Estimating Downstream Budget Impacts in Implementation Research

Dopp, Alex R.; Gold, Heather T.

doi:10.1177/0272989x20954387

Cited by 12 publications

(10 citation statements)

References 53 publications

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“…[45][46][47] In a separate study, we discuss methods for estimating the total budgetary impact by combining the implementation intervention costs with downstream health care costs. 48 The main limitation of a BIA, however, is its narrow focus on costs from a specific perspective over a relatively short term. The BIA can often be extended to include process outcomes relatively easily.…”

Section: Discussionmentioning

confidence: 99%

Estimating Costs of an Implementation Intervention

Yoon

Jacobs

et al. 2020

Med Decis Making

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Health care systems frequently have to decide whether to implement interventions designed to reduce gaps in the quality of care. A lack of information on the cost of these interventions is often cited as a barrier to implementation. In this article, we describe methods for estimating the cost of implementing a complex intervention. We review methods related to the direct measurement of labor, supplies and space, information technology, and research costs. We also discuss several issues that affect cost estimates in implementation studies, including factor prices, fidelity, efficiency and scale of production, distribution, and sunk costs. We examine case studies for stroke and depression, where evidence-based treatments exist and yet gaps in the quality of care remain. Understanding the costs for implementing strategies to reduce these gaps and measuring them consistently will better inform decision makers about an intervention’s likely effect on their budget and the expected costs to implement new interventions.

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Section: Discussionmentioning

confidence: 99%

Estimating Costs of an Implementation Intervention

Yoon

Jacobs

et al. 2020

Med Decis Making

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“…An important step in moving toward sustainability is establishing the return-on-investment for community-implemented projects. The ability to demonstrate to stakeholders that the resources necessary to start and maintain the EBI can pay dividends (e.g., improved clinical outcomes, increased community throughput, decreased employee turnover or burnout) can improve the potential for both scaling and sustaining EBI implementation efforts ( 31 – 33 ).…”

Section: Resultsmentioning

confidence: 99%

A Roadmap to Inform the Implementation of Evidence-Based Collaborative Care Interventions in Communities: Insights From the Michigan Mental Health Integration Partnership

Rusch

DeCamp

Liebrecht

et al. 2021

Front. Public Health

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Background: Despite increasing calls for further spread of evidence-based collaborative care interventions (EBIs) in community-based settings, practitioner-driven efforts are often stymied by a lack of experience in addressing barriers to community-based implementation, especially for those not familiar with implementation science. The Michigan Mental Health Integration Partnership (MIP) is a statewide initiative that funds projects that support implementation and uptake of EBIs in community-based settings. MIP also provides an in situ implementation laboratory for understanding barriers to the uptake of EBIs across a variety of settings. We report findings from a statewide qualitative study of practitioners involved in MIP projects to garner their perspectives of best practices in the implementation of EBIs.Methods: Twenty-eight semi-structured interviews of practitioners and researchers from six MIP Projects were conducted with individuals implementing various MIP EBI projects across Michigan, including stakeholders from project teams, implementation sites, and the State of Michigan, to identify common barriers, challenges, and implementation strategies deployed by the project teams, with the purpose of informing a set of implementation steps and milestones.Results: Stakeholders identified a number of barriers to and strategies for success, including the need for tailoring program deployment and implementation to specific site needs, development of web-based tools for facilitating program implementation, and the importance of upper-level administration buy-in. Findings informed our resultant community-based Implementation Roadmap, which identifies critical steps across three implementation phases—pre-implementation, implementation, and sustainability—for implementation practitioners to use in their EBI implementation efforts.Conclusion: Implementation practitioners interested in community-based EBI implementation often lack access to operationalized implementation “steps” or “best practices” that can facilitate successful uptake and evaluation. Our community-informed MIP Implementation Roadmap, offering generalized steps for reaching successful implementation, uses experiences from a diverse set of MIP teams to guide practitioners through the practices necessary for scaling up EBIs in community-based settings over pre-implementation, implementation and sustainability phases.

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“…Research-specific activities that were essential to designing and developing the original implementation generally should be excluded, sometimes called pre-implementation or design components [ 9 , 28 ]. For example, we would exclude the time required for survey completion or laboratory tests that were only used for evaluating implementation study outcomes, if those surveys or laboratory tests would not be part of usual care [ 3 , 29 ]. Two exceptions to this approach may be considered.…”

Section: Types Of Costs To Consider Measuring For An Implementation Studymentioning

confidence: 99%

“…A limitation with both charges and payments is the inability to separate variable and fixed costs. The inclusion of fixed costs can confound an analysis with a short time horizon; not only do the fixed costs overstate the costs that can be varied, but variation in the fixed costs can also reduce the power to detect meaningful differences in variable costs [ 3 ].…”

Section: Costing: Accuracy and Precisionmentioning

confidence: 99%

“…Costs have been identified as a key outcome in implementation research [ 1 , 2 ], yet there is little guidance on how to measure costs as distinct from more traditional cost-effectiveness analyses. Importantly, an implementation strategy may affect its target intervention and have further downstream impacts [ 2 ], all of which should be considered in the analysis [ 3 ]. Economic evaluations (comparing alternatives based on both costs and benefits) can inform resource allocation decisions and influence stakeholder acceptability, adoption, or sustainability of an implementation strategy or intervention [ 4 – 6 ].…”

Section: Introductionmentioning

confidence: 99%

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Cost data in implementation science: categories and approaches to costing

Gold¹,

McDermott

Hoomans

2022

Implementation Sci

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A lack of cost information has been cited as a barrier to implementation and a limitation of implementation research. This paper explains how implementation researchers might optimize their measurement and inclusion of costs, building on traditional economic evaluations comparing costs and effectiveness of health interventions. The objective of all economic evaluation is to inform decision-making for resource allocation and to measure costs that reflect opportunity costs—the value of resource inputs in their next best alternative use, which generally vary by decision-maker perspective(s) and time horizon(s). Analyses that examine different perspectives or time horizons must consider cost estimation accuracy, because over longer time horizons, all costs are variable; however, with shorter time horizons and narrower perspectives, one must differentiate the fixed and variable costs, with fixed costs generally excluded from the evaluation. This paper defines relevant costs, identifies sources of cost data, and discusses cost relevance to potential decision-makers contemplating or implementing evidence-based interventions. Costs may come from the healthcare sector, informal healthcare sector, patient, participant or caregiver, and other sectors such as housing, criminal justice, social services, and education. Finally, we define and consider the relevance of costs by phase of implementation and time horizon, including pre-implementation and planning, implementation, intervention, downstream, and adaptation, and through replication, sustainment, de-implementation, or spread.

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Estimating Downstream Budget Impacts in Implementation Research

Cited by 12 publications

References 53 publications

Estimating Costs of an Implementation Intervention

Estimating Costs of an Implementation Intervention

A Roadmap to Inform the Implementation of Evidence-Based Collaborative Care Interventions in Communities: Insights From the Michigan Mental Health Integration Partnership

Cost data in implementation science: categories and approaches to costing

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