Pragmatic Application of the RE-AIM Framework to Evaluate the Implementation of Tobacco Cessation Programs Within NCI-Designated Cancer Centers

Frontiers in Public Health

卷:8

Marika S. Rosenblum¹  Paul M. Cinciripini²  Anne Joseph³  Jamie S. Ostroff⁴  Graham W. Warren⁶  Li-Shiun Chen⁷  Alex T. Ramsey⁷  Danielle Pauk⁸  Heather D'Angelo⁸  Monica Webb Hooper⁹  Michael C. Fiore¹⁰  Timothy B. Baker¹⁰  Robert Adsit¹⁰  Betsy Rolland¹³  Lisa M. Fucito¹⁴  Steven L. Bernstein¹⁵ 

[1] 0Department of Research, William S. Middleton Memorial Veterans Hospital, Madison, WI, United States;

[2] 1Department of Behavioral Sciences, University of Texas MD Anderson Cancer Center, Houston, TX, United States;

[3] 2Department of Medicine, Masonic Cancer Center, University of Minnesota, Minneapolis, MN, United States;

[4] 3Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, United States;

[5] 4Department of Radiation Oncology, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States;

[6] 5Department of Cell and Molecular, Pharmacology and Experimental Therapeutics, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States;

[7] Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, United States;

[8] Carbone Cancer Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States;

[9] Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, United States;

[10] Department of Medicine, Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States;

[11] Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States;

[12] Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States;

[13] Institute for Clinical and Translational Research, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States;

[14] Yale Cancer Center, Smilow Cancer Hospital at Yale-New Haven, New Haven, CT, United States;

[15] Yale Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States;

关键词: Tobacco treatment;    Smoking Cessation;    Cancer center;    RE-AIM (Reach;    Effectiveness;    Adoption;   

DOI  :  10.3389/fpubh.2020.00221

来源: DOAJ

【 摘 要 】

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.

【 授权许可】

Unknown