Table 2 Themes and illustrative quotes from health economists and implementation researchers

a. Common goal to make a real-world impact

HE1: I think most health economists do have a strong interest and are into the same issues that implementation researchers are interested in, like: how can we make a real-world difference with our work?”

IS1: Yeah, so I think we’re learning over time that training in EBP is such a cost prohibitive activity and so a lot of what I think about in terms of implementation strategies is around how much bang can you get for your buck, especially when you are working in a system.

b. Growth as researchers and improved the quality of the science

HE7: I think those kind of dialogues that you have if you’re an ongoing collaborator with somebody, helps change your whole way of looking at things and I think to me that’s one of the values of it.

IS1: I was really scared of calculating cost…so having this experience is really helpful in opening my eyes towards kind of what’s out there and how impactful it can be. [it] is really important for any kind of decision making.

c. Conducting cost analyses

HE3: One thing that does tend to come up, and I think this is a common misunderstanding about economics, it’s that we all do cost-benefit analysis. I don’t do cost-benefit analysis. I don’t want to do cost-benefit analysis. [Later clarified the same was true for cost-effectiveness analyses]

IS3: If you’re going to look at new estimated costs to an implementation strategy and then doing a cost effectiveness of one implementation strategy over another, it’s important to have the health economist involved or consulting.

d. Relationships and shared interests

HE2: Many more requests are usually for cost and cost effectiveness, and cost benefit. …economists don’t usually like doing that, so I really only agree to do it if … I really enjoy working with the partner, I know the partner. …if somebody wants me to do cost effectiveness analysis of an intervention, first of all, I have to be really interested in the intervention, the population they’re serving, what they’re trying to do. That needs to be of interest.

IS8: So part of it is being really inherently interested [in cost], and learning about it enough to be able to engage the economists in essentially thinking together about how they can use their tremendous vitas and skills and grant funding for all of the research that they’ve already developed, in area in which they’re already well established, to lend some of that to a collaboration in an area that may or may not be inherently interesting to them; and, to figure out how to try to make it interesting to them. And so I saw that as part of my responsibility, that was on me.

e. Limitations of grants and publications

HE5: If you’re interested in implementation science you’re never going to get into the quarterly journal of economics, it's just not gonna happen. And they don’t even really value a JAMA piece. Whereas if you’re on the medical school, that is currency.

IS6: I feel like the bigger challenge is, there just aren’t enough of them to go around. I know that I could ask [name of health economist] that he’ll tell me, “I’m 175% funded”

a. Timing and scope of involvement

HE5: Yea, I think some people are just really good about developing partnerships early, and getting people’s input early. So instead of coming to an investigator; and it could be an economist it could be a statistician; before the grant is due and think oh, we need your help, can we put you down for five percent and can you give us a power analysis or can you help us refine the third aim. I think the most successful partnerships are one where you’ve got a complicated problem and you pull the team together early.

IS3: I ask [health economists] to partner on all aspects of the research and so when we’ve written grant applications, they’re part of the study team and they’ve participated, for example the latest R01 that we’ve just received, they were on the study team from the beginning to help craft the aims. So, it’s not like we just write the grants and say hey, put in an economics aim, you know, we want them to be part of it from the beginning.

b. Methodological contributions beyond economic evaluations

HE2: For those ongoing partners where we go from one project to the next to the next, they do tend to use my skillset in a broader fashion that, to involve me in thinking about the study design, and the message and kind of in involving me in the overall meetings and you know, just trying to involve me in everything really, just to be an integral part of the team. Because they understand that I have a much broader skillset than just the cost piece. I think the thing that we’re pretty good at is attacking the question…we’re really trying to push the question. What we’re interested in, which is to say is it a causal model, do we really understand causality.

IS2: I think that the health economists that we’ve worked with have been really methodologically rigorous and have really been involved in health services research for quite a while, so they really have a valuable perspective on the broader application as well, and, so that’s been really helpful because they’ve had input in other areas besides the cost analyses that’s been really valuable.

c. Team Science

HE6: I think one of the things that always leads to a good partnership is individuals understanding what they know and don’t know, and, of course, always having that back-and-forth that constructive-type criticism--not necessarily trying to interfere with and dictate what you should be doing—willing to work with you and learn from you.

IS4: I am a firm believer that you don’t need to be an expert in everything and there’s a reason why we have interdisciplinary teams. But I do think it’s helpful if you have a basic understanding of what economic evaluations look for, not at the equation level but at the broad, kind of, here are the methods, here are the types of questions you can answer.