Applying the RE-AIM framework to the Alberta's Caring for Diabetes Project: a protocol for a comprehensive evaluation of primary care quality improvement interventions

Abstract

IntroductionDiabetes represents a major public health and health system burden. As part of the Alberta's Caring for Diabetes (ABCD) Project, two quality-improvement interventions are being piloted in four Primary Care Networks in Alberta. Gaps between health research, policy and practice have been documented and the need to evaluate the impact of public health interventions in real-world settings to inform decision-making and clinical practice is paramount. In this article, we describe the application of the RE-AIM framework to evaluate the interventions beyond effectiveness.Methods and analysisTwo quality-improvement interventions were implemented, based on previously proven effective models of care and are directed at improving the physical and mental health of patients with type-2 diabetes. Our goal is to adapt and apply the RE-AIM framework, using a mixed-methods approach, to understand the impact of the interventions to inform policy and clinical decision-making. We present the proposed measures, data sources and data management and analysis strategies used to evaluate the interventions by RE-AIM dimension.Ethics and disseminationEthics approval for the ABCD Project has been granted from the Health Research Ethics Board (HREB #PRO00012663) at the University of Alberta. The RE-AIM framework will be used to structure our dissemination activities by dimension.ResultsIt will be presented at relevant conferences and prepared for publication in peer-reviewed journals. Various products, such as presentations, briefing reports and webinars, will be developed to inform key stakeholders of the findings. Presentation of findings by RE-AIM dimension will facilitate discussion regarding the public health impact of the two interventions within the primary care context of Alberta and lessons learned to be used in programme planning and care delivery for patients with type-2 diabetes. It will also promote the application of evaluation models to better assess the impact of community-based primary healthcare interventions through our dissemination activities.

Cost-Effectiveness Evaluation of Collaborative Care for Diabetes and Depression in Primary Care

“…15 As suggested by Glasgow et al's 16 RE-AIM (reach, efficacy, adoption, implementation, and maintenance) framework, as part of an a priori comprehensive evaluation of this quality improvement intervention, the cost effectiveness of the intervention was evaluated from the health system perspective. 15,17 Two cost-effectiveness analyses were conducted, based on depression-free days (DFDs) (primary analysis) and qualityadjusted life years (QALYs; secondary analysis) gained. Both analyses were conducted from a public payer perspective; thus, the direct costs of hospital and medical provider services were incurred by Alberta Health and Alberta Health Services, the provincial ministry and single health authority, respectively.…”

Challenges in Identifying Patients with Type 2 Diabetes for Quality-Improvement Interventions in Primary Care Settings and the Importance of Valid Disease Registries

“…We recently needed to rely upon valid disease registries to identify patients with type 2 diabetes so as to implement 2 qualityimprovement interventions in 4 nonmetro Primary Care Networks (PCNs) as part of the Alberta's Caring for Diabetes (ABCD) project (8). The interventions focused on lifestyle counselling (9) and mental health improvement (10), and both were shown to be effective in Alberta's PCN setting (11,12).…”

Collaborative Care Versus Screening and Follow-up for Patients With Diabetes and Depressive Symptoms: Results of a Primary Care–Based Comparative Effectiveness Trial

“…Our study design and rationale have been previously published (22,23). Our intervention was an adaptation of a nurse-led collaborative care model previously proven effective in randomized controlled trials in U.S. health maintenance organizations (24,25).…”

“…Irrespective of trial participation, all patients with type 2 diabetes in the province were potentially eligible for our concurrent ABCD Cohort Study (23). ABCD cohort respondents completed a written questionnaire with self-reported measures that overlapped the measures in the TEAMCare study, including the PHQ8 (30).…”

“…We chose to evaluate this model using a pragmatic, controlled implementation trial. We used a variant of the cohort multiple randomized controlled trial design (22,26) and took advantage of sampling from the Alberta's Caring for Diabetes (ABCD) Cohort Study (23), a large, ongoing, annual survey of patients with type 2 diabetes. Initial contact with cohort participants included the administration of the Patient Health Questionnaire (PHQ).…”