Frameworks

EPIS Implementation Framework

The Exploration, Preparation, Implementation, and Sustainment (EPIS) framework was developed based on the review of the literature on implementation projects in social and health service systems in the US (see Figure 2). (4,5) The EPIS framework consists of four phases and identifies key constructs, as well as “bridging factors” that are characteristics of the evidence-based practice (EBP) being implemented that may impact implementation. (4,5) The Exploration phase considers the health needs of the patient population and identifies the most effective evidence-based practices (EBPs) to address those needs. Once EBPs or innovations are identified, the Preparation phase starts. During the Preparation phase, potential barriers and facilitators of implementation are identified across outer and/or inner context (e.g., funding, leadership, patient and staff characteristics) of the community and clinical settings through a needs assessment. A needs assessment informs a detailed implementation plan that leverages the facilitators (qualities that facilitate the implementation process) and addresses potential barriers (qualities that hinder the implementation process) across subsequent phases to achieve sustainable EBP in that setting. In the Implementation phase, EBPs are initiated in the clinical and/or community setting. Ongoing monitoring of the implementation process is essential to assess effectiveness of the implementation and make adjustments. In the Sustainment phase, the outer and inner context structures, processes, and supports are ongoing so that the EBP continues to be delivered. (4,5).

**Figure 2. EPIS Framework: Exploration, Preparation, Implementation, Sustainment.**

RE-AIM Implementation Framework

The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was developed to improve translatability and public health impact of evidence-based practices (see Figure 3). (6,7) The first dimension, Reach, refers to the absolute number, proportion, and representativeness/diversity of individuals willing to participate in a given intervention. The second dimension, Effectiveness, evaluates the impact of an intervention, including potential negative effects, quality of life, and economic outcomes. The third dimension, Adoption, defines the absolute number, proportion, diversity of community and clinical settings and intervention agents willing to initiate a program. The fourth dimension, Implementation, refers to the reliability of intervention being delivered to the various elements of an intervention’s protocol. Elements include consistency of delivery as intended, adaptations made, and the time and cost of the intervention. The last dimension, Maintenance, defines the extent to which a program or policy becomes institutionalized as part of the routine organizational practices and policies. The maintenance element also has referents at the individual level based on sustained changes and long-term outcomes. (6,7)

EPIS Implementation Framework

The Exploration, Preparation, Implementation, and Sustainment (EPIS) framework was developed based on the review of the literature on implementation projects in social and health service systems in the US (see Figure 2). (4,5) The EPIS framework consists of four phases and identifies key constructs, as well as “bridging factors” that are characteristics of the evidence-based practice (EBP) being implemented that may impact implementation. (4,5) The Exploration phase considers the health needs of the patient population and identifies the most effective evidence-based practices (EBPs) to address those needs. Once EBPs or innovations are identified, the Preparation phase starts. During the Preparation phase, potential barriers and facilitators of implementation are identified across outer and/or inner context (e.g., funding, leadership, patient and staff characteristics) of the community and clinical settings through a needs assessment. A needs assessment informs a detailed implementation plan that leverages the facilitators (qualities that facilitate the implementation process) and addresses potential barriers (qualities that hinder the implementation process) across subsequent phases to achieve sustainable EBP in that setting. In the Implementation phase, EBPs are initiated in the clinical and/or community setting. Ongoing monitoring of the implementation process is essential to assess effectiveness of the implementation and make adjustments. In the Sustainment phase, the outer and inner context structures, processes, and supports are ongoing so that the EBP continues to be delivered. (4,5).

RE-AIM Implementation Framework

The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was developed to improve translatability and public health impact of evidence-based practices (see Figure 3). (6,7) The first dimension, Reach, refers to the absolute number, proportion, and representativeness/diversity of individuals willing to participate in a given intervention. The second dimension, Effectiveness, evaluates the impact of an intervention, including potential negative effects, quality of life, and economic outcomes. The third dimension, Adoption, defines the absolute number, proportion, diversity of community and clinical settings and intervention agents willing to initiate a program. The fourth dimension, Implementation, refers to the reliability of intervention being delivered to the various elements of an intervention’s protocol. Elements include consistency of delivery as intended, adaptations made, and the time and cost of the intervention. The last dimension, Maintenance, defines the extent to which a program or policy becomes institutionalized as part of the routine organizational practices and policies. The maintenance element also has referents at the individual level based on sustained changes and long-term outcomes. (6,7)