Translating Patient Safety Research into Clinical Practice

Excerpt

There is a pressing need to make patient safety research more relevant to clinicians and decisionmakers. The RE-AIM framework of Reach, Effectiveness, Adoption, Implementation, and Maintenance is one approach investigators can use to assess a study's potential for translation from research to clinical practice. In this paper, we show how the RE-AIM approach is being used to evaluate a pharmacy alert intervention designed to detect and correct medication prescribing errors for all patients prescribed medications in a large health maintenance organization (HMO). In the RE-AIM framework, Reach is assessed by calculating the participation rate and evaluating the degree to which the patients enrolled in the study are representative of the larger patient population (i.e., the “representativeness” of the sample). Effectiveness is assessed across multiple dimensions. Medication errors are the primary outcome. Other outcomes include prescriber, pharmacist, and patient satisfaction; measures of unintended consequences (e.g., false-positive alerts), and potential negative impacts (e.g., repeat patient visits to the pharmacy). Adoption is measured by calculating the participation rates of the pharmacies and pharmacists approached to participate in the project. Representativeness is assessed by comparing the characteristics of pharmacies and pharmacists that participate to those that do not. Implementation is assessed as the degree to which intervention components are delivered as intended. Measures of technical performance include the validity of alerts and system reliability. Measures of pharmacist performance include completeness of progress documentation and adherence to alert recommendations. Maintenance is assessed as the sustainability of the intervention's impact during the study (at 3, 6, 9, and 12 months), and at one year after its completion. Investigators interested in promoting the translation of their research and conducting “practical clinical trials” should consider external and internal validity issues. This paper describes one approach to the collection and reporting on measures of generalizability that are of interest to clinicians and decisionmakers.