Evidence map›Paper›PMID 35581651›Full record

ArticleBMC health services research2022

Influences of post-implementation factors on the sustainability, sustainment, and intra-organizational spread of complex interventions.

Yuting Song, Lauren MacEachern, Malcolm B Doupe, Liane Ginsburg, Stephanie A Chamberlain, Lisa Cranley, Adam Easterbrook, Matthias Hoben, Jennifer Knopp-Sihota, R Colin Reid and 5 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC health services research, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
12citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

12 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Trial
  4. Article
  5. Article
  6. Article
  7. Review
  8. Article
  9. Article
  10. Article
  11. Article
  12. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Yuting SongSchool of Nursing, Qingdao University, 308 Ningxia Road, Qingdao, 266071, Shandong Province, China. yuting.song@ualberta.ca.
Lauren MacEachernManagement & Evaluation, Institute for Health Policy, University of Toronto, 155 College Street, Suite 425, Toronto, ON, M5T 1P8, Canada.
Malcolm B DoupeMax Rady College of Medicine, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, MB, R3E 3P5, Canada.
Liane GinsburgSchool of Health Policy & Management, York University, Stong College 353, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada.
Stephanie A ChamberlainDepartment of Family Medicine, University of Alberta, 6-50 University Terrace, Edmonton, AB, T6G 2T4, Canada.
Lisa CranleyLawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street Suite 130, Toronto, ON, M5T 1P8, Canada.
Adam EasterbrookCentre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, 588 - 1081 Burrard Street, Vancouver, B.C., V6Z 1Y6, Canada.
Matthias HobenFaculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, 5-305, 11405 87 Ave, AB, T6G 1C9, Edmonton, Canada.
Jennifer Knopp-SihotaFaculty of Health Disciplines, Athabasca University, 1 University Drive, Athabasca, AB, T9S 3A3, Canada.
R Colin ReidSchool of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia - Okanagan campus, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada.
Adrian WaggDepartment of Medicine, University of Alberta, 1-198 Clinical Sciences building, 11350 - 83Avenue, Edmonton, AB, T6G 2P4, Canada.
Carole A EstabrooksFaculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, 5-305, 11405 87 Ave, AB, T6G 1C9, Edmonton, Canada.
Janice M KeefeNova Scotia Centre On Aging, Mount Saint Vincent University, McCain 201F, 166 Bedford Hwy, Halifax, NS, B3M 2J6, Canada.
Tim RapponManagement & Evaluation, Institute for Health Policy, University of Toronto, 155 College Street, Suite 425, Toronto, ON, M5T 1P8, Canada.
Whitney B BertaManagement & Evaluation, Institute for Health Policy, University of Toronto, 155 College Street, Suite 425, Toronto, ON, M5T 1P8, Canada.

Funding

The Canadian Institutes for Health Research 201803PJT-400653-KTR-CEAA-107836
6 · The paper itself

Abstract

backgroundComplex interventions are increasingly applied to healthcare problems. Understanding of post-implementation sustainment, sustainability, and spread of interventions is limited. We examine these phenomena for a complex quality improvement initiative led by care aides in 7 care homes (long-term care homes) in Manitoba, Canada. We report on factors influencing these phenomena two years after implementation.

methodsData were collected in 2019 via small group interviews with unit- and care home-level managers (n = 11) from 6 of the 7 homes using the intervention. Interview participants discussed post-implementation factors that influenced continuing or abandoning core intervention elements (processes, behaviors) and key intervention benefits (outcomes, impact). Interviews were audio-recorded, transcribed verbatim, and analyzed with thematic analysis.

resultsSustainment of core elements and sustainability of key benefits were observed in 5 of the 6 participating care homes. Intra-unit intervention spread occurred in 3 of 6 homes. Factors influencing sustainment, sustainability, and spread related to intervention teams, unit and care home, and the long-term care system.

conclusionsOur findings contribute understanding on the importance of micro-, meso-, and macro-level factors to sustainability of key benefits and sustainment of some core processes. Inter-unit spread relates exclusively to meso-level factors of observability and practice change institutionalization. Interventions should be developed with post-implementation sustainability in mind and measures taken to protect against influences such as workforce instability and competing internal and external demands. Design should anticipate need to adapt interventions to strengthen post-implementation traction.

Indexed as

Long-Term CareQuality ImprovementCanadaDelivery of Health CareHumansOrganizationsCaregiving – FormalImplementation ScienceLong-term CareManagement

Identifiers

PMID35581651
PMCPMC9116057

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.