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A Mixed-Methods Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) Study of Implementation
Jennifer Maybee1,2, Emily DeBoer1,3, Emily Meneses4
1Children's Hospital Colorado, Aurora.
Insights
The Childhood Dysphagia Management Scale (CDMS) shows high implementation and maintenance rates in pediatric hospitals, indicating readiness for broader use in managing childhood dysphagia. This validated tool effectively guides follow-up care after swallow assessments.
Area of Science:
- Implementation science in pediatric healthcare.
- Outcomes measurement for childhood dysphagia.
- Swallowing disorders and therapeutic assessment.
Background:
- The Childhood Dysphagia Management Scale (CDMS) is a validated tool for therapists to determine follow-up care for children with dysphagia.
- Assessing the implementation outcomes of the CDMS is crucial for its scalability.
Purpose of the Study:
- To evaluate the implementation outcomes of the CDMS using the RE-AIM framework.
- To determine the CDMS's readiness for scaled-out implementation in pediatric care settings.
Main Methods:
- An explanatory sequential mixed-methods design informed by the RE-AIM framework was employed.
- Quantitative data (N=4,829) on CDMS completion rates were collected over 30 months across five hospital sites.
- Qualitative data from therapists (n=35) and referring providers (n=17) were gathered through surveys and interviews.
Main Results:
- CDMS demonstrated effective reach across patient sociodemographics, with 92.3% completion overall.
- Adoption varied by site and setting, influenced by workflow integration and scoring time.
- Strong implementation (92.3% completion) and maintenance (77.1%-92.8% over 30 months) were observed.
Conclusions:
- The CDMS is implementable, adoptable, and sustainable within a pediatric hospital system.
- Findings indicate the CDMS is ready for widespread adoption in managing childhood dysphagia.
- The study highlights the CDMS's utility in guiding follow-up care following instrumental swallow assessments.
Purpose:
The Childhood Dysphagia Management Scale (CDMS) is a validated outcomes measure completed by evaluating therapists following instrumental swallow assessments to determine the level of follow-up care needed for children with dysphagia. We assessed the implementation outcomes of the CDMS to evaluate its readiness to be scaled out.
Method:
The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) implementation science framework informed our explanatory sequential mixed-methods design. CDMS implementation outcomes were tested in a single tertiary-care children's hospital with five sites. Quantitatively, completion (number of CDMS completed/number of possible) was measured across all possible instrumental swallow assessments over a 30-month period (N = 4,829), compared across sites and settings (inpatient vs. outpatient), measured longitudinally, and evaluated using linear mixed models across sociodemographic variables. Qualitatively, therapists (n = 35) and referring providers (n = 17) participated in surveys, focus groups, and semistructured interviews. Qualitative data were analyzed and integrated with quantitative findings.
Results:
By RE-AIM domain, CDMS completion was not significantly associated with any patient sociodemographic factor outside of age, showing effective reach across patient-level factors. Effectiveness outcomes are reported on in a separate article (Part 2). Variability in CDMS completion was observed across the five sites and inpatient versus outpatient settings, suggesting that adoption was influenced by site of care. The CDMS was completed in 4,456 (92.3%) instrumental swallow assessments, demonstrating strong implementation across the hospital system. Surveys and qualitative interviews revealed that workflow integration and short CDMS scoring time supported high completion rates. Lower completion rates in some sites/settings were explained by inpatient characteristics and barriers to dissemination to local providers. Over 30 months, completion rates ranged from 77.1% to 92.8% across the hospital system, indicating strong maintenance.
Conclusion:
CDMS implementation outcomes across a five-site pediatric hospital system indicate that this validated outcomes measure for instrumental swallow assessments can be implemented, adopted, and sustained, demonstrating its readiness for widespread diffusion.
Supplemental Material:
https://doi.org/10.23641/asha.32942303.