Contextualizing the Proven Effectiveness of a Lifestyle Intervention for Type 2 Diabetes in Primary Care: A Qualitative Assessment Based on the RE-AIM Framework.

Implementing medicare education for medication access: A review of the literature using the RE-AIM framework.

Influenza and COVID-19 are significant vaccine-preventable causes of morbidity, mortality, and healthcare costs. Hospital-based, nurse-led models can increase vaccine uptake, yet few target adults. This study evaluates the implementation of an opportunistic patient influenza and COVID-19 vaccination program in the Central Coast Local Health District (CCLHD), led by Authorized Nurse Immunizers (ANIs). Evaluation of the ANI-led program was conducted using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework. The 10-week program involved screening patients for vaccine eligibility, offering vaccinations and collecting quantitative data and qualitative feedback across the five RE-AIM domains. Of 849 patients screened alongside service encounters, 398 were vaccinated with 76% of eligible patients consenting to flu and 59% to COVID-19 vaccination. Inpatients had lower vaccination rates on admission compared to the general population and higher rates after program contact. The program was well received by patients and staff and adopted across various CCLHD settings, effectively addressing community access barriers. Opportunistic vaccination using an ANI-led model is an effective strategy to improve vaccination coverage among higher-risk patients. This evaluation demonstrates the benefits of a dedicated nurse immunizer workforce and suggests potential for broader adoption in similar healthcare settings to improve public health outcomes.

BackgroundThe RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework is a reliable tool for the translation of research to practice. This framework has been widely applied to assess the impact of individual interventions. However, RE-AIM has rarely been used to evaluate implementation interventions, especially from multi-sector partnerships. The primary purpose of this paper is to operationalize the RE-AIM approach to evaluate large, multi-sector partnerships. SCI Action Canada, a community-university partnership aimed to promote physical activity among adults with spinal cord injury, is used as an example. A secondary purpose is to provide initial data from SCI Action Canada by using this conceptualization of RE-AIM.MethodsEach RE-AIM element is operationalized for multi-sector partnerships. Specific to SCI Action Canada, seven reach calculations, four adoption rates, four effectiveness outcomes, one implementation, one organizational maintenance, and two individual maintenance outcomes are defined. The specific numerators based on SCI Action Canada activities are also listed for each of these calculations.ResultsThe results are derived from SCI Action Canada activities. SCI Action Canada’s reach ranged from 3% (end-user direct national reach) to 37% (total regional reach). Adoption rates were 15% (provincial level adoption) to 76% (regional level adoption). Implementation and organizational maintenance rates were 92% and 100%, respectively.ConclusionsWe have operationalized the RE-AIM framework for larger multi-sectoral partnerships and demonstrated its applicability to such partnerships with SCI Action Canada. Future partnerships could use RE-AIM to assess their public health impact.

Evaluating the translatability and feasibility of an intervention program has become as important as determining the effectiveness of the intervention. To evaluate the applicability of a 3-month jump-landing training program in basketball players, using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework. Randomized controlled trial. National and regional basketball teams. Twenty-four teams of the second highest national division and regional basketball divisions in Flanders, Belgium, were randomly assigned (1:1) to a control group and intervention group. A total of 243 athletes (control group = 129, intervention group = 114), ages 15 to 41 years, volunteered. All exercises in the intervention program followed a progressive development, emphasizing lower extremity alignment during jump-landing activities. The results of the process evaluation of the intervention program were based on the 5 dimensions of the RE-AIM framework. The injury incidence density, hazard ratios, and 95% confidence intervals were determined. The participation rate of the total sample was 100% (reach). The hazard ratio was different between the intervention group and the control group (0.40 [95% confidence interval = 0.16, 0.99]; effectiveness). Of the 12 teams in the intervention group, 8 teams (66.7%) agreed to participate in the study (adoption). Eight of the participating coaches (66.7%) felt positively about the intervention program and stated that they had implemented the training sessions of the program as intended (implementation). All coaches except 1 (87.5%) intended to continue the intervention program the next season (maintenance). Compliance of the coaches in this coach-supervised jump-landing training program was high. In addition, the program was effective in preventing lower extremity injuries.

Evaluating a Multidisciplinary Model of Care for Inherited Bone Marrow Failure and Predisposition to Hematological Malignancy

IntroductionGlobally, tuberculosis (TB) remains one of the leading infectious causes of death, with 1.3 million deaths. Digital adherence technologies (DATs) have the potential to provide person-centred care and improve outcomes....

IntroductionExercise is Medicine (EIM) is an initiative that seeks to integrate physical activity assessment, prescription, and patient referral as a standard in patient care. Methods to assess this integration have lagged behind its implementation.Purpose and ObjectivesThe purpose of this work is to provide a pragmatic framework to guide health care systems in assessing the implementation and impact of EIM.Evaluation MethodsA working group of experts from health care, public health, and implementation science convened to develop an evaluation model based on the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. The working group aimed to provide pragmatic guidance on operationalizing EIM across the different RE-AIM dimensions based on data typically available in health care settings.ResultsThe Reach of EIM can be determined by the number and proportion of patients that were screened for physical inactivity, received brief counseling and/or a physical activity prescription, and were referred to physical activity resources. Effectiveness can be assessed through self-reported changes in physical activity, cardiometabolic biometric factors, incidence/burden of chronic disease, as well as health care utilization and costs. Adoption includes assessing the number and representativeness of health care settings that adopt any component of EIM, and Implementation involves assessing the extent to which health care teams implement EIM in their clinic. Finally, Maintenance involves assessing the long-term effectiveness (patient level) and sustained implementation (clinic level) of EIM in a given health care setting.Implications for Public HealthThe availability of a standardized, pragmatic, evaluation framework is critical in determining the impact of implementing EIM as a standard of care across health care systems.

Latinos bear a disproportionate burden of the dual pandemic of obesity and diabetes. However, successful interventions addressing this disparity through primary care are lacking. To address this gap, the 5-year Vida Sana (Healthy Life) study tests a culturally adapted and technology-enhanced group-based Diabetes Prevention Program intervention in a randomized controlled trial with overweight/obese Latino adults who have metabolic syndrome and/or pre-diabetes. Eligible, consenting patients (n=186) from a large community-based multispecialty group practice in Northern California will be randomly assigned to receive the culturally-adapted intervention or usual care. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework guided the planned evaluations. The primary aim is to determine the effectiveness of the intervention (the “E” in RE-AIM). We hypothesize that the intervention will lead to a greater mean reduction in weight at 24months (primary endpoint) vs. usual care. Secondary outcomes will include measures of cardiometabolic risk factors (e.g., blood pressure), psychosocial well-being (e.g., health-related quality of life), and behavior change (e.g., physical activity). The secondary aim is to evaluate the other RE-AIM dimensions using mixed methods: reach (e.g., participation rate of the target population), adoption (e.g., participating clinic and provider characteristics), implementation (e.g., intervention fidelity), and maintenance (e.g., sustainability in the practice setting). These findings have real word applicability with value to clinicians, patients, and other decision makers considering effective diabetes prevention programs for primary care that would support the millions of Latino adults who experience a disproportionate burden of diabetes.Trial registration: NCT02459691.

The physical activity levels of children in Australia are critically low and correlate with reduced academic achievement and poor health outcomes. Schools provide an ideal setting for physical activity interventions to help children move more. Instead of targeting in-service teachers, this study embedded an evidence-based active pedagogy program called Transform-Ed! into pre-service teacher education. Pre/post surveys and post-program interviews and focus group discussions were conducted with key stakeholders (n = 5), lecturers (n = 6), and pre-service teachers (n = 274) involved with the 12-week program. The design, implementation, and evaluation of the study were systematically guided by all five dimensions of Glasgow and colleagues’ RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework. Linear mixed models, descriptive analysis and a framework approach were used to analyse the data. Significant improvements were observed in pre-service teachers’ willingness, confidence, and competence to implement physically active pedagogic strategies following the intervention. Pre-service teacher perceived effectiveness of such strategies on student outcomes also significantly increased and perceived barriers decreased. High adherence was consistently reported and the program was maintained after completion of the implementation trial by all lecturers. Four key themes spanning multiple dimensions and participant levels informed recommendations for program scalability: an “inter-systemic approach”, a “co-design” approach, “embedded in professional practice”, and “evidence of impact” on teacher practice. Anchored in real-world settings and tethered by implementation science, Transform-Ed! could have the potential to advance the teaching capability of teachers, and transform the learning experience and physical and academic outcomes of primary school students.

Outdoor play has been described as essential for healthy childhood development. Lack of safety is one barrier to children participating in outdoor play. Play Streets are an intervention to help increase outdoor play by temporarily closing public streets (closures are recurring or episodic) to traffic, creating a safe place for active play. This systematic grey literature review aimed to examine and describe what is known about implementing Play Streets using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, which is widely used in implementation research. A systematic search for and review of nonacademic, or grey, literature was conducted using Academic Search Complete, Google Scholar, and a general Google search. Included literature was published in English, through December 2017, in nonacademic sources (ie, organizational/grant/municipal reports, newspapers, conference presentations, previous intervention advertisement materials, Web-based articles) or found in reference lists of academic articles about Play Streets, Pop-up Parks, or Open Streets/Ciclovías with a Play Street component. Resources were selected that documented Play Streets, which are defined as recurring or episodic temporary street closures to traffic that provide the public with a no-cost, safe space to actively play and be physically active. These approaches are designed primarily for youth and may include various marked play areas, loose equipment, and/or group activities. RE-AIM measures guided data extraction. Of the 36 articles composing the final sample, 100% reported on implementation, although the level of detail varied. Only 14 of 36 articles reported measures of effectiveness; limited information was provided for other RE-AIM components. In the grey literature, there are several inconsistencies in how the implementation of Play Streets is reported and level of detail. Specific details regarding implementing and evaluating Play Streets are needed to support widespread replication.

University Cooperative Extension, which may be the original rural Implementation Science model, holds great promise for translating research into practice and addressing rural health disparities. As this model not only requires successful collaboration between academic researchers and Extension Educators but also possible implementation adaptation to the context of Cooperative Extension and the environments in which they work, implementation research is critical to effective translation into practice and impact. This study was informed by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework describes Cooperative Extension Educators' implementation of the virtual Happy Healthy Homes interventions, a nutrition intervention and a children's environmental health intervention, for rural Family Child Care Home providers. Educators provided feedback on curricula, were trained and conducted the two virtual interventions with providers. Implementation of intervention activities and dose were recorded using REDCap. Virtual, structured interviews were conducted to assess Educators' intervention adoption, implementation, and maintenance. Transcribed interviews were analyzed for themes by two investigators and confirmed by a third. Results indicated that the majority the intervention curricula and activities were delivered as planned. Adoption themes included topical relevance to the community; toolkit provision and financial resource need; and need for additional marketing materials. Implementation themes included Educator's content expertise; learning environment distractions; and virtual delivery. Maintenance themes included transferability of content to multiple audiences; mission alignment; and Educator awareness. Overall, the implementation partnership with Extension Educators was successful. Virtual implementation was novel for Educators but considered to be positive and an opportunity for expanding future reach.

The adaptation and translation of the PEACH™ RCT intervention: the process and outcomes of the PEACH™ in the community trial

Globally, the population aged 65 years and over is increasing and with this growth comes a rising risk of chronic diseases that often require emergency care. Older adults living in Residential Aged Care Facilities (RACFs) have increased healthcare utilisation including visits to Emergency Departments (EDs). EDs are busy, noisy environments poorly suited to meeting the care needs of older adults. Older adults attending EDs often receive delayed and fragmented care, unnecessary procedures and tests and are at greater risk of iatrogenic complications. The Older Person’s Emergency Network Acute Outreach Service (OPEN AOS) based in Queensland, Australia, is a nurse-led, physician-supported model that provides ED substitution care to older adults living in RACFs. This paper outlines the OPEN AOS study protocol, which comprises three components and uses the integrated Practical, Robust, Implementation, and Sustainability Model (PRISM) and Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework to guide a comprehensive evaluation. The study comprises a pragmatic multi-methods design, consisting of three discrete yet related components. Component 1 is a retrospective, quasi-experimental design comparing outcomes for patients seen in the RACF by the OPEN AOS clinical team (intervention group) to standard ambulance attendance in the RACF resulting in transport to ED care (control group) between 1 July 2022 and 30 June 2023. Component 2 is a retrospective economic evaluation of the OPEN AOS model measuring the incremental cost per patient of OPEN AOS care compared to standard ambulance attendance resulting in transport to ED care. Component 3 adopts a prospective qualitative approach to explore and understand the contextual factors influencing implementation with the aim of informing effective delivery and supporting the potential scale and spread of the OPEN AOS model. The OPEN AOS model aims to deliver ED-substitution care in RACFs for older adults. This study will adopt a pragmatic approach to assess both outcomes and implementation processes, utilizing the integrated PRISM and RE-AIM frameworks for comprehensive evaluation. Findings will inform the design of similar models and guide health system decision-making for adopting approaches like the OPEN AOS model.

Midline qualitative evaluation of an integrated health, livelihood, agriculture, and conservation program: Application of the RE-AIM framework.

BackgroundRates of substance use disorders (SUDs) continue to rise in the USA with parallel rises in admissions to outpatient SUD treatment programs. Insomnia symptoms reduce treatment adherence, trigger relapse, and generally undermine SUD recovery efforts. Cognitive-behavioral therapy for insomnia (CBT-I) is the first-line treatment recommended for chronic insomnia. No study has examined the effectiveness of CBT-I for individuals who recently entered an outpatient SUD treatment program embedded within a therapeutic community (i.e., long-term drug-free residential setting).MethodsA randomized controlled trial conducted at a SUD program embedded in a therapeutic community aimed to compare group-based CBT-I (gCBT-I) (N = 10) with the standard of care (SOC) (N = 11) among individuals who have SUDs and comorbid insomnia. We present a RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework evaluation to provide empirical data on gCBT-I feasibility and facilitators and barriers of conducting an insomnia-focused clinical effectiveness study within a therapeutic community.ResultsParticipants in both study arms reported moderately severe insomnia symptoms at admission and reductions in insomnia symptoms over time. Among participants who completed the Insomnia Severity Index (ISI) beyond admission, ISI decreased to ≤ 8 (the clinical cutoff for mild insomnia) in 80% of individuals in the gCBT-I group compared with 25% of individuals in the SOC group. A RE-AIM framework evaluation showed initial success with Reach and Adoption while Implementation, and Maintenance were limited. Effectiveness was inconclusive because of challenges with recruitment, intervention integrity, and missing data that precluded meeting the planned recruitment and study aims and led to study termination. Coordination and communication with staff and leadership facilitated gCBT-I implementation, yet well-known CBT-I barriers including time- and resource-intensive sleep medicine training for interventionalists and maintenance of treatment integrity during an 8-week intervention limited gCBT-I sustainability.ConclusionsThis analysis supports the feasibility of conducting behavioral sleep medicine research in outpatient SUD treatment programs embedded within therapeutic communities. Implementation of an insomnia-focused intervention was widely accepted by patients and providers and has potential to address insomnia symptoms in early SUD recovery. Addressing patient- and organizational-level implementation barriers may enhance the sustainability and scalability of sleep interventions and provide new hope to effectively treat insomnia among people living with SUDs.Trial registrationClinicaltrials.gov: NCT03208855. Registered July 6, 2017https://clinicaltrials.gov/ct2/show/NCT03208855?term=NCT03208855&draw=2&rank=1