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

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

doi:10.3389/frhs.2023.1205951

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. eCollection 2023.

Authors

Kristin M Mattocks^{1

2}, Aimee Kroll-Desrosiers^{1

2}, Susan Crowley^{3

4}, Katherine Tuozzo³, Ian Rifkin^{5

6}, David Moore^{3

4}, Lorrie Walker¹, Ramon Bonegio^{5

6}

Affiliations

¹ VA Central Western Massachusetts Healthcare System, Leeds, MA, United States.
² Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States.
³ VA Connecticut Healthcare System, West Haven, CT, United States.
⁴ Yale University School of Medicine, New Haven, CT, United States.
⁵ VA Boston Healthcare System, Boston, MA, United States.
⁶ Boston University School of Medicine, Boston, MA, United States.

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.

Keywords: access to care; health services; kidney disease; telemedicine; veterans.

Grants and funding

This study was funded by the U.S. Department of Veterans Affairs (VA) Office of Rural Health PRFY-00526. Visit www.ruralhealth.va.gov to learn more.