Implementation Resources: The Getting to Outcomes® Framework

IMAPP's implementation tools and resources are organized around the Getting to Outcomes® (GTO) framework*. GTO provides a structured approach to implementation that helps community partnerships to

  • Plan an effective intervention,
  • Implement the intervention,
  • Evaluate the intervention,
  • Improve the intervention, and
  • Sustain the intervention.

In this section of the IMAPP, we provide a high-level overview of the 10 steps and link to tools and other resources in each step that may be useful to North Carolina community partnerships.  Inclusion and exclusion criteria was used to determine whether a resource is an appropriate fit for the site.

When using the GTO framework, it is important to remember that the steps are not mutually exclusive, and they do not necessarily have to occur in this order. You may find that you need to go back and forth between steps.

A more detailed overview and focus area-specific GTO manuals are available on the RAND website. See also

  • Little GTO: This document describes each step in one overview page. 
  • Getting to Outcomes 2004: This manual provides “how-to” information and tools for each step. 


In addition, make sure to use the Nine Quality Aims for Public Health throughout the selection and implementation of your EBI to ensure quality. The Aims are:

  • Population-Centered
  • Equitable
  • Proactive
  • Health Promoting
  • Risk Reducing
  • Vigilant
  • Transparent
  • Effective
  • Efficient 


GTO as a Painter's Palette

The graphic below shows a representation of the GTO framework as a "painter's palette." To read more about the steps of the framework and access relevant resources, select a paint color (step) from the palette.

Needs and Resources   Goals and Objectives   Best Practices   Fit   Capacities   Plan   Implementation Process Evaluation   Outcome Evaluation   Improve CQI   Sustain   Success Stories  

*Development of GTO was supported by the U.S. Centers for Disease Control and Prevention, and, since 2004, it has been adapted for use in a wide range of programs. You can read more about how GTO helps address implementation challenges in Wandersman A, Alia KA, Cook B, Ramaswamy R. Integrating empowerment evaluation and quality improvement to achieve healthcare improvement outcomes. BMJ Qual Saf. 2015 Jul 15. [Epub ahead of print]