Measuring persistence of implementation: QUERI Series

Abstract

As more quality improvement programs are implemented to achieve gains in performance, the need to evaluate their lasting effects has become increasingly evident. However, such long-term follow-up evaluations are scarce in healthcare implementation science, being largely relegated to the "need for further research" section of most project write-ups. This article explores the variety of conceptualizations of implementation sustainability, as well as behavioral and organizational factors that influence the maintenance of gains. It highlights the finer points of design considerations and draws on our own experiences with measuring sustainability, framed within the rich theoretical and empirical contributions of others. In addition, recommendations are made for designing sustainability analyses. This article is one in a Series of articles documenting implementation science frameworks and approaches developed by the U.S. Department of Veterans Affairs Quality Enhancement Research Initiative (QUERI).

Figure 1

Three possible outcomes of performance improvement: Successful, failed, and enhanced. (T1 = baseline period, T2 = implementation period, T3 = follow-up period).

Figure 2

Site-level performance for hepatitis A screening in HIV patients before, during and after a one-year-implementation trial. Indicated by letter and number, sites implemented either clinical reminders (R), collaboratives (C), or both (C+R).