NURS 700 Week 4 Written Assignment 2: Program Evaluation Example

Evaluating a Nurse-Led Lung Cancer Screening Outreach Program in Rural Primary Care: A Logic Model and RE-AIM Evaluation Plan

The Program and the Purpose of Evaluation

The first assignment for this course found that only 8% of eligible patients in the Blue Ridge Family Health network had completed lung cancer screening in the past year, and the critique of a large trial concluded that a coordinated stepped reminder process can raise adherence to annual screening substantially (Wernli et al., 2026). The network now plans a twelve-month program in which a registered nurse in each of its four clinics, given eight protected hours a week, will identify eligible patients from a registry, call them to offer decision counseling, pend screening orders for the clinician's signature, arrange transportation when needed and remind patients when their annual scan is due.

The purpose of the evaluation is threefold: to determine whether the program increases screening completion and annual adherence, to learn whether it reaches the patients who most need it, including those who live farthest from the scanner, and to identify what helps or hinders nurses in delivering it, so that the network can decide whether to continue, change or expand the program.

Logic Model

A logic model makes explicit how the program is expected to produce change. Table 1 summarizes it.

The model shows that the program's effect depends on a chain of steps. If nurses cannot reach patients, or clinicians do not sign pended orders, completion will not rise even if each step is well designed, which is why the evaluation measures outputs as well as outcomes.

Evaluation Questions

Five questions guide the evaluation. Does the program reach eligible patients across all four clinics, including those who live far from the scanner or lack commercial insurance? Does it increase the proportion of eligible patients who complete a first screening scan and the proportion who return for their annual scan? Do clinicians in every clinic sign the orders nurses pend for them? Do nurses deliver outreach and counseling as planned, and what makes that hard? And are the program and its effects still present after the first year? Each measure in the plan answers one of these questions, and any measure that answers none of them has been left out, which keeps the data collection within what four busy clinics can manage.

Stakeholder Involvement

The evaluation was planned with the people who will use its results. The network's medical director and nurse manager identified the decisions the evaluation must inform, chiefly whether to fund the nurses' protected hours in a second year. The four outreach nurses helped design the outreach log so that recording a call takes less than a minute. The radiology partner agreed to share monthly scan completion data, and two patients from the network's advisory group reviewed the counseling script and suggested adding the cost of travel to the questions nurses ask. Involving these groups early makes it more likely that the results will be trusted and used.

The RE-AIM Framework

The RE-AIM framework organizes the evaluation around five dimensions that together describe a program's real-world impact: reach, effectiveness, adoption, implementation and maintenance. It suits this program because a screening intervention can succeed in a trial yet fail in practice if it reaches only patients who were already likely to be screened, or if nurses cannot fit it into their day.

Reach

Reach is the proportion and representativeness of eligible patients who take part. The measure is the percentage of registry patients contacted and the percentage who complete decision counseling, broken down by age, sex, insurance, smoking status and driving distance to the scanner. The target is contact with 80% of registry patients within six months. If reach is high overall but low among patients more than 30 miles from the scanner, the program will add evening calls and transport help for that group before the second half of the year. Reach by distance matters most here, since rural barriers such as transportation and time off work were among the most frequently cited obstacles in interviews with clinicians and navigators (Reid et al., 2026).

Effectiveness

Effectiveness is the program's impact on outcomes. The primary measure is the monthly percentage of eligible patients completing a screening scan, and the secondary measure is adherence to annual screening among patients with a normal prior scan. Completion of pack-year documentation in the record is an intermediate measure, since missing smoking history prevents eligibility from being identified at all. At the start of the program, roughly a third of adult patients with any smoking history had no pack-year count recorded, so this measure may show early progress before scan completion does. The target is to raise past-year completion from 8% to 20% and annual adherence above 60% within twelve months.

Adoption

Adoption is the proportion of settings and staff who take up the program. The measure is the number of clinics and clinicians participating and the percentage of pended orders that clinicians sign within a week. Clinician engagement deserves attention, since patients in a pilot of a multilevel screening intervention reported that some physicians seemed hesitant or unsure about eligibility even when patients wanted to discuss screening (Sharifian et al., 2026).

Implementation

Implementation is whether the program is delivered as intended. Measures include the number of outreach calls per nurse per week, the percentage of counseling sessions using the decision aid and the time nurses spend per patient. Nurse and clinician interviews at six months will identify barriers. The Quality Implementation of Lung Cancer Screening system developed in Kentucky offers an index of six domains of screening program quality, including eligibility and radiology operations, which the network will use to audit its processes at the start and the end of the year (Studts et al., 2026).

Maintenance

Maintenance is whether the program and its effects last. Measures are completion and adherence rates six months after the funded year ends and whether the clinics keep the nurses' protected time. A program that depends on grant-funded hours and disappears when funding ends has not been maintained.

Evaluation Design

A randomized trial is not feasible within one small network, so the evaluation uses an interrupted time series. Monthly screening completion will be tracked for twelve months before the program and twelve months during it, which allows the analysis to separate the program's effect from any existing upward trend, such as the gradual rise in screening seen nationally. The design's main weakness is that another change occurring at the same time, for instance a change in the radiology contract, could explain a shift, so the evaluation will record any such events. Comparing clinics that start the program at different times would strengthen the design further. Because community screening programs differ widely in their care pathways (Walsh et al., 2026), each clinic's workflow will be mapped before launch so differences in results can be interpreted.

Data Collection, Analysis and Use

Data will come from the electronic record, radiology reports, the nurses' outreach log and interviews. Rates will be plotted monthly on run charts and analyzed with segmented regression at the end of the year. Interview data will be summarized by theme. Results will be shared quarterly with clinicians and nurses, so that problems can be fixed during the year rather than discovered at the end, and a final report will go to the network's board with a recommendation to continue, modify or end the program.

Ethical Safeguards

The evaluation uses existing records for quality improvement, so the network's quality committee, with consultation from an institutional review board, will confirm that it does not require research approval. Patient data will be de-identified in reports, and interviews will be voluntary and confidential. Patients who decline screening after counseling will be recorded as informed decliners rather than failures, since an informed decision against screening is a legitimate outcome.

Faithful Stewardship

Jesus told His followers that trustworthiness in small things shows trustworthiness in large ones (English Standard Version Bible, 2001/2016, Luke 16:10). A small rural network investing nurses' time in outreach has an obligation to know whether the investment is helping patients. Careful evaluation is how an organization proves faithful with the resources and the trust its patients have given it.

Conclusion

This evaluation plan connects a nurse-led outreach program to its intended outcomes through a logic model and measures its real-world impact through the RE-AIM framework, with data sources, targets and a feasible interrupted time series design. The plan is built to show not only whether screening rates rise but whether the program reaches rural patients who face the greatest barriers and whether it can last.

References

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Reid, M. J., LeLaurin, J. H., Ali, S., Sorial, C., Bylund, C. L., Woodard, J. N., Wollney, E. N., Goede, D. L., Lee, J. H., Nelson, D. S., Carter-Bawa, L., & Salloum, R. G. (2026). Identifying barriers and strategies to support a community navigator-driven approach for lung cancer screening. Current Oncology, 33(9), Article 499. https://doi.org/10.3390/curroncol33090499

Sharifian, M., Hoyt, M. A., Madan, A., Lee, S., Nguyen, T. Q., & Sadigh, G. (2026). Patients' and providers' perspective of a multi-level approach to improve participation in low-dose CT for lung cancer screening (Empower LCS): A mixed-methods analysis. Academic Radiology, 33(6), 2352-2360. https://doi.org/10.1016/j.acra.2026.03.014

Studts, J. L., Knight, J. R., Yates, A. R., Alexander, J. L., Damron, K. J., Barry, A. M., Studts, C. R., Brooks, M. T., & Mullett, T. W. (2026). Quality implementation of lung cancer screening system: A system to support high-quality delivery of lung cancer screening in diverse settings. Chest, 170(2), 619-631. https://doi.org/10.1016/j.chest.2025.10.050

Walsh, C., Palazzo, L., Hansell, L., Louie, T., Long, S., Brown, M., Hippe, D. S., Coronado, G. D., Decell, K., Leone, R. J., Lodhi, S., Wysham, N., Wernli, K. J., & Triplette, M. (2026). Lung cancer screening care pathways in community settings: An examination of 3 healthcare systems. Annals of the American Thoracic Society, 23(6), 908-917. https://doi.org/10.1093/annalsats/aaoag029

Wernli, K. J., Anderson, M. L., Palazzo, L., Luce, C., Bezman, N., Rogers, K., Chin, M., Gao, H., Ralston, J., Su, Y. R., Carter-Bawa, L., Triplette, M., Tuzzio, L., Vasavada, A., & Green, B. B. (2026). Health communication and stepped reminders interventions for lung cancer screening: A randomized clinical trial. JAMA Internal Medicine. Advance online publication. https://doi.org/10.1001/jamainternmed.2026.3666