted outreach and recruitment for hard to reach women
Conducting professional development or provider education
Conducting CHW activities
Conducting patient navigation/case management services
Establishing data sharing agreements
Other (please specify): _____________________
22. Was the partnership with Indian Health Service (IHS) a new partnership category in PY2?
Yes (skip to question 24)
No
23. Did your BCCEDP program expand the number of partners within Indian Health Service (IHS) in PY2?
Yes
No
24. Was the partnership with Indian Health Service (IHS) formalized through a written agreement during PY2 (e.g., memoranda of understanding, memoranda of agreement, contract, grant)? Respond “yes” if you collaborated with one or more partners of this type and at least one partnership was formalized in PY2.
Yes, the partnership was formalized during PY2
No, the partnership was formalized prior to PY2
No, the partnership is not formalized
25. In general, what activities did you conduct with Indian Health Service (IHS) during PY2? (Check all that apply)
Implementing evidence-based interventions recommended by The Community Guide (i.e., small media, client reminders, provider reminders, removing structural barriers, provider assessment/feedback)
Conducting mass media
Conducting quality improvement/quality assurance activities (that are not an evidence based intervention)
Conducting activities to improve the use of data (e.g., assess screening rates, measure screening quality)
Facilitating insurance enrollment or 3rd party funding
Promoting organizational change (e.g., establishing absentee policy so that workers can take leave for screening appointments)
Conducting worksite wellness programs
Conducting special events (e.g. breast cancer awareness month activities)
Conducting activities related to health reform, including related planning
Conducting targeted outreach and recruitment for hard to reach women
Conducting professional development or provider education
Conducting CHW activities
Conducting patient navigation/case management services
Establishing data sharing agreements
Other (please specify): _____________________
26. Was the partnership with Employers/worksites in your state/area a new partnership category in PY2?
Yes (skip to 28)
No
27. Did your BCCEDP program expand the number of partners within Employers/worksites in your state/area in PY2?
Yes
No
28. Was the partnership with Employers/worksites in your state/area formalized through a written agreement during PY2 (e.g., memoranda of understanding, memoranda of agreement, contract, grant)? Respond “yes” if you collaborated with one or more partners of this type and at least one partnership was formalized in PY2.
Yes, the partnership was formalized during PY2
No, the partnership was formalized prior to PY2
No, the partnership is not formalized
29. In general, what activities did you conduct with Employers/worksites in your state/area during PY2? (Check all that apply)
Implementing evidence-based interventions recommended by The Community Guide (i.e., small media, client reminders, provider reminders, removing structural barriers, provider assessment/feedback)
Conducting mass media
Conducting quality improvement/quality assurance activities (that are not an evidence based intervention)
Conducting activities to improve the use of data (e.g., assess screening rates, measure screening quality)
Facilitating insurance enrollment or 3rd party funding
Promoting organizational change (e.g., establishing absentee policy so that workers can take leave for screening appointments)
Conducting worksite wellness programs
Conducting special events (e.g. breast cancer awareness month activities)
Conducting activities related to health reform, including related planning
Conducting targeted outreach and recruitment for hard to reach women
Conducting professional development or provider education
Conducting CHW activities
Conducting patient navigation/case management services
Establishing data sharing agreements
Other (please specify): _____________________
30. Was the partnership with Accountable Care Organizations a new partnership category in PY2?
Yes (skip to question 32)
No
31. Did your BCCEDP program expand the number of partners within Accountable Care Organizations in PY2?
Yes
No
32. Was the partnership with Accountable Care Organizations formalized through a written agreement during PY2 (e.g., memoranda of understanding, memoranda of agreement, contract, grant)? Respond “yes” if you collaborated with one or more partners of this type and at least one partnership was formalized in PY2.
Yes, the partnership was formalized during PY2
No, the partnership was formalized prior to PY2
No, the partnership is not formalized
33. In general, what activities did you conduct with Accountable Care Organizations during PY2? (Check all that apply)
Implementing evidence-based interventions recommended by The Community Guide (i.e., small media, client reminders, provider reminders, removing structural barriers, provider assessment/feedback)
Conducting mass media
Conducting quality improvement/quality assurance activities (that are not an evidence based intervention)
Conducting activities to improve the use of data (e.g., assess screening rates, measure screening quality)
Facilitating insurance enrollment or 3rd party funding
Promoting organizational change (e.g., establishing absentee policy so that workers can take leave for screening appointments)
Conducting worksite wellness programs
Conducting special events (e.g. breast cancer awareness month activities)
Conducting activities related to health reform, including related planning
Conducting targeted outreach and recruitment for hard to reach women
Conducting professional development or provider education
Conducting CHW activities
Conducting patient navigation/case management services
Establishing data sharing agreements
Other (please specify): _____________________
34. Was the partnership with State Primary Care Associations (or similar) a new partnership category in PY2?
Yes (skip to question 36)
No
35. Did your BCCEDP program expand the number of partners within State Primary Care Associations (or similar) in PY2?
Yes
No
36. Was the partnership with State Primary Care Associations (or similar) formalized through a written agreement during PY2 (e.g., memoranda of understanding, memoranda of agreement, contract, grant)? Respond “yes” if you collaborated with one or more partners of this type and at least one partnership was formalized in PY2.
Yes, the partnership was formalized during PY2
No, the partnership was formalized prior to PY2
No, the partnership is not formalized
37. In general, what activities did you conduct with State Primary Care Associations (or similar) during PY2? (Check all that apply)
Implementing evidence-based interventions recommended by The Community Guide (i.e., small media, client reminders, provider reminders, removing structural barriers, provider assessment/feedback)
Conducting mass media
Conducting quality improvement/quality assurance activities (that are not an evidence based intervention)
Conducting activities to improve the use of data (e.g., assess screening rates, measure screening quality)
Facilitating insurance enrollment or 3rd party funding
Promoting organizational change (e.g., establishing absentee policy so that workers can take leave for screening appointments)
Conducting worksite wellness programs
Conducting special events (e.g. breast cancer awareness month activities)
Conducting activities related to health reform, including related planning
Conducting targeted outreach and recruitment for hard to reach women
Conducting professional development or provider education
Conducting CHW activities
Conducting patient navigation/case management services
Establishing data sharing agreements
Other (please specify): _____________________
SECTION 5: DATA USE
In the table below, for each data source that you and your BCCEDP staff used (e.g., BRFSS), please check the box or boxes that reflect how those data were used (e.g., measure screening rates). (Check all data uses that apply)
Data Source |
Did not use in PY2 |
Measure screening rates |
Measure clinical quality
|
Monitor and evaluate an activity |
Assessment and planning |
State or Regional Cancer Plan |
|
|
|
|
|
BRFSS |
|
|
|
|
|
State cancer registry, SEER data, or U.S. Cancer Statistics (USCS) |
|
|
|
|
|
State or local screening registry |
|
|
|
|
|
Census data (including Small Area Health Insurance Estimates) |
|
|
|
|
|
IHS GPRA data (Government Performance and Results Act) |
|
|
|
|
|
Medicaid data |
|
|
|
|
|
Medicare data |
|
|
|
|
|
Private insurer data (e.g., Kaiser, Blue Cross/Blue Shield) |
|
|
|
|
|
All payor claims database |
|
|
|
|
|
Patient records or aggregate/summary patient data (e.g., within clinics or health systems, RPMS for tribal programs) |
|
|
|
|
|
Primary data collection (e.g., pre-& post-tests, provider survey, patient satisfaction survey) |
|
|
|
|
|
National or state health survey data (e.g., American Community Survey)
|
|
|
|
|
|
Other (please specify):
|
|
|
|
|
|
Other (please specify): |
|
|
|
|
|
During PY2, did you and your BCCEDP staff provide technical assistance to providers or staff of health systems to improve the use of their own data (e.g., improving use of provider or health system data to assess screening rates (EMR), measure screening quality)? We are not referring to BCCEDP specific data (MDEs).
Yes
No – skip to Section 6
During PY2, to what types of organizations did you and your BCCEDP staff provide this sort of technical assistance? (Check all that apply)
Federally Qualified Health Centers or Community Health Centers
Indian Health Service or other tribal health organizations
Health care systems or insurers (e.g., Kaiser, VA, hospital)
Individual offices or clinics
Local health department clinics
Other (please specify):______________________
SECTION 6: TRAINING AND TECHNICAL ASSISTANCE
Using a scale of high to low, please rate the current need for training (not limited to PY2) among you and your BCCEDP staff in the areas listed below.
Area of Training/Technical Assistance |
Level of Need for Training |
||
High |
Medium |
Low |
|
Management activities |
|
|
|
Program planning |
|
|
|
Logic model development & use |
|
|
|
Systems change |
|
|
|
Program monitoring & evaluation |
|
|
|
Data collection, management, & analysis |
|
|
|
Determining eligible population size for screening through the BCCEDP |
|
|
|
|
|
|
|
Program Activities (Evidence-based) |
|
|
|
Provider reminders |
|
|
|
Provider assessment & feedback |
|
|
|
Client reminders |
|
|
|
Small media |
|
|
|
Reducing structural barriers |
|
|
|
|
|
|
|
Program Activities (other) |
|
|
|
Professional development/Provider education |
|
|
|
Use of social media |
|
|
|
Community health worker strategies |
|
|
|
Patient navigation/case management |
|
|
|
Recruiting hard to reach populations |
|
|
|
|
|
|
|
Quality Assurance/Quality Improvement |
|
|
|
Clinical guidelines for screening |
|
|
|
Clinical guidelines for diagnostic evaluation |
|
|
|
Quality assurance/quality improvement strategies |
|
|
|
|
|
|
|
Health Systems Partnerships |
|
|
|
Establishing a business case for partnering |
|
|
|
Identifying health systems partners |
|
|
|
Assessing cancer screening systems |
|
|
|
Helping health systems use electronic health records to improve cancer screening |
|
|
|
Other |
|
|
|
Partnership development & maintenance |
|
|
|
|
|
|
|
2. What training and TA needs do you have related to health reform?__________
3. How useful have you found the following technical assistance resources provided by CDC?
|
N/A – did not use |
Very useful |
Somewhat useful |
Not useful |
CDC Webinars (e.g., QSST, PETO) |
|
|
|
|
Printed guide: An Action Guide for Working with Health Systems |
|
|
|
|
Printed guide: An Action Guide for Engaging Employers and Professional Medical Organizations |
|
|
|
|
ACA reference guide and fact sheets |
|
|
|
|
ACA messaging tool |
|
|
|
|
On-going technical assistance provided by PCs |
|
|
|
|
Individual grantee survey reports |
|
|
|
|
MDE data review/reports |
|
|
|
|
IPR data reports |
|
|
|
|
NBCCEDP Partnership toolkit |
|
|
|
|
Other: ___________ |
|
|
|
|
Section 7: Program Management
Do you and your BCCEDP staff know or have you estimated the current size of the eligible BCCEDP population in your state/tribe/territory/jurisdiction?
Yes
No
If Congress eliminated the 60/40 requirement, would your BCCEDP program spend less than the currently required 60% on clinical service delivery in order to conduct more non-screening activities?
Yes
No -- Skip to question 7.4
To what activities might you shift your resources? (Check all that apply)
Evidence-based strategies to increase population-based screening (e.g., provider assessment and feedback, client reminders)
Patient navigation/case management activities for non-BCCEDP clients
Community health worker activities
Screening surveillance or other data-related efforts
Health systems partnerships
Other (please specify):___________________________
During PY2, what were the top 3 challenges that impacted the management of your BCCEDP program?
Management challenges |
Check top 3 |
Staff furloughs/hiring freezes/turnover |
|
Significant changes in administrative systems and/or data systems |
|
Loss of Federal funds (other than CDC NBCCEDP funds) |
|
Loss of non-Federal funds (e.g., State funds) |
|
Loss of in-kind resources |
|
Agency reorganization |
|
Health care reform |
|
Changes in clinical guidelines for breast and cervical cancer (e.g., provider adherence to guidelines) |
|
Identifying women eligible for screening through the BCCEDP and meeting screening projections |
|
Collaborating with state/tribal partners |
|
Meeting the 60/40 requirement |
|
Integrating population-based activities into your BCCEDP program |
|
Planning for the future of your BCCEDP |
|
Other (please specify): |
|
Please list the amount of Federal, State, non-profit, and other funding that supported your BCCEDP program in PY2. Pro-rate funding if needed to associate with PY2.
Funding Source |
Amount Received in PY2 |
Federal (Do not include funds received from CDC through the NBCCEDP DP12-1205) |
$ |
State |
$ |
Tribal |
$ |
Non-profit (e.g., ACS, Komen for the Cure, LIVESTRONG) |
$ |
Other - please specify: |
$ |
We are asking about your experience to date (not limited to the time period of PY2).
6. Has your BCCEDP program developed tools related to health reform that may be useful to others?
Yes
No – Skip to END
7. Please describe: _______________
Thank you VERY MUCH for your time in completing this survey. The data provide a systematic assessment of NBCCEDP grantee implementation activities. Your program will receive a report summarizing your data along with aggregate data for the program in the near future. If you have any questions, please contact Stephanie Melillo at 770.488.4294 or bcu6@cdc.gov.
END OF SURVEY
NBCCEDP Survey – PY2
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | CDC User |
| File Modified | 0000-00-00 |
| File Created | 2021-01-20 |