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Abstract
The Department of Defense (DoD) and veterans affairs (VA) built the practice-based implementation (PBI) Network in 2013 to facilitate more rapid translation of psychological health (PH) research findings into clinical practice. DoD PBI Network operations include centrally located facilitators, a military treatment facility PH clinic network, liaison site champions, and enterprise governance. The PBI Network works to identify new research findings for enterprise-wide practice change implementation; pilots identified practice changes; evaluates implementation; and provides enterprise feedback to inform policy and practice decisions. Infrastructure establishment yielded two major benefits: increased speed of selecting, piloting, and adopting sustained practice change, and increased stakeholder buy-in during implementation. The PBI Network grant final report required evaluation of return-on-investment (ROI) (DoD Citation2016). The DoD health care system did not produce data necessary to conduct a traditional ROI, or to assess cost effectiveness using normally qualifying concept categories; the complex framework of the PBI Network includes many intrinsic factors not normally qualifying for a traditional ROI analysis. Instead, we developed a new alternative model and methodology, identified data requirements and limitations, and tested the model. This manuscript describes the theoretical basis for the model and methodology, and explores further potential applications of the model.
Disclosure statement
No potential conflict of interest was reported by the authors.
Notes on Contributors
Kate McGraw, PhD, clinical psychologist, is the Deputy Division Chief of the Psychological Health Center of Excellence where she originally co-lead the development of the concept, pilot, implementation, and sustainment of the VA/DoD PBI Network, and the ROI general concept. Brett Gelso, PhD, health economist, co-developed the economic model for the ROI.
David Barry, PsyD, clinical psychologist, was instrumental in the implementation of the first PBI Network pilot, and the development of the ROI concept.
Meghan Short Bechowski, MPH, health economist, strengthened the ROI concept.
Keryn Tate, MPH, continues to support PBI Network implementation pilots and evaluation of pilot results.
Jorielle Houston, PhD, clinical psychologist, is the current lead for the DoD PBI Netowrk, and ensures sustainment of the effort.
All authors were employed by DoD either when this theoretical framework was conceptualized and evaluated, or when working to describe it in this article.
Notes
2 The Clinger-Cohen Act of 1996 was the first legislation to support using ROI to evaluate the effectiveness of DoD programs and policies. As noted in this research, there are significant limitations to using ROI to evaluation government programs. The approach outlined in this article address several limitations by expanding the definition of ROI to include aspects of the PBI Network that are non-marketed and do not pass through interactions of supply and demand. See: https://www.gpo.gov/fdsys/pkg/PLAW-104publ106/html/PLAW-104publ106.htm.
3 The Static Cost model presented in this research assumes all inputs for the model are fixed at one point in time, As such military rotational assignments and civilian turnover, which is common in the DoD environment, is not incorporated into the cost model.
4 Wage rate is obtained through the use of a separate empirical model. Wage rates for various labor categories are available at an abundant amount of public sources. For example, the US B. of Labor Statistics provides wages by occupation and area, and is available at: https://www.bls.gov/bls/blswage.htm. Since the purpose of this research is to develop a conceptual framework to quantify the ROI of the PBI Network, further discussion of the empirical estimation of wages is not presented.