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
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
- 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
Reach
- Participation rates.
- Representativeness among the sampling frame of patients with diabetes.
Strengths:
- Telephonic delivery.
Challenges:
- Community realities—"bring a neighbor".
- Denominators.
Slide 4
Reach
- HIGH.
Slide 5
Efficacy/Effectiveness:
- Design: RCT.
- Outcomes:
- Primary:
Metabolic control (A1c, BP, chol).
Functional status. - Secondary:
Self-care behaviors.
Cost.
- Primary:
Strengths:
- Community setting—representativeness/effectiveness.
- One-on-one, potent intervention.
- DVD component.
Challenges:
- Community-member delivered—intervention fidelity.
Slide 6
Effectiveness
- MED-HIGH.
Slide 7
Adoption:
- More speculative (!).
- Cost.
- Requires new resources?
Strengths:
- Low-cost.
Challenges:
- No infrastructure to sustain program (Healthcare Reform?).
Slide 8
Adoption
- LOW (MED?).
Slide 9
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
Implementation
- LOW (MED?).
Slide 11
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
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
Maintenance
- MED.
Slide 14
RE-AIM for iADAPT?
| R | E | A | I | M | Audience(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 | Med | Med | Med | Med | Med | Patient | Heart Disease |
Slide 15
RE-AIM for iADAPT?
| R | E | A | I | M | Audience(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 | Med | Med | Med | Med | Med | Patient | Heart Disease |
Note: The row beginning "CHW Outreach" is circled.
Slide 16
RE-AIM for iADAPT?
| R | E | A | I | M | |
|---|---|---|---|---|---|
| In Person CHW Outreach | Med | Med | Low | Low | Low |
| CHW Telephonic Outreach | High | Med (High?) | Low (Med?) | Low (Med?) | Med |
Slide 17
RE-AIM for iADAPT?
- CER's.
- "Arm chair quarterbacking".
- Comparison framework:
- e-VALUE-ation.
- QALYs?
