--- title: "Implementing universal Lynch syndrome screening (IMPULSS). | Sutter Health" description: "Goal is to combine our data with theories & tools from implementation science to create an organizational toolkit to facilitate implementation of LS screening." url: "https://www.sutterhealth.org/research/publications/implementing-universal-lynch-syndrome-screening-impulss-1055312375" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. Implementing universal Lynch syndrome screening (IMPULSS). # Implementing universal Lynch syndrome screening (IMPULSS): protocol for a multi-site study to identify strategies to implement, adapt, and sustain genomic medicine programs in different organizational contexts. Rahm AK, Cragun D, Hunter JE, Epstein MM, Lowery J, Lu CY, Pawloski PA, Sharaf RN, Liang SY, Burnett-Hartman AN, Gudgeon JM, Hao J, Snyder S, Gogoi R, Ladd I, & Williams MS. _BMC Health Serv Res. 18(1):824. doi: 10.1186/s12913-018-3636-2._ 2018-10-30 ## Abstract BACKGROUND: Systematic screening of all colorectal tumors for Lynch Syndrome (LS) has been recommended since 2009. Currently, implementation of LS screening in healthcare systems remains variable, likely because LS screening involves the complex coordination of multiple departments and individuals across the healthcare system. Our specific aims are to (1) describe variation in LS screening implementation across multiple healthcare systems; (2) identify conditions associated with both practice variation and optimal implementation; (3) determine the relative effectiveness, efficiency, and costs of different LS screening protocols by healthcare system; and (4) develop and test in a real-world setting an organizational toolkit for LS screening program implementation and improvement. This toolkit will promote effective implementation of LS screening in various complex health systems. METHODS: This study includes eight healthcare systems with 22 clinical sites at varied stages of implementing LS screening programs. Guided by the Consolidated Framework for Implementation Research (CFIR), we will conduct in-depth semi-structured interviews with patients and organizational stakeholders and perform economic evaluation of site-specific implementation costs. These processes will result in a comprehensive cross-case analysis of different organizational contexts. We will utilize qualitative data analysis and configurational comparative methodology to identify facilitators and barriers at the organizational level that are minimally sufficient and necessary for optimal LS screening implementation. DISCUSSION: The overarching goal of this project is to combine our data with theories and tools from implementation science to create an organizational toolkit to facilitate implementation of LS screening in various real-world settings. Our organizational toolkit will account for issues of complex coordination of care involving multiple stakeholders to enhance implementation, sustainability, and ongoing improvement of evidence-based LS screening programs. Successful implementation of such programs will ultimately reduce suffering of patients and their family members from preventable cancers, decrease waste in healthcare system costs, and inform strategies to facilitate the promise of precision medicine. [PubMed abstract](https://www.ncbi.nlm.nih.gov/pubmed/30376847) ![Su-Ying Liang, Ph.D.](https://dyn.mktgcdn.com/p/cRIUee_GK3HEL1Wq8svqoUApvABjlwVVA-KUHVGzuNw/fit=crop,gravity=auto,dpr=2,width=188,height=250,quality=100) Su-Ying Liang, Ph.D. Principal investigator [View profile](https://www.sutterhealth.org/research/investigators/su-ying-liang-phd-1049681030) ## Research topics - [All Cancer](https://www.sutterhealth.org/research-search-results?query=%22%5C%22All+Cancer%5C%22%22) - [Colorectal Cancer](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Colorectal+Cancer%5C%22%22) - [Disease Management](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Disease+Management%5C%22%22) - [Genetics](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Genetics%5C%22%22) - [Health Services](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Health+Services%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [The Healthcare Systems Research Network (HCSRN) as an environment for dissemination and implementation research: a case study of developing a multi-site research study in precision medicine.](https://www.sutterhealth.org/research/publications/hcsrn-as-environment-for-implementation-research-1055312447) Rahm AK, Ladd I, Burnett-Hartman AN, Epstein MM, Lowery JT, Lu CY, Pawloski PA, Sharaf RN, Liang SY, Hunter JE. EGEMS (Wash DC). 7(1):16. doi: 10.5334/egems.283. 2019 Apr 12 - Publication ### [The importance of integrating narrative into health care decision making.](https://www.sutterhealth.org/research/publications/integrate-narrative-in-healthcare-decision-making-1055312429) Dohan D, Garrett SB, Rendle KA, Halley M, Abramson C. Health Aff (Millwood). 35(4):720-5. doi: 10.1377/hlthaff.2015.1373. 2016 Apr 01 - Publication ### [In absentia: an exploratory study of how patients are considered in multidisciplinary cancer team meetings.](https://www.sutterhealth.org/research/publications/pt-consideration-multidisciplin-cancer-team-mtgs-1055312430) Hahlweg P, Hoffmann J, Härter M, Frosch DL, Elwyn G, Scholl I. PLoS One. 10(10):e0139921. doi: 10.1371/journal.pone.0139921. eCollection 2015. 2015 Oct 06 - Publication ### [Evolving goals of care discussions as described in interviews with individuals with advanced cancer and oncology and palliative care teams.](https://www.sutterhealth.org/research/publications/goals-of-care-discussions-in-advanced-cancer-1055312861) Dillon EC, Meehan A, Nasrallah C, Lai S, Colocci N, Luft H. Am J Hosp Palliat Care. 1049909120969202. doi: 10.1177/1049909120969202. Online ahead of print. 2020 Oct 28 - Publication ### [Redefining risk and benefit: understanding the decision to undergo contralateral prophylactic mastectomy.](https://www.sutterhealth.org/research/publications/decsion-for-contralateral-prophylactic-mastectomy-1055312294) Rendle KA, Halley MC, May SG, Frosch DL. Qual Health Res. 25(9):1251-9. doi: 10.1177/1049732314557085. Epub 2014 Nov 4. 2015 Sep 01 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/implementing-universal-lynch-syndrome-screening-impulss-1055312375#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"Implementing universal Lynch syndrome screening (IMPULSS)."}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/implementing-universal-lynch-syndrome-screening-impulss-1055312375#medicalscholarlyarticle","name":"Implementing universal Lynch syndrome screening (IMPULSS): protocol for a multi-site study to identify strategies to implement, adapt, and sustain genomic medicine programs in different organizational contexts.","headline":"Implementing universal Lynch syndrome screening (IMPULSS).","abstract":"BACKGROUND: Systematic screening of all colorectal tumors for Lynch Syndrome (LS) has been recommended since 2009. Currently, implementation of LS screening in healthcare systems remains variable, likely because LS screening involves the complex coordination of multiple departments and individuals across the healthcare system. Our specific aims are to (1) describe variation in LS screening implementation across multiple healthcare systems; (2) identify conditions associated with both practice variation and optimal implementation; (3) determine the relative effectiveness, efficiency, and costs of different LS screening protocols by healthcare system; and (4) develop and test in a real-world setting an organizational toolkit for LS screening program implementation and improvement. This toolkit will promote effective implementation of LS screening in various complex health systems. METHODS: This study includes eight healthcare systems with 22 clinical sites at varied stages of implementing LS screening programs. Guided by the Consolidated Framework for Implementation Research (CFIR), we will conduct in-depth semi-structured interviews with patients and organizational stakeholders and perform economic evaluation of site-specific implementation costs. These processes will result in a comprehensive cross-case analysis of different organizational contexts. We will utilize qualitative data analysis and configurational comparative methodology to identify facilitators and barriers at the organizational level that are minimally sufficient and necessary for optimal LS screening implementation. DISCUSSION: The overarching goal of this project is to combine our data with theories and tools from implementation science to create an organizational toolkit to facilitate implementation of LS screening in various real-world settings. Our organizational toolkit will account for issues of complex coordination of care involving multiple stakeholders to enhance implementation, sustainability, and ongoing improvement of evidence-based LS screening programs. Successful implementation of such programs will ultimately reduce suffering of patients and their family members from preventable cancers, decrease waste in healthcare system costs, and inform strategies to facilitate the promise of precision medicine.","description":"Goal is to combine our data with theories & tools from implementation science to create an organizational toolkit to facilitate implementation of LS screening.","keywords":["All Cancer","Colorectal Cancer","Disease Management","Genetics","Health Services"],"datePublished":"2018-10-30","url":"https://www.sutterhealth.org/research/publications/implementing-universal-lynch-syndrome-screening-impulss-1055312375","inLanguage":"en-US","identifier":[{"@type":"PropertyValue","propertyID":"PMID","value":"30376847"},{"@type":"PropertyValue","propertyID":"DOI","value":"10.1186/s12913-018-3636-2"}],"sameAs":["https://pubmed.ncbi.nlm.nih.gov/30376847/","https://doi.org/10.1186/s12913-018-3636-2"],"isPartOf":{"@type":"Periodical","name":"BMC Health Serv Res"},"author":[{"@type":"Person","name":"Rahm AK"},{"@type":"Person","name":"Cragun D"},{"@type":"Person","name":"Hunter JE"},{"@type":"Person","name":"Epstein MM"},{"@type":"Person","name":"Lowery J"},{"@type":"Person","name":"Lu CY"},{"@type":"Person","name":"Pawloski PA"},{"@type":"Person","name":"Sharaf RN"},{"@type":"Person","@id":"https://www.sutterhealth.org/research/investigators/su-ying-liang-phd-1049681030","name":"Liang SY","url":"https://www.sutterhealth.org/research/investigators/su-ying-liang-phd-1049681030"},{"@type":"Person","name":"Burnett-Hartman AN"},{"@type":"Person","name":"Gudgeon JM"},{"@type":"Person","name":"Hao J"},{"@type":"Person","name":"Snyder S"},{"@type":"Person","name":"Gogoi R"},{"@type":"Person","name":"Ladd I"},{"@type":"Person","name":"Williams MS"}],"sourceOrganization":{"@type":"MedicalOrganization","name":"Palo Alto Medical Foundation Research Institute"},"about":[{"@type":"DefinedTerm","name":"All Cancer","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22All+Cancer%22%5D%7D%5D&verticalKey=research_publication"},{"@type":"DefinedTerm","name":"Colorectal Cancer","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Colorectal+Cancer%22%5D%7D%5D&verticalKey=research_publication"},{"@type":"DefinedTerm","name":"Disease Management","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Disease+Management%22%5D%7D%5D&verticalKey=research_publication"},{"@type":"DefinedTerm","name":"Genetics","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Genetics%22%5D%7D%5D&verticalKey=research_publication"},{"@type":"DefinedTerm","name":"Health Services","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Health+Services%22%5D%7D%5D&verticalKey=research_publication"}],"mainEntityOfPage":{"@type":"WebPage","@id":"https://www.sutterhealth.org/research/publications/implementing-universal-lynch-syndrome-screening-impulss-1055312375","breadcrumb":{"@id":"https://www.sutterhealth.org/research/publications/implementing-universal-lynch-syndrome-screening-impulss-1055312375#breadcrumblist"}}} ```