Table 1 Example for specifying dimensions of a policy’s function (Recommendation 1)

Example scenario

A state health agency announces a policy that requires insurance companies and contracted providers to report on quality metrics related to the delivery of behavioral health services.

EPIS framework application steps

1. Review legal documents or conduct qualitative interviews with policymakers to specify the policy goal(s).

  • The policy goal is to increase the quality of behavioral health services delivered.

2. Review legal documents to specify the policy type as part of its innovation characteristics or to place it as a determinant or other variable within the EPIS framework.

  • The policy is a “big P” policy type because it arises from the state health agency and requires compliance from payors and providers.

3. Conduct a landscape analysis and/or speak with stakeholders about the policy to describe the multi-level outer and inner contexts affected by dissemination and implementation efforts and determine whether they are multi-level.

  • The state health agency is part of the outer context.

  • The multi-level inner context consists of insurance companies and provider organizations who must submit quality metric reports.

  • Further investigation is needed to better define the outer and inner contexts and their relevant stakeholders. EPIS constructs (e.g., leadership, organizational characteristics, service environment) should be investigated regarding the state health agency, insurance companies, and provider organizations. For example, is outer context leadership limited to the state health agency, or should it also include the governor or federal agency leaders? Is the service environment specific to publicly funded behavioral health services, or does this include privately funded care?

4. Review legal documents, policy budgets, and any investigative journalism published about the policy to identify any capital exchanged.

  • The capital exchanged via the policy is data on the quality of behavioral health services delivered.

  • Researchers should examine how frequently this capital is exchanged and which stakeholders stand to benefit from these data (e.g., patients deciding about care options, provider organizations seeking a competitive ranking, vendors paid to manage the reporting system).