Sustaining the Gains: Research On the Sustainability of Evidence-Based Practice in Health

Sustaining the gains: 

Research on the sustainability of evidence-based practice in health

Background and Purpose:  Although social work has made significant strides in implementing evidence-based practices, we know very little about how well or when evidence-based practices are sustained over time once implemented.  Grant funding periods typically preclude examining sustained use of interventions after testing.  Stakeholders with investment in sustained delivery of effective services include communities who partner in testing interventions, administrators and practitioners who adopt them, and researchers and research funders.  This paper reports results of a project to address the following two objectives:  (1) To generate questions for a research agenda on how to sustain evidence-based practices in real-world care; (2) To recommend research methodology advances for the empirical study of sustainability over time. 

Methods.  Through a one year, “conference-grant” we:  (1) conducted targeted searches of published literature and grant data bases and queried researcher funders to identify 80 sustainability experts from three stakeholder groups (researchers, funders, practice leaders) in health, mental health, and public health;  (2)  used concept mapping (CM) software methods to elicit experts’ recommendations for advancing sustainability research; (3) invited 50 of them to sort and rank statements to create clusters and (4) convened a national, 1 ½ day agenda-setting meeting in which participants interpreted the CM cluster map to generate recommendations for a research agenda and methodology recommendations for sustainability research methods.  CM is a systematic method that enables dispersed participants to generate conceptualize, and rank shared ideas. 

Results.  The CM process generated 91 items, in six themes on a concept map, on how to advance understanding of sustainability.  Using the map as a springboard, conference participants generated questions to comprise a sustainability research agenda, priorities for methodological advances, and recommendations for research funding, training, policy and practice.  Areas within the research agenda were (1) advancing definition and conceptualization, including formulating sustainability as an outcome; (2) assessing the value of sustainability to various stakeholder groups; (3) understanding how an intervention’s features affect its sustained use; (4) testing theory to explain and predict sustainability; and (5) identifying the effects of contextual factors (individual, organizational, policy environment) on sustainability.  Priorities for methods advancement include measurement development, locating data reflecting intervention use over time (e.g., partnering with treatment developer-disseminators), and longitudinal, non-linear, and multilevel analytic methods.  For example, it was recommended that studies identify and depict sustainability “curves” (e.g., flame out, crowd out, and ramp up).

Conclusions and implications.    Social work has little knowledge about how to sustain evidence-based practices, carrying risks for poor service quality and failure to reap a return on investment in developing, testing, and implementing new interventions.  Sustainability has been identified as one of the top priorities NIH priorities for research on implementing evidence-based practices.  Results inform future research needed to inform policy, practice, and training of researchers.  The paper also demonstrates the value of CM as a method for social work research. 

Funding sources:  AHRQ R13 conference grant; Barnes-Jewish Foundation.