The sustainability of new programs and innovations: a review of the empirical literature and recommendations for future research.
The sustainability of new programs and innovations: a review of the empirical literature and recommendations for future research.
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DOI：
10.1186/1748-5908-7-17
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发表时间：
2012-03-14
期刊：
影响因子：
--
通讯作者：
Charns M
中科院分区：
文献类型：
--
作者：
Wiltsey Stirman S;Kimberly J;Cook N;Calloway A;Castro F;Charns M
近年来，将循证方案和实践引入医疗机构一直是越来越多研究的主题。虽然有一些研究审查了最初的执行工作，但很少有研究确定在这一点之后会发生什么。人们越来越认识到，新项目的持续程度受到许多不同因素的影响，需要更多地了解这些因素是什么以及它们如何相互作用。为了了解可持续发展研究文献的现状，我们的团队评估了这一领域目前已知的内容，并确定了进一步研究将特别有帮助的领域。本文回顾了已使用的方法，已测量和报告的结果的类型，报告长期实施结果的研究结果，以及已被确定为对持续使用新的做法，计划或干预措施的潜在影响因素。最后，我们对未来的研究提出了建议和考虑。两名编码员确定了125项符合资格标准的可持续性研究。一个初始的编码方案的基础上确定的结构在以前的文献中的实施。通过演绎生成了其他代码。因素之间的相关结构是通过共识确定的，并在一般类别下崩溃。描述项目或创新持续程度的研究也进行了分类和总结。虽然“可持续性”是文献中最常用的一个术语，指的是最初实施后发生的情况，但并非所有审查的研究都实际提出了该术语的工作定义。大多数研究设计都是回顾性和自然主义的。大约一半的研究依靠自我报告来评估可持续性或影响可持续性的因素。大约一半采用定量方法，其余采用定性或混合方法。调查可持续性成果的研究很少采用严格的评价方法（例如，客观评价、执行质量或忠实度的判断）。在这些国家中，有少数国家报告说，它们拥有完全自我维持能力或高保真度。很少有研究审查的程度，性质，或适应的干预措施或方案一旦实施的影响。对可持续性的影响包括组织背景，能力，流程，以及与新计划或实践本身相关的因素。更明确的定义和以可持续性概念文献为指导的研究，对于发展这一领域的研究至关重要。进一步努力描述这一现象及其影响因素，将提高今后研究的质量。还必须仔细考虑多个层面的影响之间的相互作用，以及随着时间的推移，实施中的保真度、修改和变化等问题。虽然需要前瞻性和实验性的设计，但定性研究在理解现象、完善假设和制定促进可持续发展的战略方面也发挥着重要作用。
The introduction of evidence-based programs and practices into healthcare settings has been the subject of an increasing amount of research in recent years. While a number of studies have examined initial implementation efforts, less research has been conducted to determine what happens beyond that point. There is increasing recognition that the extent to which new programs are sustained is influenced by many different factors and that more needs to be known about just what these factors are and how they interact. To understand the current state of the research literature on sustainability, our team took stock of what is currently known in this area and identified areas in which further research would be particularly helpful. This paper reviews the methods that have been used, the types of outcomes that have been measured and reported, findings from studies that reported long-term implementation outcomes, and factors that have been identified as potential influences on the sustained use of new practices, programs, or interventions. We conclude with recommendations and considerations for future research. Two coders identified 125 studies on sustainability that met eligibility criteria. An initial coding scheme was developed based on constructs identified in previous literature on implementation. Additional codes were generated deductively. Related constructs among factors were identified by consensus and collapsed under the general categories. Studies that described the extent to which programs or innovations were sustained were also categorized and summarized. Although "sustainability" was the term most commonly used in the literature to refer to what happened after initial implementation, not all the studies that were reviewed actually presented working definitions of the term. Most study designs were retrospective and naturalistic. Approximately half of the studies relied on self-reports to assess sustainability or elements that influence sustainability. Approximately half employed quantitative methodologies, and the remainder employed qualitative or mixed methodologies. Few studies that investigated sustainability outcomes employed rigorous methods of evaluation (e.g., objective evaluation, judgement of implementation quality or fidelity). Among those that did, a small number reported full sustainment or high fidelity. Very little research has examined the extent, nature, or impact of adaptations to the interventions or programs once implemented. Influences on sustainability included organizational context, capacity, processes, and factors related to the new program or practice themselves. Clearer definitions and research that is guided by the conceptual literature on sustainability are critical to the development of the research in the area. Further efforts to characterize the phenomenon and the factors that influence it will enhance the quality of future research. Careful consideration must also be given to interactions among influences at multiple levels, as well as issues such as fidelity, modification, and changes in implementation over time. While prospective and experimental designs are needed, there is also an important role for qualitative research in efforts to understand the phenomenon, refine hypotheses, and develop strategies to promote sustainment.
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