Applying the Implementation Research Logic Model (IRLM) as a research planning tool in a multi-project, rural health initiative to improve cardiovascular health service delivery outcomes and quality

Abstract Background Increasingly, domestic and global initiatives are being designed to build synergistic networks of leading researchers to tackle major health challenges. In this case study, we applied the Implementation Research Logic Model (IRLM) to individual projects to enhance collaboration, learning and knowledge generation across a large research network. Methods The ReciPROcal Innovations to Improve Cardiovascular Care in Rural America (Rural PRO-CARE) network, is a five-project initiative funded by the American Heart Association. The network used the IRLM to facilitate implementation planning and learning across projects testing a variety of implementation strategies to improve cardiovascular health outcomes in rural America. A collaborative case study approach identified determinants, implementation strategies, mechanisms and outcomes for each project using the Consolidated Framework for Implementation Research (CFIR), the Expert Recommendations for Implementing Change (ERIC), and Implementation Outcomes Framework (IOF) respectively. Projects developed causal pathway diagrams to define mechanisms of action for their specified implementation strategies. Semi-structured group interviews using an After-Action Review (AAR) approach, elucidated each teams’ understanding of how the IRLM worked, what was successful and how the process could improve. Results Within the first year of the initiative, each project developed an IRLM which provided a visual and theoretical structure for planning, implementation and evaluation. This process identified similarities and differences across projects’ determinants, strategies and outcomes. The most frequently identified barriers to effective implementation of cardiovascular health strategies in rural America were high care and insurance costs, complex cardiovascular intervention workforce limitations, limited scope of practice, misaligned external policies, conflicting patient beliefs/knowledge, and lack of readiness for change. The most frequently identified implementation outcomes across projects were reach, followed by acceptability and sustainability/maintenance. From the AAR, all project teams noted greater ease and use of common implementation language and reported linking facilitators and barriers to strategies, mechanisms, and intended outcomes deepened team members’ alignment on project goals. New strategies to overcome barriers were highlighted through the IRLM process and specific measures were selected to assess implementation. Conclusion The IRLM strengthened cross-site learning by making common determinants and synergies visible across projects enabling the network to target shared challenges more strategically and improve coordination across the initiative.