Outcome Measurement Program Case Studies

Multiple Case Study Approach

A multiple case study approach was selected to enable the research team to use a holistic and integrated approach (Crowe et al., 2011; Yin, 1994) to understand how the HCBS OM tools are implemented in real-life contexts. The goal of these case studies was to assess if they are implemented as their designers intended, a concept described as “implementation fidelity” (Dusenbury et al., 2003; Carroll et al., 2007; Damschroder et al., 2009).  A series of case studies also allows researchers to compare and contrast implementation patterns across multiple types of HCBS OM tools (Crowe et al., 2011).  Past research demonstrates that the degree of implementation fidelity in the application of a program model is viewed as a potential moderating factor in how well a program achieves its desired goals or outcomes (Dusenbury, Brannigan, Falco, and Hansen, 2003; Schneider, 1998).   For this reason, researchers in recent decades have focused significant attention on implementation issues. The methods and theories on the relationship of implementation to program success have evolved considerably. 

The Consolidated Framework for Implementation Research (CFIR) was used for these case studies (Damschroder et al., 2009). The CFIR was derived through an analysis of implementation science research efforts that offer iterative steps toward standard terms and theories (Damschroder et al., 2009). The CFIR provides a limited group of constructs supported by well-researched evidence tied to constructs of implementation effectiveness.  CFIR is intended to be used as a menu from which researchers can select constructs that are relevant to their proposed analysis, and the CFIR developers encourage users to adapt the framework as needed (Damschroder et al., 2009; See Appendix A for a summary of how the framework was adapted for this case study).