Dr. Russ Glasgow is the Director of the Dissemination and Implementation Science Program at the University of Colorado School of Medicine and Research Professor of Family Medicine who has focused his career on chronic illness prevention and care models that can improve healthcare in the real world.
Back in 2013, Glasgow and UW-CTRI Director Dr. Michael Fiore were both assisting the National Cancer Institute and the Food and Drug Administration on public health initiatives. “I was fascinated with Mike’s work with national policy and its implications,” Glasgow said. Meanwhile, Glasgow and UW-CTRI Director of Research Dr. Tim Baker both work out of their home offices in the state of Oregon and have mutual friends. Glasgow quipped he considers himself a “recovering psychologist.” Building on these common interests, Glasgow, Baker, and Fiore made connections that have resulted in Glasgow helping UW-CTRI adapt its pragmatic research program for real-world clinics via a forthcoming NCI-funded Center Grant called Breaking Addiction to Tobacco for Health 2 (BREATHE 2).
Glasgow is particularly tuned into the fact that clinical research is often slow, expensive, and not particularly relevant to real-world healthcare. It takes an average of 17 years before 14 percent of research findings lead to widespread changes in healthcare (and think how long it took research to prove that!).
“People say, ‘oh man, this is really depressing, I can see why science doesn’t make it into practice, maybe we should give up and go home because I can’t control all these challenges,” Glasgow said. “But I have a more optimistic interpretation.”
That is why he and colleagues created RE-AIM, a highly cited implementation, planning and evaluation model he assisted UW-CTRI scientists in integrating into BREATHE 2. Under RE-AIM, the five steps to translate research into action are:
- Reach the target population
- Effectiveness or efficacy
- Adoption by target staff, settings, or institutions
- Implementation consistency, costs and adaptations made during delivery
- Maintenance of intervention effects in individuals and settings over time
“RE-AIM is an outcomes framework that can be used for planning and evaluation,” he said. “Each dimension is an opportunity for intervention. All steps are phases, all those stages are important and all of them provide opportunities. We’ve given almost no attention to most of these steps—particularly adoption and relatively little to maintenance or sustainability. So, I think it can be turned around and there are huge opportunities to improve public health.”
Glasgow said it’s also important to assess costs for providers as well as patients. For systems, this includes implementation costs such as adaptations for electronic health records and human resources, as well as actually providing the quit-smoking intervention.
“Currently, one important opportunity is to understand how electronic health records can be used to improve care,” Glasgow said. “It’s one reason I’m excited to collaborate with UW-CTRI, because they are way ahead of the curve on that.” Health systems have interrelated parts and BREATHE 2 will solicit input from staff at all levels of those two health systems.
BREATHE 2 will use the RE-AIM approach to test the first phased-based model for packaging varenicline or combo nicotine-replacement therapy with tobacco-treatment care management. It will examine staff time and EHR adaptation. “In real-world situations, implementation never goes like you wrote it up in the grant proposal, so we need to assess and understand adaptations,” Glasgow said.
“For me, the new frontier is using implementation models and methods such as RE-AIM for faster, more rapid analyses to assess how things are going so we can tweak in real time what is needed while still staying true to the big picture of the research and key components of the intervention.”
Glasgow is excited to work with UW-CTRI Researcher Marlon Mundt on health economics and implementation science. They’ll assess and understand cost, benefit, and value from the view of different stakeholders: Health system administrators, clinic management, clinicians, front-line delivery staff, patients and society. “Sometimes those perspectives align, sometimes those don’t,” Glasgow said. “Quantitative and qualitative elements are both important.”
He also looks forward to BREATHE 2 data speaking to health equity—the quest to get the most cost-effective intervention for all while ensuring this innovative care management system doesn’t unintentionally increase health disparities.
“I think there are opportunities to use RE-AIM in ways that are established and also cutting edge, with an eye toward implementation, health equity and broad-scale dissemination,” he said.
Glasgow admires Larry Green’s quote, “If we want more evidence-based practice, we need more practice-based evidence.” BREATHE 2 is an opportunity to bring that quote to life.