Pubic Healt

RE-AIM component

Meaning

Example

How well does the intervention work in practice?

Reach

Asks: Who is the intervention being applied to in practice? May be groups or populations that are different than those on which it was investigated or intended for, i.e., the target population.

New prescription smoking cessation drug along with behavioral intervention approved by FDA and given evidence-based rating of A for long-standing adult smokers. Adverse events include rare depression and liver disease that is reversible with cessation of medication. In practice, being used for short-term smokers and teenagers who experience increased incidence of suicidal ideas.

Effectiveness

Asks: What is the impact in practice on the intended or target population, including beneficial outcomes as well as harm?

When used for long-term adult smokers, follow-up studies demonstrate substantial long-term quit rates similar to those observed in randomized controlled trials with no serious adverse events not identified in preapproval studies. Benefits far exceed harms when used on intended target population.

How well is the intervention accepted in practice?

Adoption

Asks: How well is the intervention accepted by individuals and providers of services?

The drug is being widely used for long-term adult smokers. The drug is also being widely used for teenagers.

Implementation

Asks: How should the intervention be modified to reach target population and providers of services, but not those for whom the benefits do not exceed the harms?

A “black box” warning is placed on the prescribing information, warning clinicians of the potential suicide risk when used for teenagers.

Maintenance

Asks: How can we ensure long-term continuation of use and success of intervention among individuals and providers of services?

Long-term use of smoking cessation drug is needed and is encouraged by coverage by health insurance plans.

1.   Problem—What is the health problem?

•   What is the burden of a disease or other health problem?

•   What is the course of a disease or other health problem?

•   Does the distribution of the health problem help generate hypotheses?

2.   Etiology—What are the contributory causes?

•   Has an association been established at the individual level?

•   Does the “cause” precede the “effect”?

•   Has altering the “cause” been shown to alter the “effect”? (If not, use ancillary criteria.)

3.   Recommendations—What works to reduce the health impacts?

•   What is the quality of the evidence for the intervention?

•   What is the impact of the intervention in terms of benefits and harms?

•   What grade should be given to indicate the strength of the recommendation?

4.   Implementations—How can we get the job done?

•   When should the implementation occur?

•   At whom should the implementation be directed?

•   How should the intervention(s) be implemented?

5.   Evaluation—How well does the intervention work in practice?

•   How well does the intervention work in practice on the intended or target population?

•   How well does the intervention work in practice as actually used?

•   How well is the intervention accepted in practice?