Commentary on “Making Implementation Science More Rapid: Use of the RE-AIM Framework for Mid-Course Adaptations Across Five Health Services Research Projects in the Veterans Health Administration”

Jul 20,2020 | Lisa DiMartino Commentary

Continuing on the theme of adaptations in the time of COVID-19 featured in May’s newsletter, this month’s featured article is Glasgow and colleagues paper on using RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework as a guide for conducting mid-course assessments and obtain rapid feedback during health care implementation studies.1 

The authors provide a detailed and practical guide for using RE-AIM as an iterative tool that acknowledges intervention adaptations will happen along the way (whether intended or not), particularly in learning healthcare systems where change is often occurring in real-time.  They developed their methods for the tool across five diverse Veterans Health Administration improvement projects and engaged implementation project team members across all the projects throughout their process.  They discuss 3 major steps of this process: 1) first team meeting/preparation and discussion 2) ratings on the importance of and progress with the different RE-AIM dimensions and 3) second team meeting/review ratings and goal setting/action plans.  Project teams consisted of those involved closely with the implementation of the interventions (e.g., the PIs, project managers, research analysts, nurses, social workers).  The teams were found to rate Effectiveness, Reach, and Adoption as most important, and Maintenance as least important, but this varied depending on which phase the project was in.  However, Reach tended to be rated the lowest in terms of progress across the project teams.  As such, most teams selected to target Reach as the focus of their action plans.  All the teams thought the RE-AIM iterative tool was useful and feasible.  The authors conclude this process could be replicated in other settings and compared with other implementation science frameworks. 

In summary, this paper describes a novel use of RE-AIM which has typically been used either for evaluation after a study is complete or for program planning.  Of note, I wanted to highlight two other articles featured in this month’s newsletter that use RE-AIM.  Rutten and colleagues describe their Type 2 hybrid trial using RE-AIM to evaluate implementation of an electronic health record (EHR) facilitated cancer symptom control intervention, with a focus on identifying disparities in elderly patients and those living in rural areas. 2  They describe their processes for extracting RE-AIM metrics from the EHR to understand patient and clinician engagement with the intervention and qualitatively capturing RE-AIM domains through interviews with patients and care teams.  Similarly, Paniagua-Avila and colleagues also describe a Type 2 hybrid trial that uses the context-enhanced RE-AIM/Practical Robust Implementation and Sustainability (PRISM) framework to evaluate the implementation of an adapted multilevel hypertension control program in Guatemala.

As reflected in all these studies, RE-AIM can be applied in a myriad of ways.  How we can use RE-AIM and other frameworks (such as the Consolidated Framework for Implementation Research) going forward to understand how the current pandemic affects intervention implementation and adaptations across the healthcare system and communities will be an important area for implementation science in the months and years to come. 

Read the full abstract.

  1. 1. Glasgow, R. E., Battaglia, C., McCreight, M., Ayele, R. A., & Rabin, B. A. (2020). Making Implementation Science More Rapid: Use of the RE-AIM Framework for Mid-Course Adaptations Across Five Health Services Research Projects in the Veterans Health Administration. Front Public Health, 8, 194. doi:10.3389/fpubh.2020.00194
  2. 2. Finney Rutten, L. J., Ruddy, K. J., Chlan, L. L., Griffin, J. M., Herrin, J., Leppin, A. L., . . . Cheville, A. L. (2020). Pragmatic cluster randomized trial to evaluate effectiveness and implementation of enhanced EHR-facilitated cancer symptom control (E2C2). Trials, 21(1), 480. doi:10.1186/s13063-020-04335-w
  3. 3. Paniagua-Avila, A., Fort, M. P., Glasgow, R. E., Gulayin, P., Hernandez-Galdamez, D., Mansilla, K., . . . Irazola, V. (2020). Evaluating a multicomponent program to improve hypertension control in Guatemala: study protocol for an effectiveness-implementation cluster randomized trial. Trials, 21(1), 509. doi:10.1186/s13063-020-04345-8