How do researchers conceptualize and plan for the sustainability of their NIH R01 implementation projects?

Johnson, Alekhya Mascarenhas; Moore, Julia E.; Chambers, David A.; Rup, Jennifer; Dinyarian, Camellia; Straus, Sharon E.

doi:10.1186/s13012-019-0895-1

Cited by 28 publications

(32 citation statements)

References 21 publications

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“…Third, our results support a need for more flexible and dynamic assessments of sustainment when comparing diverse EBPs [ 42 , 43 ]. Although there were differences among teams based on implementation success at 6 months, our anticipated sustainment measure was a more accurate indicator of actual sustainment than implementation milestones.…”

Section: Discussionsupporting

confidence: 67%

Implementation and sustainment of diverse practices in a large integrated health system: a mixed methods study

Nevedal

Reardon

Jackson

et al. 2020

Implement Sci Commun

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Background One goal of health systems seeking to evolve into learning health systems is to accelerate the implementation and sustainment of evidence-based practices (EBPs). As part of this evolution, the Veterans Health Administration (VHA) developed the Innovation Ecosystem, which includes the Diffusion of Excellence (DoE), a program that identifies and diffuses Gold Status Practices (GSPs) across facilities. The DoE hosts an annual “Shark Tank” competition in which leaders bid on the opportunity to implement a GSP with 6 months of implementation support. Over 750 diverse practices were submitted in cohorts 2 and 3 of Shark Tank; 23 were designated GSPs and were implemented in 31 VA networks or facilities. As part of a national evaluation of the DoE, we identified factors contributing to GSP implementation and sustainment. Methods Our sequential mixed methods evaluation of cohorts 2 and 3 of Shark Tank included semi-structured interviews with at least one representative from 30/31 implementing teams ( N = 78/105 people invited) and survey responses from 29/31 teams ( N = 39/47 invited). Interviews focused on factors influencing implementation and future sustainment. Surveys focused on sustainment 1.5–2 years after implementation. The Consolidated Framework for Implementation Research (CFIR) informed data collection and directed content analysis. Ordinal scales were developed inductively to rank implementation and sustainment outcomes. Results Over 50% of teams (17/30) successfully implemented their GSP within the 6-month implementation period. Despite extensive implementation support, significant barriers related to centralized decision-making, staffing, and resources led to partial ( n = 6) or no ( n = 7) implementation for the remaining teams. While 12/17 initially successful implementation teams reported sustained use of their GSP, over half of the initially unsuccessful teams ( n = 7/13) also reported sustained GSP use 1.5 years after the initial implementation period. When asked at 6 months, 18/27 teams with complete data accurately anticipated their future sustainability based on reported sustainment an average of 1.5 years later. Conclusions Most teams implemented within 6 months and/or sustained their GSP 1.5 years later. High levels of implementation and sustainment across diverse practices and teams suggest that VHA’s DoE is a successful large-scale model of diffusion. Team predictions about sustainability after the first 6 months of implementation provide a promising early assessment and point of intervention to increase sustainability.

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Section: Discussionsupporting

confidence: 67%

Implementation and sustainment of diverse practices in a large integrated health system: a mixed methods study

Nevedal

Reardon

Jackson

et al. 2020

Implement Sci Commun

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“…Sustainment has been comparatively less studied than other phases of the implementation process [39]. There are multiple explanations for the paucity of work on this topic [8,24,27,28].…”

Section: Moullin Et Al Implementation Science Communicationsmentioning

confidence: 99%

Advancing the pragmatic measurement of sustainment: a narrative review of measures

Moullin

Sklar

Green

et al. 2020

Implement Sci Commun

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Background Sustainment, an outcome indicating an intervention continues to be implemented over time, has been comparatively less studied than other phases of the implementation process. This may be because of methodological difficulties, funding cycles, and minimal attention to theories and measurement of sustainment. This review synthesizes the literature on sustainment measures, evaluates the qualities of each measure, and highlights the strengths and gaps in existing sustainment measures. Results of the review will inform recommendations for the development of a pragmatic, valid, and reliable measure of sustainment. Methods A narrative review of published sustainment outcome and sustainability measures (i.e., factors that influence sustainment) was conducted, including appraising measures in the Society of Implementation Research Collaboration (SIRC) instrument review project (IRP) and the Dissemination and Implementation Grid-Enabled Measures database initiative (GEM-D&I). The narrative review used a snowballing strategy by searching the reference sections of literature reviews and definitions of sustainability and sustainment. Measures used frequently and judged to be comprehensive and/or validated by a team of implementation scientists were extracted for analysis. Results Eleven measures were evaluated. Three of the included measures were found in the SIRC-IRP, three in the GEM-D&I database, (one measure was in both databases) and six were identified in our additional searches. Thirteen constructs relating to sustainment were coded from selected measures. Measures covered a range of determinants for sustainment (i.e., construct of sustainability) as well as constructs of sustainment as an outcome. Strengths of the measures included, development by expert panels knowledgeable about particular interventions, fields or contexts, and utility in specific scenarios. A number of limitations were found in the measures analyzed including inadequate assessment of psychometric characteristics, being overly intervention or context specific, being lengthy and/or complex, and focusing on outer context factors. Conclusion There is a lack of pragmatic and psychometrically sound measures of sustainment that can be completed by implementation stakeholders within inner context settings (e.g., frontline providers, supervisors).

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“…Healthcare research continuously produces new and innovative findings but there is evidence that these improvements are often forgotten, changed or replaced in practice long before they can reach wider populations [1][2][3][4][5][6]. Therefore, the sustainability of evidence-based interventions has been identified as one of the most critical gaps in implementation science [3,7,8].…”

Section: Introductionmentioning

confidence: 99%

Making change last? Exploring the value of sustainability approaches in healthcare: a scoping review

Lennox

Linwood-Amor

Maher

et al. 2020

Health Res Policy Sys

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Background Numerous models, tools and frameworks have been produced to improve the sustainability of evidence-based interventions. Due to the vast number available, choosing the most appropriate one is increasingly difficult for researchers and practitioners. To understand the value of such approaches, evidence warranting their use is needed. However, there is limited understanding of how sustainability approaches have been used and how they have impacted research or practice. This review aims to consolidate evidence on the application and impact of sustainability approaches in healthcare settings. Methods A systematic scoping review was designed to search for peer-reviewed publications detailing the use of sustainability approaches in practice. A 5-stage framework for scoping reviews directed the search strategy, and quality assessment was performed using the Mixed Method Appraisal Tool. Searches were performed through electronic citation tracking and snowballing of references. Articles were obtained through Web of Science, PubMed and Google Scholar. Six outcome variables for sustainability were explored to ascertain impact of approaches. Results This review includes 68 articles demonstrating the application of sustainability approaches in practice. Results show an increase in the use of sustainability approaches in peer-reviewed studies. Approaches have been applied across a range of healthcare settings, including primary, secondary, tertiary and community healthcare. Approaches are used for five main purposes, namely analysis, evaluation, guidance, assessment and planning. Results outline benefits (e.g. improved conceptualisation of sustainability constructs and improved ability to interpret sustainability data) and challenges (e.g. issues with approach constructs and difficulty in application) associated with using a sustainability approach in practice. Few articles (14/68) reported the sustainability outcome variables explored; therefore, the impact of approaches on sustainability remains unclear. Additional sustainability outcome variables reported in retrieved articles are discussed. Conclusions This review provides practitioners and researchers with a consolidated evidence base on sustainability approaches. Findings highlight the remaining gaps in the literature and emphasise the need for improved rigour and reporting of sustainability approaches in research studies. To guide future assessment and study of sustainability in healthcare settings an updated list of sustainability outcome variables is proposed. Trial Registration This review was registered on the PROSPERO database CRD 42016040081 in June 2016.

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How do researchers conceptualize and plan for the sustainability of their NIH R01 implementation projects?

Cited by 28 publications

References 21 publications

Implementation and sustainment of diverse practices in a large integrated health system: a mixed methods study

Implementation and sustainment of diverse practices in a large integrated health system: a mixed methods study

Advancing the pragmatic measurement of sustainment: a narrative review of measures

Making change last? Exploring the value of sustainability approaches in healthcare: a scoping review

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