Translating Clinical Informatics Interventions into Routine Clinical Care: How Can the RE-AIM Framework Help?
- Affiliations of the authors: School of Nursing(SB), Department of Biomedical Informatics(SB, CMR), College of Physicians and Surgeons, Columbia University, New York, NY; Center for Shared Decision Making and Nursing Research, Rikshospitalet, National University Hospital, Oslo, Norway(CMR)
- Correspondence: Suzanne Bakken, RN, DNSc, FAAN, Columbia University, 630 W. 168th Street, Mail Box 6, New York, NY 10032; e-mail: <suzanne.bakken{at}dbmi.columbia.edu>
- Received 25 November 2008
- Accepted 3 August 2009
Abstract
Objective Clinical informatics intervention research suffers from a lack of attention to external validity in study design, implementation, evaluation, and reporting. This hampers the ability of others to assess the fit of a clinical informatics intervention with demonstrated efficacy in one setting for implementation in their setting. The objective of this model formulation paper is to demonstrate the applicability of the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework with proposed extensions to clinical informatics intervention research and describe the framework's role in facilitating the translation of evidence into practice and generation of evidence from practice. Both aspects are essential to reap the clinical and public health benefits of clinical informatics research.
Design We expanded RE-AIM through the addition of assessment questions relevant to clinical informatics intervention research including those related to predisposing, enabling, and reinforcing factors and validated it with two case studies.
Results The first case study supported the applicability of RE-AIM to inform real world implementation of a clinical informatics intervention with demonstrated efficacy in randomized controlled trials (RCTs) - the Choice (Creating better Health Outcomes by Improving Communication about Patients' Experiences) intervention. The second, an RCT of a personal digital assistant–based decision support system for guideline-based care, illustrated how RE-AIM can be used to inform the design of an efficacy RCT that captures essential contextual details typically lacking in RCT design and reporting.
Conclusion The case studies validate, through example, the applicability of RE-AIM to inform the design, implementation, evaluation, and reporting of clinical informatics intervention studies.
Footnotes
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The research described and preparation of the manuscript was supported by Mobile Decision Support for Advanced Practice Nursing (R01NR008903, S. Bakken, Principal Investigator) and the Center for Evidence-based Practice in the Underserved (P30NR010677, S. Bakken, Principal Investigator) funded by the National Institute of Nursing Research, and Communication and Information Sharing between Patients and Their Care Providers (Grant 176823/S10, C. Ruland, Principal Investigator) funded by the Norwegian Research Council.
