Examples of Projects Illustrating the R’s
| Example: Study/Project/Resource Title and Relevant R’s | Study/Project/Resource Details |
|---|---|
| Particular studies and programs | |
| DIAMOND (Depression Improvement Across Minnesota–Offering a New Direction) 1. Relevant to stakeholders 2. Redefines rigor 3. Replicability | The DIAMOND initiative for depression in primary care was a statewide collaborative of practices and health plans accompanied by a separately funded NIMH research study using a stepped wedge/phased intervention design.15,25,39,40 Practices launched the DIAMOND care process in cohorts, 6 months apart, with baseline data collected for all. Outcomes that mattered to different stakeholders were compared before and after launch across the many practices launching at different times. Outcomes were tracked using both quantitative and qualitative measures, including clinical outcomes, health plan claims data, patient surveys, and practice leader surveys regarding implementation. An explicit balance of fidelity and adaptation to local situations—specifics that practices had to tailor for themselves (eg, choice of discipline for care managers, specific workflow for PHQ-9, type of data tracking system)—helped practices implement the DIAMOND intervention.41,42 |
| P4H (Prescription for Health) 1. Relevant to stakeholders 2. Recursive 3. Redefines rigor 4. Reports on resources | P4H was an initiative of The Robert Wood Johnson Foundation (RWJF) with the Agency for Healthcare Research and Quality (AHRQ) to fund a collaboration of 17 PBRNs that developed and evaluated strategies to improve health behavior changes for multiple behaviors through linkage to community resources.43 Practices worked with researchers, and teams of researchers, and PBRN leaders worked with each other and with a cross-cutting research group to share evolving learning, and develop common measures and an evolving research agenda.44 Using mixed quantitative and qualitative methods (including researcher diary data and interviews)45 and cost analyses, P4H showed that primary care practices have the ability to develop their linkages to connect patients with community resources46 to improve practice processes,47 health behavior counseling, and patient behavior change.48 |
| ¡Viva Bien! 1. Relevant to stakeholders 2. Reports on resources 3. Replicability | ¡Viva Bien!32,33 was a randomized trial that provided a clear description of methods, implementation costs for a diabetes self-management program, and estimates of costs to replicate the program under different conditions, calculating incremental costs per behavioral, biologic, and quality-of-life change. It discussed how to separate the costs of development and research from implementation, and how to conduct relatively straight-forward sensitivity analyses to estimate costs of replicating a program or policy under different conditions. |
| MOHR (My Own Health Report) 1. Relevant to stakeholders 2. Rapid and recursive 3. Redefines rigor 4. Reports on resources 5. Replicability | MOHR23,49 is a pragmatic participatory trial in which diverse primary care practices implement the collection of patient-reported information and provide patients advice, goal setting, and counseling in response—with deliberate diversity of settings and populations to ensure greater generalizability of results. Practices, patients, funding agencies, and content experts were engaged throughout the study to take into account local resources and characteristics in design, implementation, evaluation, and dissemination. Core elements of the study protocol were identified, with local tailoring to ensure implementation was relevant to local culture and practice on issues such as workflows, eligible patients, when and where assessment would be completed, whether electronic or paper, and how clinicians would receive the feedback. The trial used mixed methods, including cost analyses. |
| Research networks across studies | |
| PRC (Prevention Research Centers) of the Centers for Disease Control and Prevention 1. Relevant to stakeholders 2. Recursive 3. Replicability | PRC directs a national network of 37 academic research centers at public health or medical schools with a preventive medicine residency program, translating research results into policy and public health practice. Centers have capacity for community-based, participatory prevention research needed to drive community changes to prevent and control chronic disease. Research involves collaboration among partners bringing different expertise to the table, identifies research needs of partners, conducts research that builds on previous evidence for promising interventions, and recommends how interventions can be packaged for replication and adoption (http://www.cdc.gov/prc/index.htm). |
| QUERI (Quality Enhancement Research Initiative) 1. Relevant to stakeholders 2. Rapid and recursive 3. Redefines rigor 4. Replicability | QUERI is a Veterans Affairs initiative that brings together operations with research staff to address key gaps in quality and outcomes. It has contributed to remarkable and rapid improvements in the quality of care received by veterans across 10 conditions deemed high-risk or highly prevalent. This initiative uses a 6-step process to spot gaps in performance and to identify and implement interventions. QUERI studies and facilitates adoption of new treatments, tests, and models of care into routine clinical practice—feasibility, implementation, adoption, and impact (http://www.queri.research.va.gov/default.cfm). |
| Research application tools and resources | |
| RTIPs (Research Tested Intervention Programs) 1. Relevant to stakeholders 2. Reports on resources 3. Replicability | RTIPs is a resource of the National Cancer Institute that provides information on the specific conditions under which each of their tested interventions has been evaluated and tools for addressing issues about applicability (http://rtips.cancer.gov/rtips). New features related to external validity using the RE-AIM framework are included to help users better determine the likely public health impact of a given program if replicated in their setting. RTIPs also reports on the resources required to implement these programs. |
| PRECIS (Pragmatic Explanatory Continuum Indicator Summary) 1. Relevant to stakeholders 2. Redefines rigor 3. Replicability | PRECIS50 is a graphic representation of the extent to which a study is pragmatic (testing effect in usual conditions) vs explanatory (testing effect in ideal conditions) on 10 key dimensions. If used consistently, this tool could greatly help practitioners decide whether a study is likely to be reproducible in their setting and researchers to investigate the dimensions along which similarity is more vs less critical for replication. |
NIMH = National Institute of Mental Health; PBRN = practice-based research network; PHQ-9 = 9-item Patient Health Questionnaire; RE-AIM = Reach Effectiveness–Adoption Implementation Maintenance.