Mixed-method approaches to strengthen economic evaluations in implementation research

Abstract

BackgroundGuidance from economic evaluations on which implementation strategies represent the best return on investment will be critical to advancing the Triple Aim of health care: improving patient care and population health while minimizing per-capita cost. The results of traditional (quantitative) economic evaluations are limited by a remaining “qualitative residual” of contextual information and stakeholders perspectives, which cannot be captured by monetary values alone and is particularly prevalent in implementation science research. The emergence of qualitative methods for economic evaluation offers a promising solution.Main bodyTo maximize the contributions of economic evaluations to implementation science, we recommend that researchers embrace a mixed-methods research agenda that merges traditional quantitative approaches with innovative, contextually grounded qualitative methods. Such studies are exceedingly rare at present. To assist implementation scientists in making use of mixed methods in this research context, we present an adapted taxonomy of mixed-method studies relevant to economic evaluation. We then illustrate the application of mixed methods in a recently completed cost-effectiveness evaluation, making use of an adapted version of reporting standards for economic evaluations.ConclusionsBy incorporating qualitative methods, implementation researchers can enrich their economic evaluations with detailed, context-specific information that tells the full story of the costs and impacts of implementation. We end by providing suggestions for building a research agenda in mixed-method economic evaluation, along with more resources and training to support investigators who wish to answer our call to action.

Collaborating with health economists to advance implementation science: a qualitative study

“…Likewise, if an implementation effort is not adequately financed, it is unlikely to be sustained [2]. Although cost has been identified as a key implementation outcome, it is not frequently evaluated within implementation studies [2][3][4][5]. In order for decision makers to determine if they are going to implement an EBP and the associated strategies to implement it, information on cost is needed.…”

Building capacity for dissemination and implementation to maximize research impact in a CTSA: The University of Wisconsin story

“…A growing literature stresses the importance of economic evaluation in implementation research and establishing a business case for D&I [11]. The return on investment in D&I can be measured by the impact of research conducted at our institution from the perspective of the communities the university serves.…”

Comparing, Contrasting, and Integrating Dissemination and Implementation Outcomes Included in the RE-AIM and Implementation Outcomes Frameworks

“…The area of cost assessment and analysis in dissemination and implementation science is emerging ( 16 , 19 ) and the expanded cost metrics provide a methodology for assessing costs related to reach, adoption, implementation, and organizational maintenance—with a focus on both the strategies used to enhance each outcome and the operational costs associated with each dimension. This will allow for the development of cost simulation models ( 28 ) that could vary dissemination and implementation strategy use and provide variable budget impact scenarios for systems considering the uptake of a new evidence-based intervention. For example, a new evidence-based diabetes prevention intervention, being introduced for community YMCAs could use dissemination and implementation strategies that include marketing strategies to increase adoption, participant incentives to increase reach, auditing and feedback processes to improve implementation, and a budget matrixing activity to improve likelihood of organizational maintenance.…”