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Understanding RE-AIM

Understanding RE-AIM. Barbara Resnick, PhD, CRNP, FAAN, FAANP. RE-AIM. The Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. 14 years old. The first RE-AIM publication was in the American Journal of Public Health in 1999.

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Understanding RE-AIM

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  1. Understanding RE-AIM Barbara Resnick, PhD, CRNP, FAAN, FAANP

  2. RE-AIM • The Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. • 14 years old. • The first RE-AIM publication was in the American Journal of Public Health in 1999. • The model grew out of need for improved reporting on key issues related to implementation/real world research. • Driven by work and teams within the BCC.

  3. Definition of RE-AIM Components

  4. Definition of RE-AIM Components

  5. Challenges/Recommendations for Reach • Not reporting characteristics of participants compared with nonparticipants. • Not reporting on recruitment methods and implicit “screening/selection.” • Not reporting on a “valid denominator.” • Report on any criteria you can, even if it is just 1 characteristic.

  6. Challenges/Recommendations for Efficacy • Not reporting measurement of short-term or differential rates by participant characteristic or treatment group. • Not reporting on broader effects (e.g., quality of life or unintended consequences). • Measure of primary outcome relative to public health goal. • Reporting of short-term loss to follow-up can easily be added to CONSORT figures. • Use national guidelines (Healthy People 2020).

  7. Adoption • Not reporting percent of settings approached that participated based on a valid denominator. • Not reporting recruitment of setting details and exclusion criteria (e.g., only picking optimal sites). Use of a valid denominator at the setting level can be challenging. • Use any information you can. • At minimum, report the sampling frame from which your settings were selected and percentage of participation.

  8. Implementation • Not reporting adaptations made to interventions during study. • Not reporting on costs and resources required. • Not reporting differences in implementation or outcomes by different staff. • Report any changes that made the intervention easier to delivery or to fit into real world settings. • Remember, this is not the same as fidelity.

  9. Maintenance • Not reporting results of long-term broader outcomes, such as quality of life or unintended outcomes. • Reporting broader outcomes provides a context in which to evaluate the long-term primary outcome results.

  10. Results • Reach: • 300 settings invited: 99 sites (33%) volunteered and 38 attended the initial face-to-face (28% of sites). Potentially impacted 3,676 older adults.

  11. Efficacy : Descriptive Outcomes at Baseline and Follow up

  12. RE-AIM Results • Adoption : 21 settings (21%) did not participate. • Implementation : all components implemented in 79 sites. Did not consider costs. • Maintenance: through 12 months positive qualitative findings; enduring environment and policy changes.

  13. Challenges/Opportunities Identified With Regard to Dissemination and Implementation Work • Have to be flexible and meet the needs of each setting (ex. We revised materials for them; wrote policies) • Utilize measures that are practical and real world (ex. falls and hospitalizations versus actigraphy) • Have to have champion and site buy in

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