Table 3.
Evaluation Using RE‐AIM Framework
| RE‐AIM element | Data source(s) | Evaluation measures |
|---|---|---|
| Reach | ||
| Representativeness: participant | Enrollment data | Number/proportions by demographic subgroups |
| Representativeness: setting | Site characteristics | Size, location, staff, and demographic of patients served |
| Penetration/refusion reasons | Screening lists | Number/proportions not participating for each reason overall and by subgroups |
| Effectiveness | ||
| Primary outcome: adherence | Participant follow‐up data |
Number of sessions attended relative to number prescribed* Goal ≥70% of sessions: VWCR: 25 of 36 virtual sessions (education, EP, and NC sessions); CBCR: 25 of 36 in‐person sessions |
| Secondary outcome: adherence |
Number of sessions attended relative to sessions prescribed Number of self‐directed moderate‐intensity exercise sessions completed per week |
|
| Secondary outcome: retention | Percentage of participants completing baseline and 3‐ and 6‐mo and follow‐up clinical assessments | |
| Secondary outcome: clinical | 3‐mo CVH (LE8 score) outcome, MACEs | |
| Secondary outcome: cost‐effectiveness | 3‐ and 6‐mo estimated per‐participant direct and indirect health care costs for both VWCR and CBCR | |
| Adoption | ||
| Acceptability/satisfaction | Focus groups |
Participant satisfaction with VWCR intervention or CBCR CR staff (EP, NC) satisfaction with VWCR intervention |
| Barriers/facilitators to adoption |
Focus groups Implementation checklists Study team notes |
Site‐specific impediments to program execution; catalyzing factors supporting program uptake by implementers |
| Implementation | ||
| Fidelity |
Focus groups Implementation checklists Protocol variations Participant follow‐up data VW platform data Study team notes |
Fidelity to intervention (VWCR) and control (CBCR) groups will be measured as follows: Curriculum: number of sessions/participant, session type (group/individual), independent use (unscheduled visits), and completion of experiential learning activities (eg, fitness center, restaurant), EP and NC: number of virtual (or in‐person) visit sessions/participant, mode of delivery (telephone/video, in‐person), session duration, session type (group/individual), what was delivered (eg, exercise, health behavior counseling, or SDOH review), and quality of interventionist delivery (enthusiasm, confidence, and communication style) |
| Maintenance | ||
| Sustainability and scalability | Stakeholder focus groups | Projected facilitators/barriers to sustainability/scaling from stakeholders (clinicians, payers, and advocacy groups) as follows: review of direct and indirect health care costs, personnel costs (salaries), intervention materials, and facility‐level overhead costs |
CBCR indicates center‐based CR; CR, cardiac rehabilitation; CVH, cardiovascular health; EP, exercise physiologist; LE8, Life's Essential 8; MACE, major adverse cardiovascular event; NC, nurse coach; RE‐AIM, Reach, Effectiveness, Adoption, Implementation, and Maintenance; SDOH, social determinants of health; VW, virtual world; and VWCR, VW–based CR.
Number of VWCR sessions/participant, session type (group/individual), independent use (unscheduled visits), and areas visited (eg, fitness center, restaurant).