■退伍军人事务部(VA)农村健康办公室(ORH)支持国家VA计划办公室通过其企业范围倡议(EWIs)计划将医疗保健扩展到农村退伍军人的努力。2017年,ORH选择了Reach,有效性,收养,实施,和维护(再AIM),实施科学框架,构建EWI评估和报告流程。作为其改进EWI计划评估的任务的一部分,企业计划评估中心进行了定性评估,以更好地了解EWI团队对,障碍和促进者,EWI评估过程。
■我们对48名团队成员进行了43次半结构化访谈(例如,评价者,项目办公室领导,和现场线索)代表2020年4月至12月的21个EWIs。问题侧重于参与者使用针对每个RE-AIM维度的策略的经验。在MAXQDA中对访谈进行了归纳分析。我们还系统地审查了51份FY19-FY20EWI年度报告,以确定RE-AIM误用的趋势。
■参与者有不同的RE-AIM经验水平。虽然参与者理解ORH选择共同框架来构建评估的基本原理,RE-AIM和EWIs\'工作之间的感知错位成为一个重要主题。关注集中在3个子主题上:(1)(错误)与RE-AIM尺寸保持一致,(2)RE-AIM和EWI之间的(Mis)对齐,和(3)(Mis)与RE-AIM的对齐与其他理论,模型,或框架。与会者描述了在独特环境中区分和操作维度的挑战。与会者对RE-AIM及其与工作的相关性也有误解,例如,它是针对既定计划的,没有抓住主动计划的各个方面,适应,或可持续性。不太常见,参与者分享了RE-AIM的替代模型或框架。尽管受到批评,许多参与者发现重新设定目标有用,提到培训对理解其应用很重要,并确定未来需要额外的培训。
■选择共享的实现科学框架可能是有益的,但在应用于不同的倡议或背景时也具有挑战性。我们的研究结果表明,建立共识,为特定程序实施框架维度,评估培训需求可以更好地使合作伙伴将共享框架纳入其评估。
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.