A Pragmatic Application of the RE-AIM Framework for Evaluating the Implementation of Physical Activity as a Standard of Care in Health Systems

• Type of Material: Article
• Authors: Mark Stoutenberg, University of Miami; Karla Galaviz Arredondo, Emory University; Felipe Lobelo, Emory University; Elizabeth Joy, Intermountain Healthcare; George W. Heath, University of Tennessee Chattanooga; Adrian Hutber, American College of Sports Medicine; Paul Estabrooks, University of Nebraska Medical Center
• Language: English
• Date: 2018-05-01
• Publisher: Centers for Disease Control and Prevention
• Publication Version: Final Published Version
• Copyright Statement: © 2018 Centers for Disease Control and Prevention (CDC).
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.5888/pcd15.170344
• Title of Journal or Parent Work: Preventing Chronic Disease
• ISSN: 1545-1151
• Volume: 15
• Issue: 5
• Start Page: E54
• End Page: E54
• Grant/Funding Information: Dr Stoutenberg, Dr Lobelo, and Dr Hutber receive funding from the ACSM for their work with the EIM initiative.
• Keywords: Public, Environmental & Occupational Health; Science & Technology; SERVICES TASK-FORCE; EXERCISE; CONCEPTUAL-FRAMEWORK; CARDIOVASCULAR-DISEASE; VITAL SIGN; ACTIVITY PLAN; TRIAL; Life Sciences & Biomedicine; PUBLIC-HEALTH; INACTIVITY; PROMOTION INTERVENTIONS
• Research Categories: Health Sciences, Public Health; Education, Health

Abstract

Introduction Exercise is Medicine (EIM) is an initiative that seeks to integrate physical activity assessment, prescription, and patient referral as a standard in patient care. Methods to assess this integration have lagged behind its implementation. Purpose and Objectives The purpose of this work is to provide a pragmatic framework to guide health care systems in assessing the implementation and impact of EIM. Evaluation Methods A working group of experts from health care, public health, and implementation science convened to develop an evaluation model based on the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. The working group aimed to provide pragmatic guidance on operationalizing EIM across the different RE-AIM dimensions based on data typically available in health care settings. Results The Reach of EIM can be determined by the number and proportion of patients that were screened for physical inactivity, received brief counseling and/or a physical activity prescription, and were referred to physical activity resources. Effectiveness can be assessed through self-reported changes in physical activity, cardiometabolic biometric factors, incidence/burden of chronic disease, as well as health care utilization and costs. Adoption includes assessing the number and representativeness of health care settings that adopt any component of EIM, and Implementation involves assessing the extent to which health care teams implement EIM in their clinic. Finally, Maintenance involves assessing the long-term effectiveness (patient level) and sustained implementation (clinic level) of EIM in a given health care setting. Implications for Public Health The availability of a standardized, pragmatic, evaluation framework is critical in determining the impact of implementing EIM as a standard of care across health care systems.