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Table 3 Selected Quotes Representing the Five RE-AIM Elements

From: Assessing the implementation of a patient navigation intervention for colonoscopy screening

Re-aim dimension Qualitative data Source
Reach We literally sat down with a map of New Hampshire and looked at where the low income, uninsured, vulnerable minority populations were located, and we contracted with endoscopy sites, 12 of them, in those areas. Medical Director
I think because of [NHCRCSP’s] relationships with all the federally qualified health centers, they’re the key to always getting referrals. Program Director
Nothing’s perfect, but I guess the challenge is that the needs are probably greater than the program can meet.  
I know they have some constraints with the number of patients that they can see.  
Efficacy I’m not surprised that they’ve had success, knowing the [staff] people that are in this program and their dedication to that. That, with the backing of a lot of smart partners, I think that they were definitely set up to be successful, and they delivered on it. Stakeholder
Honestly, at the beginning I was not expecting the 100% success rate … I was really surprised to say it’s 98% of prepped success. Nobody has that. Nobody has that. Stakeholder
Oh, I think it’s the coaching, the navigator, a little bit of the pre-selection of people who are motivated to have it done. I mean, it’s not a procedure people are wanting to have done. So that it’s covered and they are able to have it done, and they know they need to, and it’s a population that’s plugged in to the medical community, I think they’re sort of motivated already to do it. Endoscopist
I would phrase it the other way to say that the people who call us seem, perhaps, to have a higher degree of motivation NHCRCSP Staff
Adoption You’ve got to have someone who’s passionate about it, and that comes across in everything [Medical Director] does. That really energizes partners, and so people know that she’s really true to the cause, really gets it; she understands the on the ground realities of certainly providers, but also partner organizations, and she, again, communicates that passion. She and [Program Director] are both very well connected. Stakeholder
So I just volunteered to be the “physician champion” for the sort of promotion of colorectal screening in our enterprise. So that’s how I got involved with [Senior PN] and her program and the other folks in our enterprise that have made up this committee to promote colorectal health. Primary care physician
Number one, they [NHCRCSP] had the Dartmouth brand and the Comprehensive Cancer Collaboration backing their work. So they chose already established, recognized partners on the ground in the state, so that helped. We helped with that as well, but Dartmouth and Comp Cancer already have credibility within the community, so that gave them a good jumping off point. Stakeholder
One thing we all struggle with is, because the program can only pay to a certain point, if someone has found something, whether they need cancer treatment or just surgery for some kind of lesion they found that’s not cancerous, but it’s something they couldn’t remove with a colonoscopy, what can be frustrating, depending on what healthcare system you work with, is … ok, now these people have no money. How are they going to get the care they need? NHCRCSP Staff
Implementation I think they’re doing an awesome job. Yup. And it was an excellent program that helped me out a lot, and that’s the bottom line. Patient
[Navigator] was really wonderful. She just, every time she would call, the first thing she would ask is ‘do you have any other questions or concerns, anything that you need to know?’ … the patient navigator was just a really nice touch to the program because it made me feel really at ease to know that I could get a hold of that person. Patient
Sometimes it’s difficult when they [patient] change their phone numbers, and you can’t reach them for an extended period of time. That becomes challenging. That becomes challenging to connect with that patient and to establish that rapport and that communication. I have learned that you always have to keep asking if that’s a current [phone] number. NHCRCSP Staff
Maintenance It’s very helpful, I think, to be located in an academic medical center [Dartmouth-Hitchcock]. It really has been helpful for a grant program like this, and the reason is that there’s tremendous support. Dartmouth already has, as any academic institution will have, reach into the community on its own to some degree. There is expertise everywhere for whatever you want … So it really does provide access if you have a problem with anything, whether it be medical or statistical or research or whatever it is. NHCRCSP Staff
We would not be where we are [without the data system] with any of this, patient navigation, it would not be supported … And then when it comes to the CCDE [data reporting] time, we’re done. So that is like the daily reports that they can run to see who they need to call today, what type of call … We have so many reports, now. So the database, it’s like a live other person for us. I mean, really, it would be a whole other person. NHCRCSP Staff
So they’re [American Cancer Society] a key, key partner, but we’ve made other partners, like Anthem has been a great partner. We knew we had to meet with them because they have a family practice doctor who is their medical director. So he gets us in places we wouldn’t be able to get into without him. I mean, wherever we can find a partner, we’ll take a partner. NHCRCSP Staff
I’m so lucky with the two people [navigators] that we have right now … If you hire the wrong person, it’s a challenge. NHCRCSP Staff