Department of Behavioral and Policy Sciences, RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA.
Graduate School of Social Work, University of Denver, Craig Hall, 2148 South High St, Denver, 80208, CO, USA.
Implement Sci. 2021 Jun 29;16(1):66. doi: 10.1186/s13012-021-01137-9.
Implementation researchers are increasingly using economic evaluation to explore the benefits produced by implementing evidence-based practices (EBPs) in healthcare settings. However, the findings of typical economic evaluations (e.g., based on clinical trials) are rarely sufficient to inform decisions about how health service organizations and policymakers should finance investments in EBPs. This paper describes how economic evaluations can be translated into policy and practice through complementary research on financing strategies that support EBP implementation and sustainment.
We provide an overview of EBP implementation financing, which outlines key financing and health service delivery system stakeholders and their points of decision-making. We then illustrate how economic evaluations have informed decisions about EBP implementation and sustainment with three case examples: (1) use of Pay-for-Success financing to implement multisystemic therapy in underserved areas of Colorado, USA, based in part on the strength of evidence from economic evaluations; (2) an alternative payment model to sustain evidence-based oncology care, developed by the US Centers for Medicare and Medicaid Services through simulations of economic impact; and (3) use of a recently developed fiscal mapping process to collaboratively match financing strategies and needs during a pragmatic clinical trial for a newly adapted family support intervention for opioid use disorder.
EBP financing strategies can help overcome cost-related barriers to implementing and sustaining EBPs by translating economic evaluation results into policy and practice. We present a research agenda to advance understanding of financing strategies in five key areas raised by our case examples: (1) maximize the relevance of economic evaluations for real-world EBP implementation; (2) study ongoing changes in financing systems as part of economic evaluations; (3) identify the conditions under which a given financing strategy is most beneficial; (4) explore the use and impacts of financing strategies across pre-implementation, active implementation, and sustainment phases; and (5) advance research efforts through strong partnerships with stakeholder groups while attending to issues of power imbalance and transparency. Attention to these research areas will develop a robust body of scholarship around EBP financing strategies and, ultimately, enable greater public health impacts of EBPs.
实施研究人员越来越多地使用经济评估来探索在医疗保健环境中实施基于证据的实践（EBP）所带来的收益。然而，典型的经济评估（例如基于临床试验的评估）的结果通常不足以为卫生服务组织和决策者如何为 EBP 的投资提供资金提供信息。本文描述了如何通过对支持 EBP 实施和维持的融资策略进行补充研究，将经济评估转化为政策和实践。
我们概述了 EBP 实施融资，其中概述了关键的融资和卫生服务提供系统利益相关者及其决策点。然后，我们通过三个案例示例说明了经济评估如何为 EBP 的实施和维持做出决策：（1）利用成功付费融资在美国科罗拉多州服务不足的地区实施多系统疗法，部分基于经济评估结果的强度；（2）美国医疗保险和医疗补助服务中心通过对经济影响进行模拟，开发了一种维持循证肿瘤护理的替代支付模式；（3）在一项新改编的家庭支持干预药物使用障碍的实用临床试验中，使用最近开发的财政映射过程来协作匹配融资策略和需求。
EBP 融资策略可以通过将经济评估结果转化为政策和实践，帮助克服实施和维持 EBP 的成本相关障碍。我们提出了一个研究议程，以推进我们案例示例提出的五个关键领域的融资策略理解：（1）使经济评估更能为现实世界的 EBP 实施提供参考；（2）在经济评估中研究融资系统的持续变化；（3）确定给定融资策略最有利的条件；（4）探索融资策略在实施前、实施中和维持阶段的使用和影响；（5）通过与利益相关者团体建立强有力的伙伴关系并关注权力不平衡和透明度问题，推进研究工作。关注这些研究领域将围绕 EBP 融资策略发展出一个稳健的学术研究体系，并最终使 EBP 产生更大的公共卫生影响。
