Intervention design, implementation, and evaluation.

PURPOSE: Strategies to improve the design, implementation, and evaluation of interventions in pharmacy practice-based research are discussed.
SUMMARY: Various issues inherent in the clinical research continuum explain the lack of research translation into practice settings. The RE-AIM model is used to frame descriptions of strategies to design, implement, and evaluate practice-based research interventions. A major feature of RE-AIM is the shift in focus from short-term efficacy among restricted samples in controlled settings to longer-term effectiveness among more diverse samples in practice settings. The RE-AIM model consists of five dimensions: reach, effectiveness, adoption, implementation, and maintenance. Various strategies are suggested to optimize an intervention's reach. In addition to clinical measures, economic, humanistic, and process measures are recommended for measuring and optimizing the effectiveness of an intervention. Adoption is considered an assessment of an intervention's reach at the organizational level. Assessment of representativeness among participating settings should also be conducted based on key characteristics relevant to a study. Several strategies are suggested to improve stakeholder buy in, thereby increasing the likelihood of intervention adoption. Intervention fidelity is important for maximizing a study's internal validity and consists of two components: integrity and differentiation. Several factors influence the likelihood and degree of intervention maintenance, including the use of existing personnel to deliver an intervention and evaluation measures that are meaningful to institutional stakeholders.
CONCLUSION: Application of the RE-AIM model's dimensions can enhance the reach, effectiveness, adoption, implementation, and maintenance of interventions, thus improving the quality and impact of practice-based research.