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Using the RE-AIM framework to evaluate the implementation of a clinical workflow designed to identify, refer, and
Garrett M Steinbrink1, Jenna L Springer1, Korey A Kennelty2,3
1Department of Health, Sport, and Human Physiology, University of Iowa, Iowa City, IA, United States.
Background:
Primary care is well-positioned to connect patients to physical activity (PA) interventions but is underutilized.
Purpose:
To describe the implementation of a clinical workflow designed to identify, refer, and connect insufficiently active patients to health coaching (HC).
Methods:
From June 2023 to March 2025, a physical inactivity screening and referral workflow was implemented in six primary care clinics within a large university healthcare system. Guided by the RE-AIM framework, descriptive analyses focused on the number and proportion of patients who (i) were screened for inactivity, (ii) were identified as insufficiently active, (iii) expressed interest in HC, (iv) were referred to HC, and (v) were connected to HC. We also assessed provider uptake, evaluated workflow modifications, and computed measures of central tendency and dispersion during the final year.
Results:
Monthly, a mean (SD) of 1771 (153) patients were screened. Of these, 1013 (102), or 57.1%, were insufficiently active. A median of 288 patients (29%) expressed interest in HC, of which 243 (89%) were referred. A median of 20 patients (10% of those referred) were connected to HC monthly. Among providers with patients requesting a referral, 86% referred. Workflow changes were followed by shifts in metrics, while variability remained low during the final year of evaluation.
Conclusion:
This workflow identifies and refers many insufficiently active patients to HC. However, there is a gap between patient HC referral and connection to support. Identifying and implementing strategies to overcome barriers and improve patient connection rates is a critical next step.
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