RE-AIMing Research for Application: Ways to Improve Evidence for Family Medicine

ArticleinThe Journal of the American Board of Family Medicine 19(1):11-9 · January 2006with10 Reads
DOI: 10.3122/jabfm.19.1.11 · Source: PubMed
To outline changes in clinical research design and measurement that should enhance the relevance of research to family medicine. Review of the traditional efficacy research paradigm and discussion of why this needs to be expanded. Presentation of practical clinical and behavioral trials frameworks, and of the RE-AIM model for planning, evaluating, and reporting studies. Recommended changes to improve the external validity and relevance of research to family medicine include studying multiple clinical practices, realistic alternative program choices, heterogeneous and representative patients, and multiple outcomes including cost, behavior change of patients and staff, generalization, and quality of life. The methods and procedures discussed can help program planners, evaluators and readers of research articles to evaluate the replicability, consistency of effects, and likelihood of widespread adoption of interventions.
    • "Adoption includes an assessment of the delivery settings (i.e., intervention locations) and the participation rate of delivery agents (i.e., individuals who delivered the intervention components) involved in the implementation of a program [15,28]. Adoption of C.H.A.M.P. was analyzed by: (a) providing an overview of the delivery settings, the use of these settings over the 2-year period, and their potential for translating the research program into practice; and (b) summing the number of individuals and/or community organizations in London, Ontario and surrounding areas that were involved in the implementation of the program . "
    [Show abstract] [Hide abstract] ABSTRACT: Increasing rates of childhood overweight and obesity highlight a need for the evaluation of lifestyle interventions. The purpose of the study was to determine the Reach, Effectiveness, Adoption, Implementation and Maintenance of a novel family-focused program targeting children with obesity (i.e., the Children's Health and Activity Modification Program [C.H.A.M.P.]) using the RE-AIM framework, an evaluation tool for community-based health interventions. A single-centre, single cohort interventional feasibility study was conducted over the course of two years. Children with obesity and their families completed a 4-week group-based lifestyle intervention in Year 1 (n = 15; M age = 10.6; 53% female) and/or Year 2 (n = 25; M age = 10.6; 56% female). Outcome variables were measured pre- and post-intervention, as well as 6- and 12-months following completion of the formal program. Overall, C.H.A.M.P. had high reach in terms of participant representativeness. In addition, participation in the program was associated with significantly improved standardized body mass index (BMI-z), body fat percentage, lean mass percentage, and child- and parent-proxy reported quality of life (QOL; effectiveness/individual maintenance). Furthermore, a number of community partnerships were built, strengthened, and maintained prior to, during, and following implementation of the two-year program (adoption/setting maintenance, respectively). Finally, the intervention was delivered as intended as evidenced by high adherence to the schedule, attendance rates, and cost effectiveness (implementation). Based on RE-AIM metrics, C.H.A.M.P. appears to be a promising childhood obesity program. The findings reported will inform researchers and practitioners on how to design and implement future community-based programs addressing pediatric obesity. ISRCTN Registry, Study ID ISRCTN13143236. Registered 27 March 2015.
    Full-text · Article · Dec 2015
    • "An overview of our data collection and methods is presented inTable 3. The outcomes for the implementation and scalability assessment are framed around Glasgow's RE-AIM framework and will include Reach, Adoption, Implementation, and Maintenance52535455 . The comparative effectiveness trial will focus on Effectiveness. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Evidence-based preventive services for early detection of cancer and other health conditions offer profound health benefits, yet Americans receive only half of indicated services. Policy initiatives promote the adoption of information technologies to engage patients in care. We developed a theory-driven interactive preventive health record (IPHR) to engage patients in health promotion. The model defines five levels of functionality: (1) collecting patient information, (2) integrating with electronic health records (EHRs), (3) translating information into lay language, (4) providing individualized, guideline-based clinical recommendations, and (5) facilitating patient action. It is hypothesized that personal health records (PHRs) with these higher levels of functionality will inform and activate patients in ways that simpler PHRs cannot. However, realizing this vision requires both technological advances and effective implementation based upon clinician and practice engagement. Methods/design: We are starting a two-phase, mixed-method trial to evaluate whether the IPHR is scalable across a large number of practices and how its uptake differs for minority and disadvantaged patients. In phase 1, 40 practices from three practice-based research networks will be randomized to add IPHR functionality to their PHR versus continue to use their existing PHR. Throughout the study, we will engage intervention practices to locally tailor IPHR content and learn how to integrate new functions into their practice workflow. In phase 2, the IPHR to all nonintervention practices to observe whether the IPHR can be implemented more broadly (Scalability). Phase 1 will feature an implementation assessment in intervention practices, based on the RE-AIM model, to measure Reach (creation of IPHR accounts by patients), Adoption (practice decision to use the IPHR), Implementation (consistency, fidelity, barriers, and facilitators of use), and Maintenance (sustained use). The incremental effect of the IPHR on receipt of cancer screening tests and shared decision-making compared to traditional PHRs will assess Effectiveness. In phase 2, we will assess similar outcomes as phase 1 except for effectiveness. Discussion: This study will yield information about the effectiveness of new health information technologies designed to actively engage patients in their care as well as information about how to effectively implement and disseminate PHRs by engaging clinicians. Trial registration: NCT02138448.
    Full-text · Article · Dec 2014
    • "The program evaluation as outlined in this paper is designed to provide an understanding of the issues impacting the implementation of an effective approach for CDPS within primary care that may be adapted to become sustainable in the nonresearch setting. The RE-AIM framework informs our evaluation which includes a composite index to assess effectiveness in real-world settings [5,21,22,24]. "
    [Show abstract] [Hide abstract] ABSTRACT: Background The objectives of this paper are to describe the planned implementation and evaluation of the Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Primary Care (BETTER 2) program which originated from the BETTER trial. The pragmatic trial, informed by the Chronic Care Model, demonstrated the effectiveness of an approach to Chronic Disease Prevention and Screening (CDPS) involving the use of a new role, the prevention practitioner. The desired goals of the program are improved clinical outcomes, reduction in the burden of chronic disease, and improved sustainability of the health-care system through improved CDPS in primary care.Methods/designThe BETTER 2 program aims to expand the implementation of the intervention used in the original BETTER trial into communities across Canada (Alberta, Ontario, Newfoundland and Labrador, the Northwest Territories and Nova Scotia). This proactive approach provides at-risk patients with an intervention from the prevention practitioner, a health-care professional. Using the BETTER toolkit, the prevention practitioner determines which CDPS actions the patient is eligible to receive, and through shared decision-making and motivational interviewing, develops a unique and individualized `prevention prescription¿ with the patient. This intervention is 1) personalized; 2) addressing multiple conditions; 3) integrated through linkages to local, regional, or national resources; and 4) longitudinal by assessing patients over time. The BETTER 2 program brings together primary care providers, policy/decision makers and researchers to work towards improving CDPS in primary care. The target patient population is adults aged 40¿65. The reach, effectiveness, adoption, implementation, maintain (RE-AIM) framework will inform the evaluation of the program through qualitative and quantitative methods. A composite index will be used to quantitatively assess the effectiveness of the prevention practitioner intervention. The CDPS actions comprising the composite index include the following: process measures, referral/treatment measures, and target/change outcome measures related to cardiovascular disease, diabetes, cancer and associated lifestyle factors.DiscussionThe BETTER 2 program is a collaborative approach grounded in practice and built from existing work (i.e., integration not creation). The program evaluation is designed to provide an understanding of issues impacting the implementation of an effective approach for CDPS within primary care that may be adapted to become sustainable in the non-research setting.
    Full-text · Article · Oct 2014
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