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ORIGINAL RESEARCH article

Front. Health Serv.
Sec. Implementation Science
Volume 4 - 2024 | doi: 10.3389/frhs.2024.1198191
This article is part of the Research Topic Using the RE-AIM Framework and other Implementation Theories, Models, and Frameworks to guide the Implementation and Evaluation of Rural Health Innovations View all 18 articles

Using the RE-AIM Framework and Other Implementation Theories, Models, and Frameworks to Guide the Implementation and Evaluation of Rural Health Innovations

Provisionally accepted
Chelsea Leonard Chelsea Leonard 1,2*Jessica Young Jessica Young 3lauren mckown lauren mckown 1carolyn klassen carolyn klassen 3george e. kaufman george e. kaufman 3daniel abrahamson daniel abrahamson 3
  • 1 Seattle-Denver Center of Innovation, VA Eastern Colorado Health Care System, Denver, United States
  • 2 Department of Healthcare Policy and Research, Graduate School of Medical Sciences, Cornell University, Ithaca, New York, United States
  • 3 VA Puget Sound Health Care System, Veterans Health Administration, United States Department of Veterans Affairs, Seattle, Washington, United States

The final, formatted version of the article will be published soon.

    Introduction –Anticipating and addressing implementation challenges is critical to ensuring success of mobile healthcare programs. Mobile Prosthetic and Orthotic (O&P) Care (MoPOC) is a new U.S. Department of Veterans Affairs (VA) program that aims to improve access to VA-based O&P services through a national network of traveling O&P clinicians who deliver care in rural communities. We conducted an iterative evaluation guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to identify challenges and associated strategies for successful implementation of this mobile O&P program. Methods – MoPOC is delivered by an O&P clinician anchored at a VA medical center (VAMC). Clinicians travel to remote VA clinics and Veteran’s homes with a custom vehicle which provides storage and a workshop to modify O&P devices. Each clinician is supported by a program support assistant. MoPOC was implemented in three phases. The qualitative evaluation of MoPOC implementation was conducted as part of a larger evaluation of MoPOC program outcomes. We conducted semi-structured interviews and regular check-ins with MoPOC clinicians, site managers, and stakeholders both prior to implementation and throughout the implementation process. Interviews were recorded and transcribed verbatim. Data was analyzed across sites and comparatively by phase using a rapid matrix analysis to identify themes related to adoption and implementation challenges and key strategies developed to address those challenges. Results – We identified four key themes related to successful program implementation, each with associated challenges and improvement strategies: 1) “Finding the right sites for MoPOC” through intentional recruitment and site selection; 2) Identifying the “sweet spot”: Balancing program capacity, sustainability, and MoPOC clinician satisfaction; 3) Shifting from testing to standardizing; and 4) “Being strategic with hiring” to improve program adoption. Discussion – Implementation challenges were related to recruiting and selecting successful sites, ensuring timely program adoption, balancing site level adaptation and program standardization, and scaling programs to enhance efficiency, reach, and satisfaction. An iterative approach guided by the RE-AIM framework resulted in program improvement and more rapid implementation in each successive phase. The challenges described in MoPOC implementation may be common issues in implementing new mobile programs in rural areas.

    Keywords: rural, RE-AIM evaluation framework, Orthotic and prosthetic, implementation, Mobile care

    Received: 31 Mar 2023; Accepted: 16 Oct 2024.

    Copyright: © 2024 Leonard, Young, mckown, klassen, kaufman and abrahamson. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Chelsea Leonard, Seattle-Denver Center of Innovation, VA Eastern Colorado Health Care System, Denver, United States

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.