RE-AIM Plus To Evaluate Effective Dissemination of AHRQ CER Products

Slide presentation from the AHRQ 2011 conference.

On September 19, 2011, Michele Heisler made this presentation at the 2011 Annual Conference. Select to access the PowerPoint® presentation (2 MB). Plugin Software Help.


Slide 1

RE-AIM Plus To Evaluate Effective Dissemination of AHRQ CER Products

RE-AIM Plus To Evaluate Effective Dissemination of AHRQ Comparative Effectiveness Research (CER) Products

Michele Heisler, MD, MPA
September, 2011

Slide 2

Web-Based Tool to Facilitate Diabetes Medications Decision-making

Web-Based Tool to Facilitate Diabetes Medications Decision-making (AHRQ R18, Heisler)

iDecide:

  • Assessing the use of a Web-based, interactive, tailored decision tool in improving diabetes health outcomes.

Decido:

  • Evaluando el uso de un herramieta de decision en mejorar los resultados de la salud en pacientes con diabetes.

Slide 3

Definition of Tailoring

Definition of Tailoring

  1. Assess an individual's characteristics relevant to the behavior.
  2. Use assessment data to generate messages relevant to that individual's specific needs.
  3. Deliver these messages in a clear, vivid—and interactive—format.

Slide 4

iDecide

iDecide

  • Project description:
    • Community health worker (CHW)-delivered intervention to improve knowledge of diabetes medications among low-literacy, low-income adults (Latinos and African Americans) with poor glycemic control/reported medication problems.
  • 2 arms (n=210):
    • Control group: reviews the static, paper AHRQ patient guide with a CHW.
    • Intervention group: reviews the tailored, Web-based program with a CHW.

Slide 5

Goals of the Study

Goals of the Study

Aim 1: (Work together to) Build an interactive, tailored diabetes medication decision aid to help people:

  • Assess their treatment goals.
  • Identify personal preferences and concerns.
  • Understand options for improving their diabetes care (when appropriate).

Slide 6

Goals of the Study

Goals of the Study (continued)

Aim 2: Compare the tailored tool with the print AHRQ CER guides on participant:

  • Knowledge of medications.
  • Satisfaction with information.
  • Decisional conflict.

Slide 7

Goals of the Study

Goals of the Study (continued)

Aim 3: Look at how the tool affects:

  • Participant changes to medication.
  • Self-reported medication adherence.
  • Participant beliefs about medication.
  • A1c levels.

Slide 8

What Do Qualitative Methods Add to Implementation Evaluation?

What Do Qualitative Methods Add to Implementation Evaluation?

  • Use open-ended techniques, e.g., interviews, observation:
    • Goal is understanding, rather than measurement.
  • Get into the "black box":
    • Uncover the whys and hows behind quantitative measures.
    • Identify and understand implementation processes, how influenced by context and how affect implementation success.

Slide 9

Development of RE-AIM Plus

Development of RE-AIM Plus

  • Systematically review each RE-AIM dimension and create open-ended questions.
  • Add information sources and data analyses to address:
DimensionQuantitative MeasuresQualitative Inquiry
Reach  
Effectiveness  
Adoption  
Implementation  
Maintenance  

Slide 10

RE-AIM Plus: Reach

RE-AIM Plus: Reach

Quantitative Measures:

How many and what proportion of target population is being contacted and participating?

  • Measures:
    • # eligibles contacted/# eligibles.
    • # eligibles participating/# eligibles.
  • Use measures to track patient contact and participation.
  • Look at variation across sites.
  • Data Source:
    • Clinic data, recruitment, and activity data sets.

Qualitative Inquiry:

What explains variation across sites?
What are factors and processes underlying barriers to contacting patients and patient participation, and how do we address them?

Data Sources:

  • Semi-structured interviews with Key Informants.
  • Site visits and observations.
  • E-mails between stakeholders and research staff.

Slide 11

RE-AIM Plus: Effectiveness

RE-AIM Plus: Effectiveness

Quantitative Measures:

Evaluate effects of intervention on outcomes:

  • Measure:
    • Changes between baseline and follow-up in survey measures and A1cs.
  • Data Source:
    • Surveys and point-of-service A1cs.

Qualitative Inquiry:

Explain summative outcomes:

  • What are the conditions and mechanisms that lead to effectiveness?
  • Why did the intervention work? Why not?
  • What explains variation across sites?
  • What are factors and processes underlying barriers to implementation, and how did we address them?

Data Sources: All

Slide 12

RE-AIM PLUS: Implementation

RE-AIM PLUS: Implementation

Quantitative Measures:

Implementation:
Did CHWs use the decision aid with participants as anticipated?

  • Measures:
    • % of enrolled patients with decision aid session.
    • % of enrolled patients who received follow-up call.
    • % of enrolled patients who discussed questions/concerns with MDs.
  • Data Source:
    • Activity reports/Surveys.

Qualitative Inquiry:

Pre-implementation:
What are site-specific issues that might influence implementation? What modifications do we need to make and how do we make them?

Implementation:

  • What were the problems with key implementation processes?
  • What are the barriers to conducting the sessions, follow-up calls, MD discussions.

Data Sources: all

Slide 13

RE-AIM PLUS: Maintenance

RE-AIM PLUS: Maintenance

Quantitative Measures:

Is the program maintained after the study period?

Qualitative Inquiry:

  • Can the program be sustained after the study period?
  • What is the feasibility of retaining program-specific staff to continue the intervention?
  • What is the perception of program value among stakeholders?

Slide 14

Important Methods Considerations

Important Methods Considerations

Methods:

  • Effective procedures and instruments to systematically collect data.
  • Multiple data sources.
  • Data management system to facilitate data retrieval:
    • Including real time.

Slide 15

Concluding Thoughts

Concluding Thoughts

RE-AIM Plus:

  • Useful in generating context-specific and generalizable information on implementation.
  • Allows understanding of implementation mechanisms behind both process and outcome measures.
  • May improve ways to adapt implementation in real time and increase likelihood of success when interventions are disseminated.
Current as of March 2012
Internet Citation: RE-AIM Plus To Evaluate Effective Dissemination of AHRQ CER Products. March 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/events/conference/2011/heisler/index.html