Using RE-AIM to examine implementation of a tele-nephrology program for veterans living in rural areas

Mattocks, Kristin M; Kroll-Desrosiers, Aimee; Crowley, Susan; Tuozzo, Katherine; Rifkin, Ian; Moore, David; Walker, Lorrie; Bonegio, Ramon

dc.contributor.author	Mattocks, Kristin M
dc.contributor.author	Kroll-Desrosiers, Aimee
dc.contributor.author	Crowley, Susan
dc.contributor.author	Tuozzo, Katherine
dc.contributor.author	Rifkin, Ian
dc.contributor.author	Moore, David
dc.contributor.author	Walker, Lorrie
dc.contributor.author	Bonegio, Ramon
dc.date.accessioned	2024-01-04T16:34:08Z
dc.date.available	2024-01-04T16:34:08Z
dc.date.issued	2023-09-13
dc.identifier.citation	Mattocks KM, Kroll-Desrosiers A, Crowley S, Tuozzo K, Rifkin I, Moore D, Walker L, Bonegio R. Using RE-AIM to examine implementation of a tele-nephrology program for veterans living in rural areas. Front Health Serv. 2023 Sep 13;3:1205951. doi: 10.3389/frhs.2023.1205951. PMID: 37780402; PMCID: PMC10533984.	en_US
dc.identifier.eissn	2813-0146
dc.identifier.doi	10.3389/frhs.2023.1205951	en_US
dc.identifier.pmid	37780402
dc.identifier.uri	http://hdl.handle.net/20.500.14038/52905
dc.description.abstract	Introduction: Chronic kidney disease (CKD) and refractory hypertension (rHTN) are common, chronic conditions that affect 10%-16% of Veterans. Several small studies have suggested that tele-nephrology can deliver nephrology care effectively to rural Veterans. The purpose of this evaluation was to examine perceptions and experiences with this tele-nephrology program among spoke site staff and clinicians using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to guide our understanding of tele-nephrology implementation. Methods: We conducted semi-structured interviews with fourteen clinicians at five tele-nephrology spoke sites. We used content analysis to analyze the results using our RE-AIM framework. Results: Five major themes arose: (1) Active engagement of a centralized clinical champion was a key factor in early success of tele-nephrology program; (2) Transition from community-based nephrology to VA tele-nephrology was heralded as the most meaningful indicator of the effectiveness of the intervention; (3) Effective adoption strategies included bi-weekly training with Hub nephrology staff and engagement of a local renal champion; (4) Meeting the needs of Veterans through proper staffing during tele-nephrology examinations was a key priority in facility program implementation; and (5) Growing reliance on Hub nephrologists may give rise to insufficient availability of nephrology appointments in some Spoke sites. Discussion: This evaluation represents an important step forward as VA considers how to provide care to Veterans at facilities without VA specialty providers. The COVID-19 pandemic has drastically shifted options for Veterans, and increasingly, the VA is moving to shift care from community to VA via virtual care. Further research should examine how the VA manages potential problems related to access to virtual providers and examine Veteran perspectives on community in-person vs. virtual VA care.	en_US
dc.language.iso	en	en_US
dc.relation.ispartof	Frontiers in Health Services	en_US
dc.relation.url	https://doi.org/10.3389/frhs.2023.1205951	en_US
dc.rights	© 2023 Mattocks, Kroll-Desrosiers, Crowley, Tuozzo, Rifkin, Moore, Walker and Bonegio. 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) and the copyright owner(s) 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.	en_US
dc.rights	Attribution 4.0 International	*
dc.rights.uri	http://creativecommons.org/licenses/by/4.0/	*
dc.subject	access to care	en_US
dc.subject	health services	en_US
dc.subject	kidney disease	en_US
dc.subject	telemedicine	en_US
dc.subject	veterans	en_US
dc.title	Using RE-AIM to examine implementation of a tele-nephrology program for veterans living in rural areas	en_US
dc.type	Journal Article	en_US
dc.source.journaltitle	Frontiers in health services
dc.source.volume	3
dc.source.beginpage	1205951
dc.source.endpage
dc.source.country	Switzerland
dc.identifier.journal	Frontiers in health services
refterms.dateFOA	2024-01-04T16:34:10Z
dc.contributor.department	Population and Quantitative Health Sciences	en_US

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© 2023 Mattocks, Kroll-Desrosiers, Crowley,
Tuozzo, Rifkin, Moore, Walker and Bonegio.
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) and the
copyright owner(s) 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.

Except where otherwise noted, this item's license is described as © 2023 Mattocks, Kroll-Desrosiers, Crowley, Tuozzo, Rifkin, Moore, Walker and Bonegio. 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) and the copyright owner(s) 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.