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. 2021 Mar 20;18(3):176–185. doi: 10.1007/s11904-021-00550-5

Table 2.

Areas of advancement to enhance the impact of CEA in implementation scientific research

RE-AIM domain Implementation-process data needs for CEA Implementation-cost data needs for CEA Examples of approaches for answering data needs
Intended populations (reach)

● Integrating surveillance and reporting systems to derive population-level reach within and across settings

● Emphasizing granular data to distinguish access to services by population subgroups

● Costs as a function of population reach specific to delivery settings and key population subgroups

● Functional form of the cost function capturing economies of scale (or decreasing returns as reach increases)

● Publicly available surveillance data to determine baseline service utilization levels and feasible population reach

● Reporting of costs for implementation strategies increasing reach across different systems, settings, population subgroups, and levels of implementation

Service delivery (adoption)

● Existing levels of implementation for EBIs, specific to delivery settings (e.g., formal healthcare sector, community based, schools) and by payer

● Impact of interventions improving system-level adoption

● Costs as a function of increasing adoption accounting for heterogeneity across settings and geographical location

● Functional form of the cost function to capture economies of scale and scope

● Estimate system capacity and public-health-department intended targets for adoption levels, see MISII for measurement framework example [76]

● Increased reporting (and development) of quantitative measures of determinants of adoption and other implementation phases [77]

Planning (effectiveness)

● Human resources needed for pre-implementation planning

● Real-world effectiveness of EBIs, overall and within key subgroups

● Costs of pre-implementation planning

● Direct and indirect costs attributable to different funding agencies

● Increased use of hybrid effectiveness-implementation (type 2) study designs [35] to determine the real-world scalability and generalizability of EBIs

● Systematic and harmonized reporting of human resource (e.g., FTEs), see Cidav et al. [52] and Saldana et al. [54] for pragmatic approaches

Scaling up (implementation)

● Timing of adoption across delivery settings

● Evidence on changing population characteristics at increasing scales of delivery

● Flexible cost functions accounting for scale and scope when implementation timing changes

● Budget impact of speeding up implementation to determine if feasible or affordable under current budget constraints

● Establish reporting guidelines and standardized instruments for quantitative population-level measures of different implementation phases [78]

● Estimate statistical models (e.g., multiple linear regression) to determine cost functions accounting for system and implementation components [70]

Sustaining impact (maintenance)

● Longitudinal measurement of scale of delivery

● Funding mechanisms for EBIs over time

● Impact of interventions improving population-level sustainment

● Costs for the maintenance of EBI implementation over period of sustainment

● Costs for retraining to maintain impact of EBIs

● Establish a standardized and explicit definition of maintenance/sustainment implementation phase for generalizability of reporting [62]

● Yearly reporting of reach and adoption levels

● Tracking of increasing or decreasing delivery costs

RE-AIM, Reach Effectiveness Adoption Implementation Maintenance; EBIs, evidence-based interventions; CEA, cost-effectiveness analysis; MISII, measure of innovation-specific implementation intentions; FTE, full-time equivalency