Table 1.

Stakeholder needs and engagement and alignment with RE-AIM dimensions.

Stakeholder needs and steps to address them
Patient need (REACH)	Implementation method to address the need
Skills-based pain management during COVID with an extended perioperative time frame	• Clinician delivery of intervention    ° Low patient engagement with automated treatment supports a model for therapist-delivery for a single-session intervention (Empowered Relief) • On-line delivery of intervention • A live instructor delivered the class to supports patient convenience and safety during pandemic • Brief and accessible intervention to target the need for additional patient support and continuity of care during an extended perioperative period in the COVID-19 pandemic
Clinician need (ADOPTION)	Implementation method to address the need
Efficient scheduling and low burden workflow	• Class order through the electronic health record created for rapid scheduling and tracking of patients • Accessible educational materials for patients to support clinicians in communicating the purpose of the class and minimizing additional questions • Use of electronic technology to communicate with patients  ° Automated class reminders and login instructions and billing information sent to patients prior to the class
Approaches to enhancing stakeholder engagement in empowered relief
Patients (REACH, ADOPTION)	• Surgeons lead messaging to patient that class will support effective surgical pain management • Online treatment delivery expands access to home-based behavioral pain care during COVID restrictions • Online classes offered 1-2 time weekly • Integrating Empowered Relief as standard care minimizes stigma and assures consistency in the messaging patients receive from multiple care providers
Clinicians (IMPLEMENTATION, MAINTENANCE)	• Identify clinical champions (surgeons, nursing, behavioral medicine, program manager) • Create multi-disciplinary work group • Provide surgical team education on Empowered Relief and operational systems designed to decrease staff burden • Empowered Relief instructors are supported by an administrative staff who attends to participants logistical and tech questions, thereby freeing them to focus on delivering the clinical content • Continuous education to entire spine staff on the class, including updates on referral process, continuous improvement efforts and outcomes