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Enhancing Real-World Research: Understanding the RE-AIM Framework

Dive into the RE-AIM framework developed by Barbara Resnick, PhD, to improve reporting on implementation and real-world research. Learn about challenges and recommendations for Reach, Efficacy, Adoption, Implementation, and Maintenance components to ensure successful program outcomes. Explore the significance of reporting key data, measuring outcomes, and adapting interventions for long-term success.

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Enhancing Real-World Research: Understanding the RE-AIM Framework

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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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