Table 2.

Pragmatic application of RE-AIM to evaluate tobacco treatment program implementation at three NCI-Designated Cancer Centers funded through the Cancer Center Cessation Initiative.

RE-AIM construct	Evaluation measuresa		Washington University Siteman Cancer Center	Yale University Smilow Cancer Hospital	Case Western Reserve University Case Comprehensive Cancer Centerc
REACH	Smoking prevalenceb		12.5%	18%	21.1%
	Smokers reached with at least one evidence-based cessation treatment		43.1% of smokers were prescribed cessation medications and/or received brief counseling at the point-of-care	7% of smokers were prescribed cessation medications, referred to the TTS, and/or referred to SmokefreeTXT	24.3% of smokers were prescribed cessation medications, referred to TIPS, and/or referred to SmokefreeTXT
EFFECTIVENESS	Assessment method		Tobacco use status from EHR for most recent visit during 6-months period post-treatment	Assessed at 6-months in person or via phone & documented in EHR	Assessed at 6-months in person or via phone and documented in EHR.
	6-month follow-up rate		67.2%	13.5%	54.4%
	30-day point prevalence abstinence	Counting patients lost to follow-up as smokers	29.5%	2.2%	19.5%,
		Among patients with follow-up data	43.9%	16.7%	35.1%
ADOPTION	Setting level adoption		21/21 outpatient oncology clinics over a 6-months implementation period.	Adopted at Smilow Cancer Center and 9/10 Care Centers over ~8 months.	Adopted in 3/3 healthcare systems. One launched center-wide, two launched in thoracic and gynecological oncology clinics.
	Provider level adoption		99% providers initiated assessment, 79% initiated documentation of medication, 85% initiated offer of counseling referral.	Not assessed	Number of referring providers (N = 64) has increased by 25% over 1 year of implementation.
IMPLEMENTATION	Setting level tobacco use assessment rate		93%	49.5%	80%
	Provider-level tobacco use assessment rate		93% providers achieved ≥90% rate	Not assessed	Not assessed
	Implementation of key program components		Pharmacotherapy rate: 49% of providers achieve ≥20% rate; Counseling offer rate: 51% of providers achieve ≥50% rate	BPA utilization rates for referrals to the TTS, pharmacotherapy or both.	51% of referred patients received at least one component of the TIPS intervention.
MAINTENANCE	Sustainability plans/goals		• 6-months ongoing reach and effectiveness evaluation. • Incentivize care using data transparency and performance feedback. • Low-burden, low cost decision support tool for point-of-care use ($3 per patient).	Hiring another tobacco treatment specialist to maintain program at Care Centers. Billing for services using an APRN and expanding telehealth services. Integrating referrals into new patient onboarding by nurse navigators.	• Leverage initial success. • Generate new funding sources. • Reduce patient barriers to treatment (e.g. cost, transportation. • Identify 100% of smokers & reach at least 50% of smokers with treatment.

^aReported for a 6-month period at 1-year post-implementation.

^bAmong patients screened for tobacco use.

^cAverage of three cancer healthcare settings.

TTS, Tobacco Treatment Service; TIPS, Tobacco Intervention & Psychosocial Support.