Implementation outcomes
Implementation outcomes for this study were guided by the RE-AIM framework [The primary outcome for the trial is Reach of mPATH™-CRC, defined as the proportion of patients aged 50–74 who are eligible for CRC screening who complete mPATH™-CRC in the 6th month following implementation. Patients who use mPATH™-CheckIn and are told they are due for CRC screening but advised to discuss screening with their doctor due to detected risk factors are also counted as having used mPATH™-CRC.Secondary implementation outcomes:mPATH™-CRC Reach (by month): The proportion of patients aged 50–74 who are eligible for CRC screening who complete mPATH™-CRC or have risk factors identified by mPATH™-CheckIn in months 1–5 following implementationmPATH™-CRC Reach (by socioeconomic strata): The proportion of patients aged 50–74 who are eligible for CRC screening who complete mPATH™-CRC or have risk factors identified by mPATH™-CheckIn in months 1–6 by socioeconomic strata; this outcome will also be calculated among CheckIn users onlymPATH™-CRC Adoption: The mean usage of mPATH™-CRC among staff and providers over the first 6 months following implementation; usage is calculated for each staff/provider as the proportion of times mPATH™-CRC is completed out of the total times mPATH™-CRC should have been launched.mPATH™-CRC Acceptability, Appropriateness, and Feasibility: Mean Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM), and Feasibility of Intervention Measure (FIM) scores [mPATH™-CRC Implementation Fidelity: The proportion of patients who use mPATH™-CRC and request a CRC screening test who have a test ordered or have the order dismissed (i.e., “self-order” feature is used as designed) in months 1–6mPATH™-CRC Maintenance: The proportion of patients aged 50–74 who are eligible for CRC screening who complete mPATH™-CRC or have risk factors identified by mPATH™-CheckIn in months 7–12mPATH™-CheckIn Reach: The proportion of patients aged 18 or older who complete mPATH™-CheckIn in months 1–6; this outcome will be calculated overall and within socioeconomic stratamPATH™-CheckIn Adoption: The mean usage of mPATH™-CheckIn among staff and providers over the first 6 months following implementation; usage is calculated for front desk staff as the proportion of times mPATH™-CheckIn is completed out of the total times mPATH™-CheckIn should have been handed out; usage is calculated for nurses/providers as the proportion of times mPATH™-CheckIn is completed and data is transmitted to the EHR out of the total times mPATH™-CheckIn should have been handed outmPATH™-CheckIn Acceptability, Appropriateness, and Feasibility: Mean AIM, IAM, and FIM scores for mPATH™-CheckIn as assessed on the 6-month clinic personnel surveymPATH™-CRC Maintenance: The proportion of patients aged 18 or older who complete mPATH™-CheckIn in months 7–12Exploratory implementation outcome:mPATH™ Implementation Cost: Cost to implement and maintain usage of the mPATH™ program from the perspective of a healthcare system considering implementation, including hardware (i.e., iPads, cases, charging cabinets), cloud data storage fees, training, and technical support. Clinic staff training costs will be computed using training time and national average wage values for nursing and other staff from the Bureau of Labor Statistics. Technical support costs will include travel and support staff time costs associated with the initial training, and any follow-up trainings. Ongoing costs to maintain usage of mPATH™ include costs to train new employees or replace hardware and technical support costs related to follow-up training, troubleshooting, and adapting the program as needed.