Using RE-AIM to Evaluate Encourage-2: A Cluster-randomized Trial in Rural Alabama Funded under the iADAPT Opportunity

Slide Presentation from the AHRQ 2011 Annual Conference

Slide 1

Using RE-AIM to Evaluate Encourage-2: A Cluster-randomized Trial in Rural Alabama Funded under the iADAPT Opportunity

Using RE-AIM to Evaluate Encourage-2: A cluster-randomized trial in rural Alabama funded under the iADAPT opportunity

Monika M. Safford, MD
University of Alabama at Birmingham

September 19, 2011
AHRQ Annual Conference, 2011
iADAPT Grantee Session

Slide 2

Community Health Workers (CHW) to improve functioning in diabetes + chronic pain

Community Health Workers (CHW) to improve functioning in diabetes + chronic pain

  • Pain is common in diabetes:
    • 60-80% persons with diabetes report chronic pain.
    • Osteoarthritis (OA) most common cause.
  • Pain is a barrier to self-care.
  • Cluster-randomized controlled trial (RCT), rural Alabama:
    • Participants: adults w. diabetes + chronic pain.
    • Intervention:
      • CHW-delivered telephone + DVD.
      • Cognitive behavior training to maximize functioning despite pain.
      • Diabetes self-care.
      • Comparative Effectiveness Reviews (CERs): OA, diabetes; integrated into education/training program content.
    • Outcomes: risk factors (A1c, BP, chol), functional status.

Slide 3

RE-AIM for iADAPT in Rural Alabama

Reach

  • Participation rates.
  • Representativeness among the sampling frame of patients with diabetes.

Strengths:

  • Telephonic delivery.

Challenges:

  • Community realities—"bring a neighbor".
  • Denominators.

Slide 4

RE-AIM for iADAPT in Rural Alabama

Reach

  • HIGH.

Slide 5

RE-AIM for iADAPT in Rural Alabama

Efficacy/Effectiveness:

  • Design: RCT.
  • Outcomes:
    • Primary:
      Metabolic control (A1c, BP, chol).
      Functional status.
    • Secondary:
      Self-care behaviors.
      Cost.

Strengths:

  • Community setting—representativeness/effectiveness.
  • One-on-one, potent intervention.
  • DVD component.

Challenges:

  • Community-member delivered—intervention fidelity.

Slide 6

RE-AIM for iADAPT in Rural Alabama

Effectiveness

  • MED-HIGH.

Slide 7

RE-AIM for iADAPT in Rural Alabama

Adoption:

  • More speculative (!).
  • Cost.
  • Requires new resources?

Strengths:

  • Low-cost.

Challenges:

  • No infrastructure to sustain program (Healthcare Reform?).

Slide 8

RE-AIM for iADAPT in Rural Alabama

Adoption

  • LOW (MED?).

Slide 9

RE-AIM for iADAPT in Rural Alabama

Implementation:

  • Low complexity: high.
  • Sustainable intervention fidelity: high.

Strengths:

  • Cultural concordance lowers complexity.
  • Telephone.

Challenges:

  • Community interventionists increase complexity.
  • Training needs.
  • Reliance on tenuous infrastructure (Healthcare Reform?).

Slide 10

RE-AIM for iADAPT in Rural Alabama

Implementation

  • LOW (MED?).

Slide 11

RE-AIM for iADAPT in Rural Alabama

Maintenance:

  • Individual:
    • What is f/u?
    • Do social networks form?
    • Is tailoring required?
  • System:
    • Does motivation for intervention reside in community-based organization?
    • Outreach via telephone: low cost, flexible (reimbursement?).

Slide 12

RE-AIM for iADAPT in Rural Alabama

Maintenance:

  • Strengths:
    • Social networks?
    • Telephone delivery.
  • Challenges:
    • No structure for sustained f/u (Healthcare Reform?).
    • Motivation for intervention does not reside in community-based organization.

Slide 13

RE-AIM for iADAPT in Rural Alabama

Maintenance

  • MED.

Slide 14

RE-AIM for iADAPT?

RE-AIM for iADAPT?

 REAIMAudience(s)Clinical Area(s)
In Person
CHW Outreach
Acad. Detailing
Med
Med
Med
Med
Low
Low
Low
Low
Low
Med
Patient
Provider
Diabetes
Diabetes
Group
CER Training
School
Group Therapy
Med
High
Low
Low
Low
Med
Med
Med
Med
Med
Low
Low
Med
Low
Med
Policy
Patient
Patient
Multiple
Heart Disease
Diabetes
eHealth
Clinic Kiosk
Web Patient Portal
Med
Med
Med
Med
Low
Med
High
High
Med
High
Patient
Patient &
Provider
Diabetes
Diabetes
Print/Media
Targeted Video
MedMedMedMedMedPatientHeart Disease

 

Slide 15

RE-AIM for iADAPT?

RE-AIM for iADAPT?

 REAIMAudience(s)Clinical Area(s)
In Person
CHW Outreach
Acad. Detailing
Med
Med
Med
Med
Low
Low
Low
Low
Low
Med
Patient
Provider
Diabetes
Diabetes
Group
CER Training
School
Group Therapy
Med
High
Low
Low
Low
Med
Med
Med
Med
Med
Low
Low
Med
Low
Med
Policy
Patient
Patient
Multiple
Heart Disease
Diabetes
eHealth
Clinic Kiosk
Web Patient Portal
Med
Med
Med
Med
Low
Med
High
High
Med
High
Patient
Patient &
Provider
Diabetes
Diabetes
Print/Media
Targeted Video
MedMedMedMedMedPatientHeart Disease

Note: The row beginning "CHW Outreach" is circled. 

Slide 16

RE-AIM for iADAPT?

RE-AIM for iADAPT?

 REAIM
In Person
CHW Outreach
MedMedLowLowLow
CHW Telephonic OutreachHighMed (High?)Low (Med?)Low (Med?)Med

Slide 17

RE-AIM for iADAPT?

RE-AIM for iADAPT?

  • CER's.
  • "Arm chair quarterbacking".
  • Comparison framework:
    • e-VALUE-ation.
  • QALYs?
Page last reviewed March 2012
Internet Citation: Using RE-AIM to Evaluate Encourage-2: A Cluster-randomized Trial in Rural Alabama Funded under the iADAPT Opportunity. March 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/events/conference/2011/safford/index.html