The CFIR does not explicitly incorporate implementation outcomes. Proctor et al. (2011) published a framework of outcomes that includes a list of potential measures. For example, Penetration is the extent to which an innovation is integrated within a service setting and its subsystems. In our evaluation of a telephone-based lifestyle coaching program (pending publication) and several other studies, we operationalized Penetration as referral rate – a high patient referral rate signified implementation success. It is important to understand the causal pathway and to identify an outcome that is closely associated with implementation efforts.