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

Kaiser Permanente Colorado, 335 Road Runner Lane, Penrose, CO 81240, USA.
The Journal of the American Board of Family Medicine (Impact Factor: 1.98). 01/2006; 19(1):11-9. 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.

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    • "2. Implementation of the 5AsT in primary care practice will result in sustained changes in medical practice as evaluated by the RE-AIM framework [13,14]. "
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    ABSTRACT: Background Obesity is a pressing public health concern, which frequently presents in primary care. With the explosive obesity epidemic, there is an urgent need to maximize effective management in primary care. The 5As of Obesity Management™ (5As) are a collection of knowledge tools developed by the Canadian Obesity Network. Low rates of obesity management visits in primary care suggest provider behaviour may be an important variable. The goal of the present study is to increase frequency and quality of obesity management in primary care using the 5As Team (5AsT) intervention to change provider behaviour. Methods/design The 5AsT trial is a theoretically informed, pragmatic randomized controlled trial with mixed methods evaluation. Clinic-based multidisciplinary teams (RN/NP, mental health, dietitians) will be randomized to control or the 5AsT intervention group, to participate in biweekly learning collaborative sessions supported by internal and external practice facilitation. The learning collaborative content addresses provider-identified barriers to effective obesity management in primary care. Evidence-based shared decision making tools will be co-developed and iteratively tested by practitioners. Evaluation will be informed by the RE-AIM framework. The primary outcome measure, to which participants are blinded, is number of weight management visits/full-time equivalent (FTE) position. Patient-level outcomes will also be assessed, through a longitudinal cohort study of patients from randomized practices. Patient outcomes include clinical (e.g., body mass index [BMI], blood pressure), health-related quality of life (SF-12, EQ5D), and satisfaction with care. Qualitative data collected from providers and patients will be evaluated using thematic analysis to understand the context, implementation and effectiveness of the 5AsT program. Discussion The 5AsT trial will provide a wide range of insights into current practices, knowledge gaps and barriers that limit obesity management in primary practice. The use of existing resources, collaborative design, practice facilitation, and integrated feedback loops cultivate an applicable, adaptable and sustainable approach to increasing the quantity and quality of weight management visits in primary care. Trial registration NCT01967797.
    Full-text · Article · Jun 2014 · Implementation Science
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    • "A process evaluation will be conducted alongside the randomized controlled trial to gain insight into the feasibility of this intervention for more widespread dissemination and to detect any particular study challenges that might be identified from more qualitative assessments. The process evaluation will be based on the RE-AIM framework, which consists of five dimensions: Reach, Efficacy/effectiveness, Adoption, Implementation, and Maintenance [56]. The goals of the process evaluation will be to assess the reach of the program (at both the employer and participant level), to identify any dose–response relationships between levels of participation and outcomes, to evaluate adherence to the study protocol, to assess the satisfaction and experiences of workers and facilitators, and to identify facilitators and barriers for future implementation. "
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    ABSTRACT: Background The percentage of older and chronically ill workers is increasing rapidly in the US and in many other countries, but few interventions are available to help employees overcome the workplace challenges of chronic pain and other physical health conditions. While most workers are eligible for job accommodation and disability compensation benefits, other workplace strategies might improve individual-level coping and problem solving to prevent work disability. In this study, we hypothesize that an employer-sponsored group intervention program employing self-management principles may improve worker engagement and reduce functional limitation associated with chronic disorders. Methods In a randomized controlled trial (RCT), workers participating in an employer-sponsored self-management group intervention will be compared with a no-treatment (wait list) control condition. Volunteer employees (n = 300) will be recruited from five participating employers and randomly assigned to intervention or control. Participants in the intervention arm will attend facilitated group workshop sessions at work (10 hours total) to explore methods for improving comfort, adjusting work habits, communicating needs effectively, applying systematic problem solving, and dealing with negative thoughts and emotions about work. Work engagement and work limitation are the principal outcomes. Secondary outcomes include fatigue, job satisfaction, self-efficacy, turnover intention, sickness absence, and health care utilization. Measurements will be taken at baseline, 6-, and 12-month follow-up. A process evaluation will be performed alongside the randomized trial. Discussion This study will be most relevant for organizations and occupational settings where some degree of job flexibility, leeway, and decision-making autonomy can be afforded to affected workers. The study design will provide initial assessment of a novel workplace approach and to understand factors affecting its feasibility and effectiveness. Trial registration NCT01978392 (Issued November 6, 2013)
    Full-text · Article · May 2014 · BMC Public Health
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    • "Further, the criteria of the RE-AIM framework were applied to all eligible studies. RE-AIM consists of five dimensions: Reach: participation rate and representativeness of individuals who are willing to participate in a given programme; Efficacy: the success rate of an intervention on important outcomes, when it is implemented as intended; Adoption: percentage and representativeness of organisations that will begin or adopt a programme; Implementation: quality and consistency of programme delivery when the intervention is implemented as intended in the realword settings; and Maintenance: sustainability of intervention effects on individual's behaviour change, as well as the extent to which a programme becomes institutionalised [14]. The RE-AIM evaluation framework was recently applied to assess the translation of an evidence-based intervention in patients with asthma [15]. "
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    ABSTRACT: According to practice guidelines, educational programmes for patients with COPD should address several educational topics. Which topics are incorporated in the existing programmes remains unclear. To delineate educational topics integrated in current COPD management interventions; and to examine strengths, weaknesses, and methods of delivery of the educational programmes. A systematic literature search was performed using MEDLINE/PubMed, Cochrane Central Registry of Controlled Clinical Trials, and Web of Science. The authors of included studies were contacted for additional information. Studies that contained educational programmes incorporated in COPD management interventions were included. Data were extracted using a pre-designed data form. The Reach, Efficacy, Adoption, Implementation and Maintenance (RE-AIM) framework was used for evaluating the strengths and weaknesses of the programmes. In total, 81 articles, describing 67 interventions were included. The majority (53.8%) of the studies incorporated 10 or more educational topics. The following topics were frequently addressed: smoking cessation (80.0%); medication (76.9%); exercise (72.3%); breathing strategies (70.8%); exacerbations (69.2%); and stress management (67.7%). Printed material and/or brochure (90.5%) and demonstrations and practice (73.8%), were the predominant tool and method, respectively. Nurses (75.8%), physicians (37.9%) and physiotherapists (34.8%) were the most involved healthcare professionals. Heterogeneity and wide variation in the content and the method of delivery of educational interventions were present. Alignment between educational topics incorporated in the existing programmes and those recommended by the COPD guidelines, involvement of various professionals and combined use of methods should be emphasised.
    Full-text · Article · Sep 2013 · Respiratory medicine
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