Many grant proposals identify the use of a given evaluation model or framework but offer little about how such models are implemented. The authors discuss what it means to employ a specific model, RE-AIM, and key dimensions from this model for program planning, implementation, evaluation, and reporting. The authors report both conceptual and content specifications for the use of the RE-AIM model and a content review of 42 recent dissemination and implementation grant applications to National Institutes of Health that proposed the use of this model. Outcomes include the extent to which proposals addressed the overall RE-AIM model and specific items within the five dimensions in their methods or evaluation plans. The majority of grants used only some elements of the model (less than 10% contained thorough measures across all RE-AIM dimensions). Few met criteria for "fully developed use" of RE-AIM and the percentage of key issues addressed varied from, on average, 45% to 78% across the RE-AIM dimensions. The results and discussion of key criteria should help investigators in their use of RE-AIM and illuminate the broader issue of comprehensive use of evaluation models.

Primary care is increasingly geared toward standardized care and decision-making for common chronic conditions, combinations of medical and mental health conditions, and the behavioral aspects of care for those conditions. Yet even with well-integrated team-based care for health conditions in place, some patients do not engage or respond as well as clinicians would wish or predict. This troubles patients and clinicians alike and is often chalked up informally to "patient complexity." Indeed, every clinician has encountered complex patients and reacted with "Oh my gosh"-but not necessarily with a patterned vocabulary for exactly how the patient is complex and what to do about it. Based on work in the Netherlands, patient complexity is defined here as interference with standard care and decision-making by symptom severity or impairments, diagnostic uncertainty, difficulty engaging care, lack of social safety or participation, disorganization of care, and difficult patient-clinician relationships. A blueprint for patient-centered medical home must address patient complexity by promoting the interplay of usual care for conditions and individualized attention to patient-specific sources of complexity-across whatever diseases and conditions the patient may have.

The health care system in the United States, plagued by spiraling costs, unequal access, and uneven quality, can find its best chance of improving the health of the population through the improvement of behavioral health services. It is in this area that the largest potential payoff in reduction of morbidity and mortality and increased cost-effectiveness of care can be found. A review of the evidence shows that many forms of behavioral health services, particularly when delivered as part of primary medical care, can be central to such an improvement. The evidence supports many but not all behavioral health services when delivered in settings in which people will accept these services under particular administrative and fiscal structures.Keywords: economics, cost offset, behavioral health, psychology, medical settings ALEXANDER BLOUNT received his EdD in counseling from the University of Massachusetts at Amherst. He is professor of clinical family medicine at the University of Massachusetts Medical School and director of behavioral science in the Department of Family Medicine and Community Health. He is chair of the Collaborative Family Healthcare Association. His areas of professional interest include the integration of behavioral health services into primary care settings and the training of primary care psychologists and family medicine residents. MICHAEL SCHOENBAUM received his PhD in economics from the University of Michigan. He is a researcher for the RAND Corporation. His interests include analyses of the Palestinian health system, identification of policy options for improving clinical performance and economic viability in health care, economic analyses for national trials to improve care for depression, and Web-based modeling and decision-support tools to help consumers make health benefits choices. ROGER KATHOL received his MD from the University of Kansas School of Medicine. He completed an internship in internal medicine at Good Samaritan Hospital in Phoenix, Arizona; residencies in psychiatry and internal medicine at the University of Iowa in Iowa City; and a year of endocrinology fellowship in Wellington, New Zealand. He is adjunct professor of internal medicine and psychiatry at the University of Minnesota Medical School. He has extensive experience in the integration of general medical and behavioral health care. He has international expertise in the development and operation of cross-disciplinary programs and services for clinics and hospitals; health plans; software vendors; case, disease, and disability management organizations; employee assistance programs; and employers. BRUCE L. ROLLMAN received his MD from Jefferson Medical School and his MPH from Johns Hopkins Medical School. He is an associate professor of medicine and psychiatry at the Center for Research on Health Care at the University of Pittsburgh. He is involved with the planning and implementation of clinical trials to improve the quality of treatment for depression and anxiety disorders in primary care settings and for patients wi...

Using multivariate statistics (6th ed.). Upper Saddle River, NJ: Pearson.

Research often fails to find its way into practice or policy in a timely way, if at all. Given the current pressure and pace of health care change, many authors have recommended different approaches to make health care research more relevant and rapid. An emerging standard for research, the "5 R's" is a synthesis of recommendations for care delivery research that (1) is relevant to stakeholders; (2) is rapid and recursive in application; (3) redefines rigor; (4) reports on resources required; and (5) is replicable. Relevance flows from substantive ongoing participation by stakeholders. Rapidity and recursiveness occur through accelerated design and peer reviews followed by short learning/implementation cycles through which questions and answers evolve over time. Rigor is the disciplined conduct of shared learning within the specific changing situations in diverse settings. Resource reporting includes costs of interventions. Replicability involves designing for the factors that may affect subsequent implementation of an intervention or program in different contexts. These R's of the research process are mutually reinforcing and can be supported by training that fosters collaborative and reciprocal relationships among researchers, implementers, and other stakeholders. In sum, a standard is emerging for research that is both rigorous and relevant. Consistent and bold application will increase the value, timeliness, and applicability of the research enterprise. THE NEED FOR RELEVANT RESEARCH IN A RAPIDLY CHANGING HEALTH CARE WORLDA ccelerated pressure for change in health care creates an exploding need for relevant and rapidly generated new information. A growing volume of care delivery experiments around the country pose questions that research can help answer: Which interventions or system changes improve care, access, safety, or quality-and for which populations, under what conditions? Which system changes reduce underuse, overuse, or misuse? Which approaches are implementable and engaging to clinicians and patients-and can be done at reasonable cost? 1,2 Evolving clinical, organizational, and business models for health care, such as patient-centered medical homes 3 and accountable care organizations 4 need rapidly generated research evidence in real-world experiments for multiple stakeholders: implementers who want to improve their practices; purchasers who want to pay for value; health plans that administer benefits and take risks for care provided; policy makers who are being asked to change "the rules of the game" to support new approaches; patients who wish to know their care is effective, safe, and worth their effort and money; and public health, community groups, and agencies who wish to see improved health at a societal level. 5,6 The current research approach is not up to this challenge. Most recent research is slow to influence practice, does so only in pockets, or does not address practical needs for decision making. [7][8][9] Innovative ideas to remedy this situation have been proposed and so...