Process Evaluation of the Diabetes Canada Guidelines Dissemination Strategy Using the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) Framework

Abstract

Our purpose was to disseminate and implement the Diabetes Canada (formerly the Canadian Diabetes Association) 2013 Clinical Practice Guidelines and evaluate the impact of the dissemination and implementation strategy on process outcomes (reach, adoption, implementation and maintenance). Our patient- and provider-directed strategy consisted of a guidelines website, electronic point-of-care decision-support tools, mobile applications, electronic medical record templates, laboratory prompts, continuing professional development modules, a communications campaign and printed education materials. We used the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework to assess process-level outcomes. We report on the reach, adoption, implementation and organizational maintenance by using mixed methods and multiple data sources (communications reports, mailing lists, website-usage statistics, accreditation logs, session-evaluation forms, budgets). A total of 1,786,910 contacts were made with health-care professionals, the majority of whom were nurses. The greatest reach was through the website. A total of 35,573,154 contacts were made with the general population; the greatest reach occurred through media channels. We contacted 149 and collaborated with 18 governmental, professional and health advocacy organizations about activities such as distributing resources and implementing team-based care initiatives and screening policies. Most website users were young women, with use occurring during working hours. Interactive clinical decision-support tools were most commonly accessed. Website use increased with time. The institutionalization of guidelines occurred in a few areas such as the use of an adapted screening policy in the Northwest Territories. Our interactive tools were repeatedly accessed, signifying their relevance to problems in clinical care. Our synthesized analyses indicate that the guidelines website is resource intensive, with a wide reach and the potential to change outcomes.