3035 — Expanding the RE-AIM Framework to Enhance the Evaluation of Implementation in Real-Time

Forman JH (Ann Arbor Center for Clinical Management Research), Damschroder LD (Ann Arbor Center for Clinical Management Research), Kerr EA (Ann Arbor Center for Clinical Management Research)

Objectives:
Researchers seeking to improve adoption of effective heath care practices have recognized the importance of evaluating implementation processes in addition to intervention efficacy. Such formative evaluations increase the likelihood of successful implementation and promote dissemination across real-world settings. Glasgow’s RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, designed to better assess interventions’ translatability, contains process measures that allow retrospective assessments of how well interventions were implemented. We sought to expand the RE-AIM framework to allow for effective site-specific real-time implementation assessments and for retrospective identification of reasons for varying levels of success across sites.

Methods:
As part of an evaluation plan for a pharmacist-based multi-site intervention of hypertension management, we systematically reviewed each RE-AIM dimension, and created largely open-ended companion questions, along with qualitative and quantitative data sources, measures, and analyses to address these questions. While the original RE-AIM framework focused on quantitative measurement, the expanded framework added evaluations of the why and how behind these numbers. For example, for the Reach dimension, which measures the percent and representativeness of eligible patients who participated in the intervention, we added assessments of barriers to enrollment to better understand, in real time, the reasons for low participation rates and ways to address them.

Results:
We used the expanded RE-AIM framework to focus our data collection and analysis strategies for real-time pre-implementation evaluation in our multi-site intervention. It has provided an organizing framework to pro-actively identify barriers to implementation at each site, and which modifications were necessary in each context to improve fidelity. For example, in the implementation dimension, we learned through pre-implementation interviews that how patients received BP cuffs varied by site, and designed site-specific protocols so that intervention pharmacists could get cuffs to enrollees in a timely manner.

Implications:
Expansion of the RE-AIM framework may be useful in generating context-specific and generalizable information on implementation of interventions, thus improving ways to adapt implementation in real-time and to increase the likelihood of success when interventions are disseminated.

Impacts:
The expanded RE-AIM framework may be used by QUERI investigators across the VA system to improve implementation processes and dissemination.