{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T06:55:17Z","timestamp":1790751317916,"version":"4.1.0"},"reference-count":17,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["R33AG065619"],"award-info":[{"award-number":["R33AG065619"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006379","name":"Office of Research and Development","doi-asserted-by":"publisher","award":["I01HX003420"],"award-info":[{"award-number":["I01HX003420"]}],"id":[{"id":"10.13039\/100006379","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Health Serv."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Complex, heterogeneous settings such as nursing homes require ongoing adaptation of interventions and implementation strategies. Iterative RE-AIM offers a structured approach to guide adaptations, but how the approach is operationalized may need to vary across implementation contexts. We describe how two pragmatic nursing home trials operationalized Iterative RE-AIM with FRAME-IS to enable a systematic adaptation learning cycle.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a narrative analysis of two ongoing multi-site trials: TEAM EFFORT (focused on falls reduction in State Veterans Homes) and 40 WINKS (focused on sleep improvement in nursing home residents with dementia). Both used RE-AIM for evaluation and FRAME-IS to document adaptations. Each operationalized the Iterative RE-AIM steps based on study scope, resources, team structure, and implementation timing, with a primary focus on refining a coach-supported implementation strategy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>TEAM EFFORT embedded adaptation-related data collection, deliberation, and decision-making within weekly team meetings, supported by an ongoing input tool; 40 WINKS used individual-level surveys followed by structured, once-per-wave team gatherings to decide on adaptations. These two operationalizations illustrate how the timing, methods, and cadence of an adaptation learning cycle based on Iterative RE-AIM can vary in response to implementation context.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Iterative RE-AIM can be operationalized differently across implementation contexts while remaining faithful to its underlying intent. Paired with FRAME-IS, Iterative RE-AIM can enable an adaptation learning cycle that integrates systematic documentation of adaptations with structured team deliberation. Rather than prescribing a single Iterative RE-AIM implementation protocol, these findings suggest that operationalization can respond to the context in which implementation occurs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/frhs.2026.1847212","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T06:00:24Z","timestamp":1790748024000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Operationalizing Iterative RE-AIM in two pragmatic nursing home trials to support an adaptation learning cycle"],"prefix":"10.3389","volume":"6","author":[{"given":"Annie W.","family":"Yang","sequence":"first","affiliation":[{"name":"National Clinician Scholars Program, Yale School of Medicine","place":["New Haven, CT, United States"]},{"name":"VA Connecticut Healthcare System","place":["West Haven, CT, United States"]},{"name":"Geriatric Research Education and Clinical Center, James J Peters VA Medical Center","place":["Bronx, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophia","family":"Geisser","sequence":"additional","affiliation":[{"name":"Alabama Research Institute on Aging and the Department of Psychology, The University of Alabama","place":["Tuscaloosa, AL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Recker","sequence":"additional","affiliation":[{"name":"Brown University School of Public Health","place":["Providence, RI, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerie","family":"Clark","sequence":"additional","affiliation":[{"name":"Center for Health Optimization and Implementation Research, VA Bedford Healthcare System","place":["Bedford, MA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine W.","family":"Hartmann","sequence":"additional","affiliation":[{"name":"Center for Health Optimization and Implementation Research, VA Bedford Healthcare System","place":["Bedford, MA, United States"]},{"name":"Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell","place":["Lowell, MA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. Lynn","family":"Snow","sequence":"additional","affiliation":[{"name":"Alabama Research Institute on Aging and the Department of Psychology, The University of Alabama","place":["Tuscaloosa, AL, United States"]},{"name":"Tuscaloosa VA Medical Center","place":["Tuscaloosa, AL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"n1679","DOI":"10.1136\/bmj.n1679","article-title":"Adapting interventions to new contexts-the ADAPT guidance","volume":"374","author":"Moore","year":"2021","journal-title":"Br Med J"},{"key":"B2","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1146\/annurev-publhealth-071321-041652","article-title":"Adapting public health and health services interventions in diverse, real-world settings: documentation and iterative guidance of adaptations","volume":"46","author":"Rabin","year":"2025","journal-title":"Annu Rev Public Health"},{"key":"B3","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1186\/s13012-021-01105-3","article-title":"The FRAME-IS: a framework for documenting modifications to implementation strategies in healthcare","volume":"16","author":"Miller","year":"2021","journal-title":"Implement Sci"},{"key":"B4","volume-title":"Quality Enhancement Research Initiative. QUERI Roadmap for Implementation and Quality Improvement","author":"Goodrich","year":"2020"},{"key":"B5","doi-asserted-by":"publisher","first-page":"589","DOI":"10.1093\/geront\/gnac133","article-title":"A spotlight on adaptation: preimplementation of montessori-based activity programming in long-term care using the framework for reporting adaptations and modifications-enhanced (FRAME)","volume":"63","author":"Madrigal","year":"2023","journal-title":"Gerontologist"},{"key":"B6","doi-asserted-by":"publisher","first-page":"959565","DOI":"10.3389\/frhs.2022.959565","article-title":"Use of the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework to guide iterative adaptations: applications, lessons learned, and future directions","volume":"2","author":"Glasgow","year":"2022","journal-title":"Front Health Serv"},{"key":"B7","doi-asserted-by":"publisher","first-page":"64","DOI":"10.3389\/fpubh.2019.00064","article-title":"RE-AIM Planning and evaluation framework: adapting to new science and practice with a 20-year review","volume":"7","author":"Glasgow","year":"2019","journal-title":"Front Public Health"},{"key":"B8","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1037\/ser0000137","article-title":"Adaptation of a nursing home culture change research instrument for frontline staff quality improvement use","volume":"14","author":"Hartmann","year":"2017","journal-title":"Psychol Serv"},{"key":"B9","first-page":"228","article-title":"Development of a program to support VA community living Centers\u2019 quality improvement","volume":"36","author":"Hartmann","year":"2019","journal-title":"Fed Pract"},{"key":"B10","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1097\/NCQ.0000000000000376","article-title":"Blended facilitation as an effective implementation strategy for quality improvement and research in nursing homes","volume":"34","author":"Pimentel","year":"2019","journal-title":"J Nurs Care Qual"},{"key":"B11","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1186\/1748-5908-8-65","article-title":"Development of a framework and coding system for modifications and adaptations of evidence-based interventions","volume":"8","author":"Stirman","year":"2013","journal-title":"Implement Sci"},{"key":"B12","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1186\/s13012-019-0898-y","article-title":"The FRAME: an expanded framework for reporting adaptations and modifications to evidence-based interventions","volume":"14","author":"Wiltsey Stirman","year":"2019","journal-title":"Implement Sci"},{"key":"B13","doi-asserted-by":"publisher","first-page":"598","DOI":"10.1093\/geront\/gnx023","article-title":"Applying a theory-driven framework to guide quality improvement efforts in nursing homes: the LOCK model","volume":"58","author":"Mills","year":"2018","journal-title":"Gerontologist"},{"key":"B14","doi-asserted-by":"publisher","first-page":"810","DOI":"10.1016\/j.jamda.2019.01.139","article-title":"Nursing home staff perceptions of barriers and facilitators to implementing a quality improvement intervention","volume":"20","author":"Mills","year":"2019","journal-title":"J Am Med Dir Assoc"},{"key":"B15","doi-asserted-by":"publisher","first-page":"e084011","DOI":"10.1136\/bmjopen-2024-084011","article-title":"Improving safety and preventing falls using an evidence-based, front-line staff huddling practice: protocol for a pragmatic trial to increase quality of care in state veterans homes","volume":"14","author":"Nash","year":"2024","journal-title":"BMJ Open"},{"key":"B16","doi-asserted-by":"publisher","first-page":"e291","DOI":"10.1093\/geront\/gny039","article-title":"Impact of intervention to improve nursing home resident-staff interactions and engagement","volume":"58","author":"Hartmann","year":"2018","journal-title":"Gerontologist"},{"key":"B17","author":"Gomes","year":""}],"container-title":["Frontiers in Health Services"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frhs.2026.1847212\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T06:00:25Z","timestamp":1790748025000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frhs.2026.1847212\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,30]]},"references-count":17,"alternative-id":["10.3389\/frhs.2026.1847212"],"URL":"https:\/\/doi.org\/10.3389\/frhs.2026.1847212","relation":{},"ISSN":["2813-0146"],"issn-type":[{"value":"2813-0146","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,30]]},"article-number":"1847212"}}