Pragmatic Application of the RE-AIM Framework to Evaluate the Implementation of Tobacco Cessation Programs Within NCI-Designated Cancer Centers
Pragmatic Application of the RE-AIM Framework to Evaluate the Implementation of Tobacco Cessation Programs Within NCI-Designated Cancer Centers
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DOI：
10.3389/fpubh.2020.00221
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发表时间：
2020-06-12
影响因子：
5.2
通讯作者：
Baker, Timothy B.
中科院分区：
文献类型：
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作者：
D'Angelo, Heather;Ramsey, Alex T.;Baker, Timothy B.
癌症诊断后戒烟可改善患者预后。然而，烟草治疗服务在癌症护理环境中经常不可用，多层次的实施挑战可能会阻碍新计划的实施。美国国家癌症研究所（NCI）通过癌症中心戒烟倡议（C3 I）为NCI-Designated癌症中心提供专门的癌症Moonshot资金，以实施或加强烟草治疗服务的实施。我们研究了RE-AIM框架（范围、有效性、采用、实施和维护）的实际应用，以评估通过C3 I资助的癌症中心实施的烟草治疗计划。以三个C3 I资助的中心为例，我们描述了每个RE-AIM结构是如何运作的，以评估各种戒烟服务的实施情况（例如，烟草使用筛查、咨询、戒烟热线转诊、药物治疗）。我们讨论了在真实的世界情况下评估RE-AIM结构时遇到的实际挑战，包括使用电子健康记录（EHR）来帮助评估。覆盖范围和有效性评估要求中心定义实施戒烟服务的环境（以确定“分母”），枚举患者人群，报告当前患者烟草使用情况、患者参与烟草治疗情况和6个月戒烟结果。为了减少站点异质性，提高数据准确性并减轻负担，通过标准化的EHR增强功能经常捕获覆盖范围，以改善对当前吸烟者和烟草治疗转诊的识别。通过各种数据收集方法评估的戒烟结果（参与后6个月的30天时点戒烟率）确定有效性。通过目标癌症护理机构和从事戒烟服务提供的临床医生的特征和比例来衡量采用情况。通过检查烟草筛查评估和干预组件的交付情况以及供应商层面的实施一致性来评估实施情况。维持评估确定了烟草治疗服务在实施后是否继续，并记录了可持续性计划和组织对继续提供服务的承诺。总之，本文展示了一种务实的方法，使用RE-AIM作为一个评估框架，产生相关的结果，在广泛不同的烟草治疗方法和设置的共同实施指标。
Tobacco cessation after cancer diagnosis leads to better patient outcomes. However, tobacco treatment services are frequently unavailable in cancer care settings, and multilevel implementation challenges can impede uptake of new programs. The National Cancer Institute (NCI) dedicated Cancer Moonshot funding through the Cancer Center Cessation Initiative (C3I) for NCI-Designated Cancer Centers to implement or enhance the implementation of tobacco treatment services. We examined a pragmatic application of the RE-AIM framework (reach, effectiveness, adoption, implementation, and maintenance) to evaluate tobacco treatment programs implemented within Cancer Centers funded through C3I. Using three C3I-funded Centers as examples, we describe how each RE-AIM construct was operationalized to evaluate the implementation of a wide range of cessation services (e.g., tobacco use screening, counseling, Quitline referral, pharmacotherapy) in this heterogeneous group of cancer care settings. We discuss the practical challenges encountered in assessing RE-AIM constructs in real world situations, including using the electronic health record (EHR) to aid in assessment. Reach and effectiveness evaluation required that Centers define the setting(s) where cessation services were implemented (to determine the "denominator"), enumerate the patient population, report current patient tobacco use, patient engagement in tobacco treatment, and 6-month cessation outcomes. To reduce site heterogeneity, increase data accuracy, and reduce burden, reach was frequently captured via standardized EHR enhancements that improved the identification of current smokers and tobacco treatment referrals. Effectiveness was determined by cessation outcomes (30-day point prevalence abstinence at 6-months post-engagement) assessed through a variety of data collection approaches. Adoption was measured by the characteristics and proportion of targeted cancer care settings and clinicians engaged in cessation service delivery. Implementation was assessed by examining the delivery of tobacco screening assessments and intervention components across sites, and provider-level implementation consistency. Maintenance assessments identified whether tobacco treatment services continued in the setting after implementation and documented the sustainability plan and organizational commitment to continued delivery. In sum, this paper demonstrates a pragmatic approach to using RE-AIM as an evaluation framework that yields relevant outcomes on common implementation metrics across widely differing tobacco treatment approaches and settings.