AUTHOR=Glasgow Russell E. , Battaglia Catherine , McCreight Marina , Ayele Roman , Maw Anna M. , Fort Meredith P. , Holtrop Jodi Summers , Gomes Rebekah N. , Rabin Borsika Adrienn 

TITLE=Use of the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework to guide iterative adaptations: Applications, lessons learned, and future directions

JOURNAL=Frontiers in Health Services

VOLUME=Volume 2 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/health-services/articles/10.3389/frhs.2022.959565

DOI=10.3389/frhs.2022.959565

ISSN=2813-0146

ABSTRACT=Introduction: Implementation science frameworks have been used widely for planning and evaluation, but seldom to guide adaptations during program implementation. There is great potential for these frameworks to be used to inform conceptual and data-driven decisions about adaptations.

Methods: We summarize recent applications using Iterative RE-AIM (IR) to capture and guide adaptations. IR can be repeated at multiple time points customized to each project and involves the following activities: identification of key implementation partners; rating importance of and progress on each RE-AIM dimension (reach, effectiveness, adoption, implementation, and maintenance); use of summary data on ratings to identify one or two RE-AIM dimensions for adaptations and implementation strategies; and evaluate progress and impact of adaptations. We summarize recent and ongoing IR applications across multiple care coordination and pain management projects within the Veterans Health Administration, a hypertension control trial in Guatemala, a hospital-based lung ultrasound implementation pilot, a colorectal cancer screening program in underserved communities, and a primary care weight loss study.  

Results: IR appears feasible, helpful, and broadly applicable across diverse health care issues, interventions, contexts, and populations. In general, the RE-AIM dimension showing the largest gap between importance and progress has been Reach. The dimensions most frequently selected for improvement have been Reach and Implementation We discuss commonalities, differences and lessons learned across these various applications of IR. Challenges include having objective real time data on which to make decisions, having key implementation staff available for all assessments, and rapidly scoring and providing actionable feedback. We discuss print and online resources and materials to support IR. 

Conclusions: The use of IR to guide and support understanding of adaptations has proven feasible across diverse projects, but there are still questions about its strengths, limitations, essential components, efficiency, and delivery details. Future directions include investigating the optimal frequency and timing for iterative applications; adding contextual assessments; developing more continuous and rapid data on which to make adaptation decisions; identifying opportunities to enhance health equity; and determining the level of facilitation that is most cost-effective.