Using Coincidence Analysis to Identify Causal Chains of Factors Associated with Implementation and Optimization of Lynch Syndrome Tumor Screening Across Multiple Health care Systems

Abstract

PurposeThis study of multiple case study compared Lynch syndrome universal tumor screening (UTS) to understand multi-level factors that may impact the successful implementation of complex programs. MethodsData from 66 stakeholder interviews were used to conduct multi-value coincidence analysis (mv-CNA) and identify key factors that consistently make a difference in whether UTS programs were implemented and optimized at the system level. ResultsThe selected CNA model revealed combinations of conditions that distinguish 4 optimized UTS programs, 10 non-optimized programs, and 4 systems with no program. Fully optimized UTS programs had both a maintenance champion and a positive inner setting. Two independent paths were unique to non-optimized programs: 1) positive attitudes and a mixed inner setting, or 2) limited planning & engaging among stakeholders. Negative views about UTS evidence or lack of knowledge about UTS led to a lack of planning and engaging, which subsequently prevented program implementation. ConclusionThe model improved our understanding of program implementation in health care systems and informed the creation of a toolkit to guide UTS implementation, optimization, and changes. Our findings and toolkit may serve as a use case to increase the successful implementation of other complex precision health programs.