Article Figures & Data
Tables
- Table 1.
Frequent Issues in Primary Care Research, with Efficacy and Dissemination and Implementation Science (DIS) Approaches to These Issues
Content Issue Efficacy Approach DIS Approach and Framework Considerations Multi-level context of problems and programs One-level model. Focus is 1:1, patient-provider, or family to health care team only Multi-level model including individual, organizational and health system levels. Consider CFIR or PRISM and mixed methods context assessments Representativeness (at multiple levels) and Reach Often not addressed or considered to be not possible to assess or influence RE-AIM framework focus on adoption, settings, and representativeness Program selection, innovation design, and feasibility Select maximally effective or most comprehensive program regardless of other factors Emphasis on feasibility, costs, minimum intervention needed for change (MINC)73 Variability and adaptation—across sites and over time Considered bad; poor fidelity likely means poor results; hard to standardize Inevitable, need to study and guide appropriate adaptation to context Sustainability and dissemination of program or innovation Think about this only at conclusion of evaluation “Design for Dissemination” from outset of the study CFIR, consolidated framework for implementation research; MINC, minimum intervention needed for change; PRISM, practical, robust implementation science model; RE-AIM, reach, effectiveness, adoption, implementation, maintenance.
- Table 2.
Planning Questions for Primary Care Interventions Intended to Produce Clinical Impact Using the RE-AIM Framework
RE-AIM Element and Definition* Core Questions Supplemental and Probe Questions Reach: The absolute number, proportion, and representativeness of individuals who are willing to participate in a given initiative Who will benefit from the initiative? Individuals (e.g., students, employees, patients, kids, parents, community members) Whom do you plan to reach in your initiative? Can you define the target population(s)? How or where will you reach them? How will you advertise and promote the program? Who needs to approve these methods? How will you know if you reached them and who participated? Will you reach those at higher risk or with fewer resources? How will you know? Effectiveness: The impact of an intervention on important outcomes, including potential negative effects, quality of life, and economic outcomes. What are the most important outcomes you expect to see? Individuals (e.g., more physical activity, better quality of life, less bullying, less absenteeism, less drug use) How likely is it that your initiative will achieve its key outcomes? What are the biggest threats to seeing the outcomes you want? How will you know if the outcomes were achieved? What measures will be used? Who will care about the outcomes? What unintended consequences or outcomes might there be (positive or negative)? What has gone wrong in other similar initiatives? What has gone well that wasn't anticipated? Adoption: The absolute number, proportion, and representativeness of settings and intervention agents who are willing to initiate a program. In what settings do you want to participate? Settings or organizations (e.g., uptake in worksites, schools, clinics, health departments, community organizations) What kinds of setting or organizations will need to participate in the program or policy initiative? Who will care about this? How will the intended audience hear about this? Why will they want to participate? What is needed to encourage them to get engaged? Who will deliver the program or policy (actually do the work) and do they have the skills and time? Who is willing to help? What skill sets are needed? Why might staff and volunteers want to participate? How many of these settings and organizations do you estimate will use the program or participate in your policy? What supports (for example, policies or similar programs) or threats are there? How will you know if organizations used the initiative? Who can help gather information about this? What is needed to train volunteers and who will do this? Implementation: At the setting level, implementation refers to the intervention agents' fidelity to the various elements of an intervention's protocol. This includes consistency of delivery as intended and the time and cost of the intervention. How will the initiative be delivered, including adjustments and adaptations? Settings or organizations (e.g., schools, workplaces, clinics, community settings or organizations) To what extent will the key aspects of the program or policy be delivered as intended? What are the key elements of the initiative that must be delivered to be successful? Which ones are less important for success? What adaptations or modifications do you think are necessary to help implement the initiative in your chosen settings? What are likely implementation challenges you will need to overcome? How might you adapt to address these? How will you know what adaptations or modifications were made during the program? Who can help you keep track of modifications or adjustments made? What are some of the possible obstacles to implementation? Are there competing projects or programs to consider? What costs (including time and burden, not just money) need to be considered? Are these costs and resources available and reasonable to ask for (high enough priority?) How will you keep track of implementation? Who will do this and is this feasible? Maintenance: The extent to which a program or policy becomes institutionalized or part of the routine organizational practices and policies. Maintenance in the RE-AIM framework also has referents at the individual level. At the individual level, maintenance has been defined as the long-term effects of a program on outcomes after 6 or more months after the most recent intervention contact. What will happen over the long term? [including dissemination] Individuals and Settings (e.g., sustained infrastructure; longer term benefits to children, employees, patients, students,) Can organizations sustain the initiative over time and are there plans to leave trained staff in place? What infrastructure will be needed to sustain the initiative? Is there an infrastructure and funding that will remain? How likely is your initiative to produce lasting effects for individual participants? How will individuals be delivered key program components over time? Will they stay in contact? How will you be able to follow your initiative for an extended period of time? How will you continue to track its success and provide ongoing feedback? “How's it working for you?” How will you get the word out about your product and lessons learned? What easy to understand materials can you produce to tell others about your lessons learned? How will you know that they are effective and reaching your audience? What are likely modifications or adaptations that will need to be made to sustain the initiative over time (e.g. lower cost, different staff, reduced intensity, different settings)? How can you track the major changes made over time? ↵* RE-AIM.org.
Table adapted from the UPSTREAM evaluation program funded by the Colorado Health Foundation and the Evaluation Hub of the University of Colorado Department of Family Medicine; Also adapted from “RE-AIM: Rate Your Plan Exercise” and the “RE-AIM: Extended Consort Diagram”; and elements from PRISM.
In this issue
Jump to section
- Article
- Abstract
- Dissemination and Implementation Science—What It Is and What It Can Do for Primary Care
- DIS Models for Primary Care Practice and Research
- Case Studies: Using a DIS Approach
- Key Issues and Future Directions
- Where to Begin? Learning Steps and Resources
- Conclusion
- Appendix: Dissemination and Implementation Science Key Resources
- Notes
- References
- Figures & Data
- References
- Info & Metrics
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