Use of ReAIM in Implementation Research NISA Practice Based Research Network June 6 2023 Origin StoryIts all about Context REAIM Elements Case Uses Common Misconceptions REAIM Evolution and related frameworks ID: 1045302
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1. Marcia G. Ory, Ph.D., MPHUse of Re-AIM in Implementation ResearchNISA Practice Based Research NetworkJune 6, 2023.
2. Origin Story—It’s all about ContextRE-AIM ElementsCase UsesCommon MisconceptionsRE-AIM Evolution and related frameworks ResourcesToday’s Topics
3. Graduate Training (1971-1981)Social sciences & public healthLife-course perspectiveNational Institute on Aging (1981-2001)Research DiscoveriesCollaborative effortsTexas A&M School of Public Health (2001-)Aging and public health perspectivesResearch translationCenter for Community Health and AgingHealthy aging/disease prevention as focal areasNational Working Group on RE-AIM Planning and Evaluation Framework (www.re-aim-org).My professional journey
4. Mission statement:To increase the capacity of individuals, organizations, and communities, to improve population health and aging well across the life-course utilizing a community health development approach and multi-level evidence-based solutions.Center for Community Health and Aging
5. Lack of comprehensive evaluation framework for multilevel interventionsDescribe a new way of looking at public health impactsReach, Effectiveness, Adoption, Implementation, and Maintenance Understand the interaction across different componentsMatch interventions and measures to settings, goals, and purposes Discuss counter forces across different elements“efficacious interventions may not be most translatable in real-world”RE-AIM origin Story: Glasgow et al 1999
6. Hypothetical interactions across Different Components
7. It takes 17 years for research to reach practice.Only 14% of research reaches a target recipient.Only 18% of administrators and practitioners report using evidence-based practices frequently.Balas EA, Boren, SA. Managing clinical knowledge for healthcare improvement. In Yearbook of Medical Informatics. 2000.Chagnon F, et al. Comparison of determinants of research knowledge utilization by practitioners and administrators in the field of child and fand family social services. Implementation Science. 2010:5:41.amily social services. Implementation Science. 2010:5:41.Research to practice gap
8. Rothwell PM. External validity of randomised controlled trials. Lancet 2005;365:82-93. Current Research ChallengesEven if 100% effective, impact depends on:(1) Adoption(2) Training(3) Fidelity (Implementation)(4) Access (Reach)(5) Sustainability (Maintenance)50% threshold for each step=.5*.5*.5*.5*.5=3% benefit
9. Dissemination: Information sharingImplementation: Intervention integrationPragmatic: Under “usual” conditions – relevant to stakeholders AND rigorous.Illustration by Dave Cutler
10. FrameworksModelsTabak RG et al. Bridging Research and Practice: Models for Dissemination and Implementation Research Am J Prev Med, 2012, 43: 337-350.TheoriesD&I Science
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12. Choosing a D&I ModelConsider fit with:Key constructs of your project Levels of the socio-ecological frameworkD&I purpose (dissemination, implementation, or both)Content area and/or context of your projectPragmatic issuesHow long usedEase of use
13. RE-AIM
14. RE-AIM Intervention + Implementation GoalsAdopted broadly.Sustained implementation at reasonable cost.Reaches large numbers of people.Replicable and long-lasting outcomes.
15. REACHTechnical DefinitionThe absolute number, proportion, and representativeness of individuals willing to participate in a given initiative, and the reasons why (qualitative).Pragmatic UseWHO is intended to benefit and who actually participates or is exposed to the initiative?Glasgow RE, Estabrooks PE. Pragmatic Applications of RE-AIM for Health Care... Prev Chronic Dis 2018;15:170271. DOI: http://dx.doi.org/10.5888/pcd15.17027
16. EFFECTIVENESSTechnical DefinitionThe impact of an initiative on outcomes, including potential negative effects, heterogeneity, quality of life, and economic outcomes as well as the reasons why (qualitative).Pragmatic UseWHAT is the most important benefit you are trying to achieve and what is the likelihood of negative outcomes?Glasgow RE, Estabrooks PE. Pragmatic Applications of RE-AIM for Health Care... Prev Chronic Dis 2018;15:170271. DOI: http://dx.doi.org/10.5888/pcd15.17027
17. ADOPTIONTechnical DefinitionThe absolute number, proportion, and representativeness of settings and agents willing to initiate a program, and the reasons why (qualitative).Pragmatic UseWHERE is the program applied and WHO applied it?Glasgow RE, Estabrooks PE. Pragmatic Applications of RE-AIM for Health Care... Prev Chronic Dis 2018;15:170271. DOI: http://dx.doi.org/10.5888/pcd15.17027
18. IMPLEMENTATIONTechnical DefinitionFidelity to the intervention protocol, and including adaptations, time, and cost as well as the reasons why (qualitative).Pragmatic UseHOW consistently was the program delivered, how was it adapted, how much did it cost, and WHY did the results come about?Glasgow RE, Estabrooks PE. Pragmatic Applications of RE-AIM for Health Care... Prev Chronic Dis 2018;15:170271. DOI: http://dx.doi.org/10.5888/pcd15.17027
19. MAINTENANCETechnical DefinitionThe extent to which a program becomes institutionalized at the setting level or sustained at an individual level as well as the reasons why (qualitative).Pragmatic UseWHEN was the program operational and how long are the results sustained?Glasgow RE, Estabrooks PE. Pragmatic Applications of RE-AIM for Health Care... Prev Chronic Dis 2018;15:170271. DOI: http://dx.doi.org/10.5888/pcd15.17027
20. Administration for Community Living (Administration on Aging)Centers for Disease ControlNational Institutes for HealthRobert Wood Johnson FoundationRe-AIM in National Initiatives
21. From Vision to RealityDrawing on experience with the dissemination and implementation of chronic disease self-management programsCommon themes and frameworks across different public health issues—whether programs, policies, practices
22. Successes in Delivery and Outcome of chronic disease self-management programsOry MG, Smith ML, Patton K, Lorig K, Zenker W, and Whitelaw N. Self-Management at the Tipping Point: Reaching 100,000 Americans with Evidence-Based Programs. J Am Geriatr Soc. 2013; 61(5):821-823. Ory MG, Ahn S, Jiang L, Smith ML, Whitelaw N, Ritter P, and Lorig K. Successes of a National Study of the Chronic Disease Self-Management Program: Meeting the Triple Aim of Health Care Reform. Med Care. 2013; 51 (11): 992-998. Ory MG, Ahn S, Towne SD, and Smith ML., Chronic Disease Self-Management Education: Program Success and Future Directions. In ML Malone (ed.) Geriatrics Models of Care: Bringing ‘Best Practice’ to an Aging America, Springer International Publishing Switzerland. Forthcoming 2023+.100,000500,000+
23. 3 M’S TO SUCCESS
24. Building the EBP movementCDSMP research studies1999; 2001; 2013Evidence-based Programmatic Demonstrations (2003)American Recovery and Reinvestment Act (2009)Evidence-based requirement for use of Title III-D funding (2012) Continued Support for widespread dissemination of EBPs through aging services network
25. No need to start from scratchMany different programs testedGrowing inventory of evidence-based programsRated on implementation and dissemination factorsTraining and technical assistance availableHow to Get Started with EBPshttps://www.ncoa.org/evidence-based-programs
26. Early D&I Efforts in Aging Services SectorNCOA highly encouraged use of RE-AIM Model in their grantee programCould the aging services sector successfully employ a D&I Model in the field?Highlights:Key stakeholders reported perceived utilityHowever difficult to track all of the elements in the field
27. Recent RE-AIM ExampleDiabetes is a major problem in South TexasCan we deliver a culturally relevant practice-based DSME that will improve the health of underserved populations who often lack access to medical care?Who can make this happen…Part of Healthy South Texas initiativeOry MG, Lee S, Towne SD, Jr., Flores S, Gabriel O, and Smith ML. Implementing a Diabetes Education Program to Reduce Health Disparities in South Texas: Application of the RE-AIM Framework for Planning and Evaluation. Int Journal Environ Res Public Health. 2020; 17 (17): 6312.
28. Diabetes Education Program (DEP)Adults with diabetes living in South Texas 2015-2019ADA–recognized 12-month program involving 8 hours of in-person workshop education followed by quarterly follow-up sessionsDelivered by community-health workers and health educatorsReach EffectivenessAdoptionImplementationMaintenance
29. DEP ADAPTATIONSRe-envisioned as Making Moves with DiabetesStandardized and ManualizedShorter intervention time frameBoth virtual and in-person versionsAttention to getting and keeping participants in the programOutcomes even stronger…..It is critical to understand what works…and what doesn’t and adapt implementation strategies while adhering to essential intervention strategies
30. Set within a 3-C contextLive in ControlAdapted from two evidence-based diabetes self-management training programsKey adaptationsShortened intervention periodCulturally sensitive for minority populations Family-oriented supportLay-ledNewest ExpLoration: From compensatory actions to next generation interventions*
31. Common Misconceptions about RE-AIM
32. Mapping Strategies to RE-AIM Outcomes: More Than Evaluation
33. Understanding the How and Why of Intervention Effects
34. Advanced Consideration of Dimensions
35. Consideration of Maintenance Effects
36. 700+ articles2,400+ citationsNew content areas.Glasgow, RE, et al. Front Public Health. 2020;7, 64.Holtrop et al. BMC Health Serv Res. 2018 Mar 13;18(1):177.Gaglio et al. The RE-AIM Framework…AJPH. 2013;103:38-46How has RE-aIM Evolved Over 20 + Years
37. Evolution of RE-AIM: More Complexity and Creativity
38. Evolution of RE-AIMMerging of D&I modelsCombining RE-AIM with other models, especially Pragmatic, Robust, Implementation and Sustainability (PRISM) Model- to assess relevant contextual factors
39. RE-AIMExamining Health Equity issuesRE-AIM IssueDisparityOverall ImpactReach30%70% benefitEffectiveness 0 (equal)70% benefitAdoption 30%49% benefitImplementation30%34% benefitMaintenance30%24% benefitTake Home Message: Equity issues at EACH STAGE of RE-AIM
40. Examples of Health Equity Issues
41. Key disparity Issues by Re-AIM Dimensions
42. for ImpLogic Model for Implementation Research* *https://static1.squarespace.com/static/551c1b44e4b002dbe1feee84/t/5f74cc6ae733a60563e713f0/1601490076335/PSMG+2020+IRLM+FINAL.pdf
43. RE-AIM Outcomes Cascade
44. Evolution: Lessons Learned
45. Select a D&I framework that matches the study purpose, setting, and populationConsider combining different frameworks, as neededApply chosen framework throughout your research/proposalDocument adaptations before, during, and after implementationChose pragmatic D&I assessment measuresPlan sustainability upfront with the end-in-mindRE-AIM Use Tipshttps://dissemination-implementation.org/tool/; https://implementationscience.biomedcentral.com/articles/10.1186/1748-5908-7-96https://www.youtube.com/watch?v=W3r7HEAXJHghttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9260852/
46. Key RE-AIM ReferencesGlasgow RE, Vogt TM, Boles SM. Evaluating the public health impact…the RE-AIM framework. Am J Public Health. 1999 Sep;89(9):1322-7.Estabrooks PA, Glasgow RE. Translating effective clinic-based physical activity... Am J Prev Med. (2006) 31 (4 Suppl.):S45–56. doi: 10.1016/j.amepre.2006.06.019Shoup JA, et al. Network analysis of REAIM framework. Transl Behav Med. (2015) 5:216–32. doi: 10.1007/s13142-014-0300-1Ory MG, et al. Perceived utility of the RE-AIM framework…for older adults... Front Public Health. (2015) 2:143. doi: 10.3389/fpubh.2014.00143Gaglio B, Shoup JA, Glasgow RE. The RE-AIM framework: a systematic review of use over time. Am J Public Health. (2013) 103:e38–46.doi: 10.2105/AJPH.2013.301299 Harden, et al. Fidelity to and comparative results across behavioral interventions…: a systematic review. Syst Rev. (2015) 4:155. doi: 10.1186/s13643-015-0141-0Glasgow RE, Estabrooks PE. Pragmatic Applications of RE-AIM for Health Care... Prev Chronic Dis 2018;15:170271. DOI: http://dx.doi.org/10.5888/pcd15.170271Glasgow, RE, et al. (2019). RE-AIM Planning and Evaluation Framework: 20-Year Review. Front Public Health, 7, 64. doi:10.3389/fpubh.2019.00064Special issue on RE-AIM in Frontiers of Public Health in 2020: Contains >13 articles.
47. Additional Resources at www.re-aim.orgFAQ’sGuidance on applicationSearchable list of 700+ article abstracts.Calculators, checklists, tools.Webinars, upcoming events, blogs.
48. ccha.tamu.edu mory@tamu.edu https://re-aim.org/ Contact us
49. Questions or comments