Table 2.
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