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Updated: Mar 27, 2026

Community-based Adapted Tango Dancing for Individuals with Parkinson's Disease and Older Adults

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Published on: December 9, 2014

Sustaining a Promising Clinical Practice in High-Turnover Rural Environments Through the Geriatric Referral Navigator

Eileen M Dryden^1,2, Camilla B Pimentel^1,3,4, Jessica Riley¹

¹VA Bedford Healthcare System, Center for Health Optimization and Implementation Research, Bedford, MA, United States.

JMIR Formative Research

|March 25, 2026

Summary

Implementing a geriatric referral navigator role is key to sustaining telemedicine programs in rural areas with high staff turnover. This role supports program use through relationship building, education, and problem-solving.

Keywords:

access navigators rural sustainment strategies telemedicine

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Last Updated: Mar 27, 2026

Community-based Adapted Tango Dancing for Individuals with Parkinson's Disease and Older Adults

Community-based Adapted Tango Dancing for Individuals with Parkinson's Disease and Older Adults

Published on: December 9, 2014

Area of Science:

Geriatric Medicine
Health Services Research
Implementation Science

Background:

Sustaining evidence-based healthcare programs is difficult in settings with high staff turnover.
GRECC Connect uses a hub-and-spoke telemedicine model to deliver geriatric care to rural veterans.
A geriatric referral navigator role was piloted to improve program sustainability.

Purpose of the Study:

To understand how to design and implement a navigator role to sustain telemedicine services.
To identify key tasks, skills, and characteristics for a successful navigator role.
To evaluate the perceived value of the navigator role in a rural healthcare setting.

Main Methods:

A longitudinal qualitative study using a case study approach was conducted over one year.
31 qualitative interviews and 5-9 reflection meetings were held with GRECC Connect hub site staff.
Directed content analysis and a national meeting for staff reflection were employed.

Main Results:

Navigator tasks included relationship building, education, troubleshooting, and referral evaluation.
Essential navigator traits were flexibility, creativity, problem-solving, and institutional knowledge.
The navigator role required substantial time (15-70% of full-time equivalent) and aligned with known implementation strategies.

Conclusions:

The geriatric referral navigator role integrates various recognized implementation strategies.
Investing in navigator tasks is crucial for sustaining healthcare programs and avoiding future implementation costs.
This role is vital for maintaining promising practices in rural clinical environments with high staff turnover.