The dynamic sustainability framework: addressing the paradox of sustainment amid ongoing change.
The dynamic sustainability framework: addressing the paradox of sustainment amid ongoing change.
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DOI：
10.1186/1748-5908-8-117
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发表时间：
2013-10-02
期刊：
影响因子：
--
通讯作者：
Stange KC
中科院分区：
文献类型：
--
作者：
Chambers DA;Glasgow RE;Stange KC
尽管实施研究有所增长，但有限的科学注意力集中在理解和提高卫生干预措施的可持续性上。可持续性模式一直在演变，以反映干预措施与背景之间的匹配方面的挑战。我们研究可持续发展的概念的发展，并回应两个频繁的假设-“电压下降”，即干预措施预计将产生较低的效益，因为他们从功效，有效性的实施和可持续性，和“程序漂移”，即偏离手动协议被认为是减少效益。我们认为，这些假设限制了改善护理的机会，而是主张理解不断变化的医疗保健环境，以不断完善和改善干预措施。可持续性已经从被认为是翻译研究过程的最后阶段发展到建议的“适应阶段”，在当地的组织和文化背景下整合和制度化干预措施。这些最近的方法将可持续性定位在知识转移的实施阶段，但仍然没有将干预改进作为中心主题。我们提出了一个动态的可持续发展框架，涉及：持续学习和解决问题，不断适应干预措施，主要关注干预措施和多层次背景之间的匹配，以及对持续改进的期望，而不是随着时间的推移而减少成果。动态可持续性框架为研究、政策和实践提供了基础，支持可证伪假设的开发和测试，并继续学习，以推进卫生服务研究的实施、可移植性和影响。
Despite growth in implementation research, limited scientific attention has focused on understanding and improving sustainability of health interventions. Models of sustainability have been evolving to reflect challenges in the fit between intervention and context. We examine the development of concepts of sustainability, and respond to two frequent assumptions —'voltage drop,’ whereby interventions are expected to yield lower benefits as they move from efficacy to effectiveness to implementation and sustainability, and 'program drift,’ whereby deviation from manualized protocols is assumed to decrease benefit. We posit that these assumptions limit opportunities to improve care, and instead argue for understanding the changing context of healthcare to continuously refine and improve interventions as they are sustained. Sustainability has evolved from being considered as the endgame of a translational research process to a suggested 'adaptation phase’ that integrates and institutionalizes interventions within local organizational and cultural contexts. These recent approaches locate sustainability in the implementation phase of knowledge transfer, but still do not address intervention improvement as a central theme. We propose a Dynamic Sustainability Framework that involves: continued learning and problem solving, ongoing adaptation of interventions with a primary focus on fit between interventions and multi-level contexts, and expectations for ongoing improvement as opposed to diminishing outcomes over time. A Dynamic Sustainability Framework provides a foundation for research, policy and practice that supports development and testing of falsifiable hypotheses and continued learning to advance the implementation, transportability and impact of health services research.
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DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
--
作者：
Damschroder LJ;Aron DC;Keith RE;Kirsh SR;Alexander JA;Lowery JC
通讯作者：
Lowery JC
影响因子：
2.7
作者：
Checkland, P
通讯作者：
Checkland, P
DOI：
10.1001/jama.289.22.2913
发表时间：
2003-06-11
期刊：
JAMA (Journal of the American Medical Association)
影响因子：
--
作者：
Estabrooks, Paul A.;Glasgow, Russell E.;Dzewaltowski, David A.
通讯作者：
Dzewaltowski, David A.
影响因子：
9.7
作者：
Ebi, Kristie
通讯作者：
Ebi, Kristie
影响因子：
12.7
作者：
Glasgow, Russell E.;Vinson, Cynthia;Hunter, Christine
通讯作者：
Hunter, Christine