Participatory Approach to Program Sustainment: Example From a Multisite National Geriatrics Telemedicine Program.

backgroundSustainment of evidence-based programs within dynamic health care environments requires ongoing adaptation to internal and external changes. Yet, strategies to support the sustainment of large-scale programs in heterogeneous settings are understudied. We developed and implemented a 3-phase participatory approach to support the sustainment of GRECC Connect, a 19-site Veterans Health Administration program that uses a hub-and-spoke model to expand rural access to geriatric specialty care.

objectiveOur goal is to describe a novel participatory approach for identifying sustainment strategies for large-scale health care programs in complex environments, using our experience with GRECC Connect as an example to illustrate the application of this approach.

methodsWe implemented the following 3-phase participatory approach with GRECC Connect team members from 19 hub sites. Phase 1: hub site clinicians and staff completed the Program Sustainment Assessment Tool, a publicly available online self-assessment of sustainability capacity. Phase 2: all sites then participated in a virtual retreat to exchange information, knowledge, and experiences related to sustainment strategies. Phase 3: each site submitted a locally-developed sustainment plan created with input from hub site team members. The sustainment plan worksheet included 3 questions asking respondents to reflect on the value of the participatory approach to sustainment. The process and experience of implementing this approach were also documented in structured meeting notes. Responses to Likert scale questions were analyzed with descriptive statistics, and qualitative data were analyzed using conventional content analysis.

resultsOverall, there was a high level of participation across all 19 hub sites. In phase 1, a total of 25 individuals from 14 sites responded to the Program Sustainment Assessment Tool survey; in phase 2, a total of 58 individuals from 19 sites attended the retreat; and in phase 3, a total of 17 site sustainment plans were completed. Three primary sustainment paths were proposed and discussed during the retreat. Sites varied in their confidence to sustain program activities, but were able to articulate several barriers and facilitators specific to their site. The level of specificity in the sustainment plans varied considerably across sites. Most sites reported that this participatory approach was "very useful" (ie, ≥7 on a 10-point Likert scale) for planning their program sustainment.

conclusionsThis approach offered a framework for sites to learn from one another, anticipate local barriers and facilitators, and move from reflection to identifying next steps for maintaining core program activities. Here, we describe the process used to guide 19 site teams through sustainment activities. We found the process is well-received, with sites reporting that their participation was useful for planning their sustainment journey. In elucidating our process, we provide a blueprint for other programs seeking to support sustainment across heterogeneous health care networks.