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Objective: To use a practical approach to examining the use of Expert Recommendations for Implementing Change (ERIC) strategies by Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) dimensions for rural health innovations using annual reports on a diverse array of initiatives., Data Sources and Study Setting: The Veterans Affairs (VA) Office of Rural Health (ORH) funds initiatives designed to support the implementation and spread of innovations and evidence-based programs and practices to improve the health of rural Veterans. This study draws on the annual evaluation reports submitted for fiscal years 2020-2022 from 30 of these enterprise-wide initiatives (EWIs)., Study Design: Content analysis was guided by the RE-AIM framework conducted by the Center for the Evaluation of Enterprise-Wide Initiatives (CEEWI), a Quality Enhancement Research Initiative (QUERI)-ORH partnered evaluation initiative., Data Collection and Extraction Methods: CEEWI analysts conducted a content analysis of EWI annual evaluation reports submitted to ORH. Analysis included cataloguing reported implementation strategies by Reach, Adoption, Implementation, and Maintenance (RE-AIM) dimensions (i.e., identifying strategies that were used to support each dimension) and labeling strategies using ERIC taxonomy. Descriptive statistics were conducted to summarize data., Principal Findings: A total of 875 implementation strategies were catalogued in 73 reports. Across these strategies, 66 unique ERIC strategies were reported. EWIs applied an average of 12 implementation strategies (range 3-22). The top three ERIC clusters across all 3 years were Develop stakeholder relationships (21%), Use evaluative/iterative strategies (20%), and Train/educate stakeholders (19%). Most strategies were reported within the Implementation dimension. Strategy use among EWIs meeting the rurality benchmark were also compared., Conclusions: Combining the dimensions from the RE-AIM framework and the ERIC strategies allows for understanding the use of implementation strategies across each RE-AIM dimension. This analysis will support ORH efforts to spread and sustain rural health innovations and evidence-based programs and practices through targeted implementation strategies., (Published 2024. This article is a U.S. Government work and is in the public domain in the USA. Health Services Research published by Wiley Periodicals LLC on behalf of Health Research and Educational Trust.)

Background: The Department of Veterans Affairs (VA) Office of Rural Health (ORH) supports national VA program offices' efforts to expand health care to rural Veterans through its Enterprise-Wide Initiatives (EWIs) program. In 2017, ORH selected Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM), an implementation science framework, to structure the EWI evaluation and reporting process. As part of its mandate to improve EWI program evaluation, the Center for the Evaluation of Enterprise-Wide Initiatives conducted a qualitative evaluation to better understand EWI team' perceptions of, and barriers and facilitators to, the EWI evaluation process., Methods: We conducted 43 semi-structured interviews with 48 team members (e.g., evaluators, program office leads, and field-based leads) representing 21 EWIs from April-December 2020. Questions focused on participants' experiences using strategies targeting each RE-AIM dimension. Interviews were inductively analyzed in MAXQDA. We also systematically reviewed 51 FY19-FY20 EWI annual reports to identify trends in misapplications of RE-AIM., Results: Participants had differing levels of experience with RE-AIM. While participants understood ORH's rationale for selecting a common framework to structure evaluations, the perceived misalignment between RE-AIM and EWIs' work emerged as an important theme. Concerns centered around 3 sub-themes: (1) (Mis)Alignment with RE-AIM Dimensions , (2) (Mis)Alignment between RE-AIM and the EWI , and (3) (Mis)Alignment with RE-AIM vs. other Theories, Models, or Frameworks . Participants described challenges differentiating between and operationalizing dimensions in unique contexts. Participants also had misconceptions about RE-AIM and its relevance to their work, e.g., that it was meant for established programs and did not capture aspects of initiative planning, adaptations, or sustainability. Less commonly, participants shared alternative models or frameworks to RE-AIM. Despite criticisms, many participants found RE-AIM useful, cited training as important to understanding its application, and identified additional training as a future need., Discussion: The selection of a shared implementation science framework can be beneficial, but also challenging when applied to diverse initiatives or contexts. Our findings suggest that establishing a common understanding, operationalizing framework dimensions for specific programs, and assessing training needs may better equip partners to integrate a shared framework into their evaluations., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Chasco, Van Tiem, Johnson, Balkenende, Steffen, Jones, Friberg, Steffensmeier, Moeckli, Arora, Rabin and Reisinger.)

Objectives: Advance care planning (ACP) involvement could be substantially different by physician specialty or sex group, with implications for training and methods to increase ACP activities. The objective of this article is to compare primary care physicians (PCPs) and other specialty physicians and female compared with male physicians' views and interactions surrounding ACP., Methods: This was a secondary analysis of an online anonymous survey distributed through a survey link to healthcare providers in hospital, ambulatory, and hospice settings in the greater Dayton, Ohio area in preparation for a community-wide advance care planning multitiered intervention. The measures included demographic data and questions regarding personal ACP decisions/experiences, opinions surrounding ACP in healthcare settings, and willingness to facilitate ACP with patients., Results: There were 129 physician respondents, of which 39 (30.2%) were PCPs, and 33 (25.6%) were women. Most expressed interest in ACP, responding positively to a desire for more training, and approximately 25% were willing to be trained to teach others. The respondents by specialty group were similar in age and race, the presence or absence of religious affiliation, and stated frequency of ACP conversations. More than half (52.5%) reported having ACP conversations at least twice per month. The female physicians were younger and more likely to be in primary care. Female physicians also were more likely to discuss ACP with patients ( P = 0.017), report formal training for ACP ( P = 0.025), and be more willing to permit other healthcare provider types to be involved with ACP. PCPs reported time as a barrier more frequently than specialty physicians ( P = 0.012). Other barriers to ACP were reported, including space, personal discomfort, and concerns about patient or family distress or disagreement., Conclusions: Many physicians, regardless of specialty type or sex, are interested in undertaking more ACP conversations and being trained to do so. Overall, more female physicians than male physicians were involved and interested in various aspects of ACP, and they were more accepting of the involvement of nonphysician healthcare professionals in ACP. Multiple barriers for clinicians, patients, and families were identified that will need to be addressed by work settings or through education to increase ACP.