Understanding pathways from implementation to sustainment: a longitudinal, mixed methods analysis of promising practices implemented in the Veterans Health Administration.

Autor: Nevedal AL; Center for Clinical Management Research (CCMR), Veterans Affairs Ann Arbor Healthcare System, 2215 Fuller Rd, Mail Stop 152, Ann Arbor, MI, 48105, USA. Andrea.Nevedal@va.gov., Widerquist MAO; Center for Clinical Management Research (CCMR), Veterans Affairs Ann Arbor Healthcare System, 2215 Fuller Rd, Mail Stop 152, Ann Arbor, MI, 48105, USA., Reardon CM; Center for Clinical Management Research (CCMR), Veterans Affairs Ann Arbor Healthcare System, 2215 Fuller Rd, Mail Stop 152, Ann Arbor, MI, 48105, USA., Arasim M; Center for Clinical Management Research (CCMR), Veterans Affairs Ann Arbor Healthcare System, 2215 Fuller Rd, Mail Stop 152, Ann Arbor, MI, 48105, USA., Jackson GL; Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA.; Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA., White B; Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA., Burns M; Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA., Fix GM; Center for Healthcare Organization & Implementation Research (CHOIR), Bedford & Boston Veterans Affairs Medical Centers, Bedford & Boston, MA, USA.; Section of General Internal Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.; Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA., DeLaughter K; Center for Healthcare Organization & Implementation Research (CHOIR), Bedford & Boston Veterans Affairs Medical Centers, Bedford & Boston, MA, USA., Cutrona SL; Center for Healthcare Organization & Implementation Research (CHOIR), Bedford & Boston Veterans Affairs Medical Centers, Bedford & Boston, MA, USA.; Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA.; Division of General Internal Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA., Gifford AL; Center for Healthcare Organization & Implementation Research (CHOIR), Bedford & Boston Veterans Affairs Medical Centers, Bedford & Boston, MA, USA.; Section of General Internal Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.; Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA., Jasuja GK; Center for Healthcare Organization & Implementation Research (CHOIR), Bedford & Boston Veterans Affairs Medical Centers, Bedford & Boston, MA, USA.; Section of General Internal Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.; Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA., Hogan TP; Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA.; Center for Healthcare Organization & Implementation Research (CHOIR), Bedford & Boston Veterans Affairs Medical Centers, Bedford & Boston, MA, USA., King HA; Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA.; Department of Population Health Sciences, Duke University, Durham, NC, USA.; Division of General Internal Medicine, Duke University, Durham, NC, USA., Henderson B; Innovation Ecosystem, United States Veterans Health Administration, Washington, DC, USA., Damschroder LJ; Center for Clinical Management Research (CCMR), Veterans Affairs Ann Arbor Healthcare System, 2215 Fuller Rd, Mail Stop 152, Ann Arbor, MI, 48105, USA.
Jazyk: angličtina
Zdroj: Implementation science : IS [Implement Sci] 2024 May 07; Vol. 19 (1), pp. 34. Date of Electronic Publication: 2024 May 07.
DOI: 10.1186/s13012-024-01361-z
Abstrakt: Background: The Veterans Health Administration (VHA) is the United States largest learning health system. The Diffusion of Excellence (DoE) program is a large-scale model of diffusion that identifies and diffuses evidence-informed practices across VHA. During the period of 2016-2021, 57 evidence-informed practices were implemented across 82 VHA facilities. This setting provides a unique opportunity to understand sustainment determinants and pathways. Our objective was to characterize the longitudinal pathways of practices as they transition from initial implementation to long-term sustainment at each facility.
Methods: A longitudinal, mixed-methods evaluation of 82 VHA facilities. Eighty-two facility representatives, chosen by leadership as points-of-contact for 57 DoE practices, were eligible for post-implementation interviews and annual sustainment surveys. Primary outcomes (implementation, sustainment), and secondary outcomes (institutionalization, effectiveness, anticipated sustainment) at four time-points were collected. We performed descriptive statistics and directed content analysis using Hailemariam et al.'s factors influencing sustainment.
Results: After approximately five years post-implementation (e.g., 2021 sustainment outcomes), of the 82 facilities, about one-third fully sustained their practice compared to one-third that did not fully sustain their practice because it was in a "liminal" stage (neither sustained nor discontinued) or permanently discontinued. The remaining one-third of facilities had missing 2021 sustainment outcomes. A higher percentage of facilities (70%) had inconsistent primary outcomes (changing over time) compared to facilities (30%) with consistent primary outcomes (same over time). Thirty-four percent of facilities with sustained practices reported resilience since they overcame implementation and sustainment barriers. Facilities with sustained practices reported more positive secondary outcomes compared to those that did not sustain their practice. Key factors facilitating practice sustainment included: demonstrating practice effectiveness/benefit, sufficient organizational leadership, sufficient workforce, and adaptation/alignment with local context. Key factors hindering practice sustainment included: insufficient workforce, not able to maintain practice fidelity/integrity, critical incidents related to the COVID-19 pandemic, organizational leadership did not support sustainment of practice, and no ongoing support.
Conclusions: We identified diverse pathways from implementation to sustainment, and our data underscore that initial implementation outcomes may not determine long-term sustainment outcomes. This longitudinal evaluation contributes to understanding impacts of the DoE program, including return on investment, achieving learning health system goals, and insights into achieving high-quality healthcare in VHA.
(© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje