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2023 HSR&D/QUERI National Conference Abstract

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4043 — Evaluation Theory in the Wild: The VA Office of Rural Health and RE-AIM

Lead/Presenter: Monica Matthieu,  COIN - North Little Rock
All Authors: Matthieu MM (Central Arkansas Veterans Healthcare System, HSR&D Center of Innovation Center for Mental Healthcare & Outcomes Research, Saint Louis University), Kenney R (Seattle-Denver Center of Innovation) Taylor LD (Central Arkansas Veterans Healthcare System, Geriatric Research, Education and Clinical Center) Garner KK (Central Arkansas Veterans Healthcare System, Geriatric Research, Education and Clinical Center, University of Arkansas for Medical Sciences) Oliver CM (Central Arkansas Veterans Healthcare System, HSR&D Center of Innovation Center for Mental Healthcare & Outcomes Research) Adkins DA (Central Arkansas Veterans Healthcare System, HSR&D Center of Innovation Center for Mental Healthcare & Outcomes Research) McCullough JA (Central Arkansas Veterans Healthcare System, Geriatric Research, Education and Clinical Center) Mallory M (Central Arkansas Veterans Healthcare System, Geriatric Research, Education and Clinical Center) Arora K (Carver College of Medicine, University of Iowa) Reisinger, HS (University of Iowa) Young J (Seattle-Denver Center of Innovation) Klocko R (Seattle-Denver Center of Innovation)

Objectives:
The Foundations for Evidence-based Policymaking Act of 2018 (H.R.4174 - 115th Congress, 2019) shifted program evaluation from a mission critical element to an essential function for programs and policies supported by federal funding. To support rigorous evaluation across a national portfolio of grants, the Department of Veterans Affairs (VA) Office of Rural Health (ORH) commissioned a health services and implementation science research group to build evaluation capacity specifically related to their grantees. In 2016, VA ORH established Enterprise-Wide Initiatives (EWI) (Enterprise-Wide Initiatives - Office of Rural Health, n.d.). The purpose of these initiatives is to support and scale field-based innovations focused on reaching rural veterans. VA used this opportunity with the advent of the Evidence Act to make evaluation a core component of these efforts and required the application of Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) (Glasgow et al., 1999) framework to guide future evaluation efforts of all EWIs.

Methods:
RE-AIM was adopted to guide the grantees’ evaluation of VA-wide innovative initiatives that reach rural veterans and to standardize the reporting of outcomes and impacts. This presentation shares the process of integrating RE-AIM from ORH’s perspective, three grantee case examples, and lessons learned using RE-AIM metrics in their individual programs.

Results:
Challenges and solutions to using RE-AIM for the programs and the funder are offered for consideration by other large health care systems, funding organizations, and research and development agencies.

Implications:
. Participants will walk away with an understanding of why RE-AIM was chosen, how evaluators apply the elements of RE-AIM to real world projects, and how VA uses evaluation reports to reach its vision of ensuring that American’s veterans thrive in rural communities.

Impacts:
ORH has developed new evaluation components for EWIs to include: an annual report using a standardized report template (with RE-AIM as a focal point), a review by the EWI Teams (Evaluators), and a draft of a RE-AIM Logic Model. These components support standardized reporting and comparison of impacts across programs related to the reach of the program in improving access for rural residing veterans and providers to engage in VHA innovative programs and best practices.