Assessing long-term sustainment of clinic participation in NIATx200: Results and a new methodological approach
Assessing long-term sustainment of clinic participation in NIATx200: Results and a new methodological approach
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DOI：
10.1016/j.jsat.2018.06.012
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发表时间：
2018-09-01
影响因子：
3.9
通讯作者：
Robinson, James M.
中科院分区：
文献类型：
--
作者：
Ford, James H., II;Stumbo, Scott P.;Robinson, James M.
背景：可持续性框架区分了可持续性能力和组织变革的维持。多项研究审查了可持续能力，但尚未探讨评估长期可持续能力的方法。本研究解决了这一差距，描述了一个长期的维持方法的发展和评估其应用程序，利用数据从药物滥用诊所参加的质量改进collaboration.Methods：该研究涉及诊所（n = 121）在三个州（MI，NY和WA）参加2007-2009 NIATx 200质量改进（QI）干预。它扩展了主要分析，重点是诊所的长期维持的等待时间，保留和入院的改善。长期维持的定义是积极执行期结束后两年（2010和2011日历年）。分析定义的情况下排除标准和样条“结”的时间间隔，允许C，统计使用，以解决临床数据的波动性，建立了结构的维持图，并探讨NIATx的实施strategies.Results之间的差异：示例样条和维持图突出了NIATx 200诊所的长期维持方法的应用。在有纵向结果数据的诊所中，40.8%（76家诊所中的31家）的等待时间持续改善，26.7%（75家诊所中的20家）的保留时间持续改善，28.1%（114家诊所中的32家）的入院时间持续改善。诊所分配NIATx 200实施策略并没有显着影响诊所的长期维持，除了较低的等待时间的变化，在利益圈的干预。30家诊所（24.8%）在两个结局方面持续改善，6家诊所（5.0%）在所有三个结局方面持续改善。维持多个结果改善的诊所被分配到兴趣圈（n = 12），学习会话（n = 10），组合（n = 8）和辅导（n = 6）实施策略。在其他质量改进settings.Conclusions应用长期维持方法的指导：关于可持续发展能力和持续变化的研究已成为越来越重要的传播和实施研究。在多组织质量改进协作（QIC）的长期维持评估是必要的，以确定何时发生的程序漂移和干预衰减。如果“分界点”表明效果何时减弱，则可在质量、创新和能力建设结构内制定和采用具体的可持续性模块，以改善组织的长期可持续性。可对教练和变革小组进行培训，使其注重组织变革的持续性，并加强制度化的可能性。
Background: Sustainability frameworks differentiate between sustainability capacity and sustainment of organizational change. Multiple studies have examined sustainability capacity, Methodological approaches to assess long-term sustainment have not been explored. This study addresses this gap by describing the development of a long-term sustainment methodology and evaluating its application utilizing data from substance abuse clinics participating in a quality improvement collaborative.Methods: The study involved clinics (n = 121) in three states (MI, NY and WA) participating in the 2007-2009 NIATx200 quality improvement (QI) intervention. It extended the primary analysis to focus on clinics' long-term sustainment of wait time, retention and admission improvements. Long-term sustainment was defined as two years post end of the active implementation period (Calendar Years 2010 and 2011). The analysis defined case exclusion criteria and spline "knot" time intervals; allowed for C, statistic use to address clinic data volatility; established the structure of sustainment plots and explored differences between NIATx implementation strategies.Results: Example spline and sustain plots highlight the application of the long-term sustainment methodology for NIATx200 clinics. In clinics with available longitudinal outcome data, 40.8% (n = 31 of 76 clinics) sustained improvements in wait time, 26.7% (n = 20 of 75 clinics) in retention, and 28.1% (n = 32 of 114 clinics) for admissions. Clinic assignment to a NIATx200 implementation strategy did not significantly influence a clinics' long-term sustainment except for lower wait time changes in the interest circle interventions. Thirty clinics (24.8%) sustained improvements for two outcomes and six clinics (5.0%) did so for all three outcomes. The clinics that sustained multiple outcome improvements were assigned to the interest circle (n = 12), learning session (n = 10), combination (n = 8), and coaching (n = 6) implementation strategies. Guidance for applying the long-term sustainment methodology in other quality improvement settings is described.Conclusions: Research about sustainability capacity and sustainment of change has become increasingly important in dissemination and implementation research. Assessment of long-term sustainment in a multi-organizational quality improvement collaborative (QIC) is needed to identify when program drift and intervention decay occurs. If "cut-points" indicate when effects diminish, specific sustainability modules could be developed and introduced within the structure of a QIC to improve organizational long-term sustainment. Coaches and change teams could be trained to focus on organizational change sustainment and strengthen the likelihood of institutionalization.