Table 2 Example of costing adaptations organized by the RE-AIM framework
From: The economics of adaptations to evidence-based practices
RE-AIM domain | Outcome | Adaptation | Cost relevance implications of adaptation | Considerations for cost analysis | Planned vs. unplanned |
|---|---|---|---|---|---|
Reach | Number of patients with at least one ORC appointment | Expanding eligibility criteria for ORC services | Time/resources required for serving additional patients | Interrupted time series could examine cost of new policy on patient reach | Unplanned. Causal inference may not be achieved due to endogeneity |
Effectiveness | Number of patients on high-risk LTOT transitioned to safer regimens | New initiative at site requires regular monitoring of patients transferred to safer regimens | Time/resources required for monitoring patients post launch of the initiative | Interrupted time series could examine cost of adaptation on effectiveness per time unit | Unplanned. Causal inference may not be achieved due to endogeneity |
Adoption | Number of providers referring patients for opioid reassessment | New dashboard for PCPs to determine patients pre-requisites for ORC | Start-up costs for dashboard development along w/ training in the use of dashboard | The additional implementation costs could be assessed in relevance to outcome of interest | Unplanned. Causal inference may not be achieved due to endogeneity |
Implementation | Number of patients seen by ORC | Tele-ORC tested at random sites due to COVID | Start-up costs for training on Tele-ORC and coordination. Changes in patient health care utilization due to tele-health delivery | Sensitivity analysis could show cost differentials in these delivery methods | Planned. Causal inference may be achieved with random assignment |
Number of patients successfully completing treatment with ORC | New addiction specialist hired on site w/ specialty in tapering | Salary addition for new specialist on the implementation team. More time consulting/coordinating care w/ more patients | The additional implementation costs could be assessed in relevance to increased rate of outcome per unit time | Unplanned. Causal inference may not be achieved due to endogeneity | |
Maintenance | Number of providers referring patients for opioid reassessment and completed consults, and number of patients seen | Tele-ORC maintained due to COVID and expanded in a step-wedged fashion to other sites | Additional start-up costs for training on Tele-ORC and coordination. Patient health care utilization continues to differ due to tele-health delivery | Sensitivity analysis could show cost differentials in these delivery methods | Planned. Causal inference may be achieved due to random assignment |