Implementation evaluation of virtual family-centered hospital rounds using the RE-AIM framework: a mixed methods study

Abstract Background This study reports the implementation evaluation of a completed clinical trial that compared “virtual family-centered rounds (FCR)” to standard FCR. We aimed to measure RE-AIM (reach, effectiveness, adoption, implementation, maintenance) outcomes and identify PRISM (practical, robust, implementation and sustainability model) contextual factors that influenced implementation outcomes of virtual FCR. Methods We used a convergent mixed methods design. The quantitative component was a cross-sectional analysis of neonatal intensive care unit hospitalizations using electronic health records and parent/guardian surveys. The qualitative component was a thematic analysis of interviews with 29 parents and 25 providers. We compared quantitative and qualitative data by synthesizing them in a joint display table, organized by RE-AIM dimensions. We categorized these key findings into the PRISM domains. Results During the 12-month trial, 486 families were randomized (325 intervention, 161 control). Contextual factors that influenced RE-AIM implementation outcomes included the following thematic findings: 1) implementation outcomes depended on how parents and providers experienced and used virtual FCR, with provider delivery influencing the degree of family-centeredness and parent familiarity with healthcare influencing engagement; 2) virtual FCR had limitations as a substitute for in-person rounds, yet expanded participation and improved communication, while exposing workflow barriers to consistent delivery of family-centered care; and 3) virtual FCR was broadly beneficial, particularly for families facing structural barriers, but maintaining equitable implementation remained challenging because of provider-dependent adoption and digital barriers. Quantitative and qualitative findings across RE-AIM dimensions mostly converged. Divergence emerged for parent-reported quality of life outcomes: qualitative data suggested intervention benefits, while quantitative findings were null. Conclusions This implementation evaluation identified perceived benefits of virtual family-centered rounds that were not revealed in the quantitative assessment while also revealing implementation challenges that influence the sustainability of this telehealth healthcare delivery innovation. Addressing these challenges will enhance the ability of our intervention to achieve broad impact. Trial registration ClinicalTrials.gov Identifier: NCT05762835. Status: Completed. First Posted: 3/10/2023; Last Update Posted: 8/7/2024.