Examining the sustainability potential of a multisite pilot to integrate alcohol screening and brief intervention within three primary care systems
Abstract
The U.S. Preventive Services Task Force recommends that clinicians adopt universal alcohol screening and brief intervention as a routine preventive service for adults, and efforts are underway to support its widespread dissemination. The likelihood that healthcare systems will sustain this change, once implemented, is under-reported in the literature. This article identifies factors that were important to postimplementation sustainability of an evidence-based practice change to address alcohol misuse that was piloted within three diverse primary care organizations. The Centers for Disease Control and Prevention funded three academic teams to pilot and evaluate implementation of alcohol screening and brief intervention within multiclinic healthcare systems in their respective regions. Following the completion of the pilots, teams used the Program Sustainability Assessment Tool to retrospectively describe and compare differences across eight sustainability domains, identify strengths and potential threats to sustainability, and make recommendations for improvement. Health systems varied across all domains, with greatest differences noted for Program Evaluation, Strategic Planning, and Funding Stability. Lack of funding to sustain practice change, or data monitoring to promote fit and fidelity, was an indication of diminished Organizational Capacity in systems that discontinued the service after the pilot. Early assessment of sustainability factors may identify potential threats that could be addressed prior to, or during implementation to enhance Organizational Capacity. Although this study provides a retrospective assessment conducted by external academic teams, it identifies factors that may be relevant for translating evidence-based behavioral interventions in a way that assures that they are sustained within healthcare systems.
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The results support the assertion that strengthening other sustainability domains may help contribute to program sustainment even in the face of weak financial stability.
“Thus, the results support the assertion that strengthening other sustainability domains may help contribute to program sustainment even in the face of weak financial stability [27, 42].”
King et al. hypothesized that funding challenges could potentially be overcome by strengthening factors in other sustainability domains such as increasing commitment to the program and by adapting programs to ensure efficient integration into current practices and workflows.
“The authors hypothesized that funding challenges could potentially be overcome by strengthening factors in other sustainability domains such as increasing commitment to the program and by adapting programs to ensure efficient integration into the current practices and workflows.”
Findings are consistent with previous research using the PSAT showing higher levels of environmental support are reported by programs with greater sustainment success.
“Our findings are consistent with previous research using the PSAT showing higher levels of environmental support are reported by programs with greater sustainment success [31, 32, 42].”
King et al. found all non-sustaining primary care systems had low levels of funding stability, but also found evidence of weak funding stability in one site exhibiting sustainment success.
“In their study on the sustainability potential of an alcohol screening and brief intervention program within three primary care systems, King and colleagues [42] found that all non-sustaining primary care systems had low levels of funding stability. However, they also found evidence of weak funding stability in one site exhibiting sustainment success.”
King et al. found program evaluation was the only domain rated consistently strong for all sustaining sites and consistently weak for all non-sustaining sites.
“In a study conducted by King and colleagues [42], program evaluation was the only domain which was rated consistently strong for all sustaining sites and consistently weak for all non-sustaining sites.”
Cites
Durlak, J. A., & DuPre, E. P. (2008) · American Journal of Community Psychology · doi:10.1007/s10464-008-9165-0 · Cited by 5,304 · see citing works
(2005) · Cited by 3,748 · see citing works
Qualitative Data Analysis for Health Services Research: Developing Taxonomy, Themes, and Theory
Bradley, E. H., Curry, L. A., & Devers, K. J. (2007) · Health Services Research · doi:10.1111/j.1475-6773.2006.00684.x · Cited by 3,437 · see citing works
Bridging Research and Practice
Tabak, R. G., Khoong, E. C., Chambers, D. A., & Brownson, R. C. (2012) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2012.05.024 · Cited by 1,386 · see citing works
Wiltsey Stirman, S., Kimberly, J., Cook, N., Calloway, A., Castro, F., & Charns, M. (2012) · Implementation Science · doi:10.1186/1748-5908-7-17 · Cited by 1,355 · see citing works
Shediac-Rizkallah, M. C., & Bone, L. R. (1998) · Health Education Research · doi:10.1093/her/13.1.87 · Cited by 1,129 · see citing works
Issues in Disseminating and Replicating Effective Prevention Programs
Elliott, D. S., & Mihalic, S. (2004) · Prevention Science · doi:10.1023/b:prev.0000013981.28071.52 · Cited by 794 · see citing works
An Agenda for Research on the Sustainability of Public Health Programs
Scheirer, M. A., & Dearing, J. W. (2011) · American Journal of Public Health · doi:10.2105/ajph.2011.300193 · Cited by 775 · see citing works
The effectiveness of brief alcohol interventions in primary care settings: A systematic review
KANER, E. F. S., DICKINSON, H. O., BEYER, F., PIENAAR, E., SCHLESINGER, C., CAMPBELL, F., SAUNDERS, J. B., BURNAND, B., & HEATHER, N. (2009) · Drug and Alcohol Review · doi:10.1111/j.1465-3362.2009.00071.x · Cited by 434 · see citing works
Moyer, V. A. (2013) · Annals of Internal Medicine · doi:10.7326/0003-4819-159-3-201308060-00652 · Cited by 426 · see citing works
Building capacity and sustainable prevention innovations: a sustainability planning model
Johnson, K., Hays, C., Center, H., & Daley, C. (2004) · Evaluation and Program Planning · doi:10.1016/j.evalprogplan.2004.01.002 · Cited by 411 · see citing works
The Program Sustainability Assessment Tool: A New Instrument for Public Health Programs
Luke, D. A., Calhoun, A., Robichaux, C. B., Elliott, M. B., & Moreland-Russell, S. (2014) · Preventing Chronic Disease · doi:10.5888/pcd11.130184 · Cited by 364 · see citing works
Examining Adaptations of Evidence-Based Programs in Natural Contexts
Moore, J. E., Bumbarger, B. K., & Cooper, B. R. (2013) · The Journal of Primary Prevention · doi:10.1007/s10935-013-0303-6 · Cited by 250 · see citing works
Pagoto, S., Spring, B. J., Coups, E. J., Mulvaney, S. A., Coutu, M., & Özakinci, G. (2007) · Journal of Clinical Psychology · doi:10.1002/jclp.20376 · Cited by 183 · see citing works
The sustainability of healthcare innovations: a concept analysis
Fleiszer, A. R., Semenic, S. E., Ritchie, J. A., Richer, M., & Denis, J. (2015) · Journal of Advanced Nursing · doi:10.1111/jan.12633 · Cited by 166 · see citing works
Linking Sustainability Research to Intervention Types
Scheirer, M. A. (2013) · American Journal of Public Health · doi:10.2105/ajph.2012.300976 · Cited by 161 · see citing works
Using qualitative comparative analysis to understand and quantify translation and implementation
Kane, H., Lewis, M. A., Williams, P. A., & Kahwati, L. C. (2014) · Translational Behavioral Medicine · doi:10.1007/s13142-014-0251-6 · Cited by 124 · see citing works
Sustaining Evidence-Based Prevention Programs: Correlates in a Large-Scale Dissemination Initiative
Cooper, B. R., Bumbarger, B. K., & Moore, J. E. (2015) · Prevention Science · doi:10.1007/s11121-013-0427-1 · Cited by 117 · see citing works
Using the Program Sustainability Assessment Tool to Assess and Plan for Sustainability
Calhoun, A., Mainor, A., Moreland-Russell, S., Maier, R. C., Brossart, L., & Luke, D. A. (2014) · Preventing Chronic Disease · doi:10.5888/pcd11.130185 · Cited by 100 · see citing works
Fleiszer, A. R., Semenic, S. E., Ritchie, J. A., Richer, M., & Denis, J. (2015) · BMC Health Services Research · doi:10.1186/s12913-015-1192-6 · Cited by 75 · see citing works
Sackmann, S. A., Eggenhofer-Rehart, P. M., & Friesl, M. (2009) · The Journal of Applied Behavioral Science · doi:10.1177/0021886309346001 · Cited by 74 · see citing works
Bernstein, E., Topp, D., Shaw, E., Girard, C. D., Pressman, K., Woolcock, E., & Bernstein, J. (2009) · Academic Emergency Medicine · doi:10.1111/j.1553-2712.2009.00516.x · Cited by 72 · see citing works
Sustaining Change: Once Evidence-Based Practices Are Transferred, What Then?
Virani, T., Lemieux-Charles, L., Davis, D., & Berta, W. (2009) · Healthcare Quarterly · doi:10.12927/hcq.2009.20420 · Cited by 71 · see citing works
Sustainability of Behavioral Interventions: Beyond Cost-Effectiveness Analysis
Brown, P., Cameron, L. D., & Ramondt, S. (2014) · International Journal of Behavioral Medicine · doi:10.1007/s12529-014-9437-z · Cited by 61 · see citing works
Hunter, S. B., Han, B., Slaughter, M. E., Godley, S. H., & Garner, B. R. (2015) · Implementation Science · doi:10.1186/s13012-015-0364-4 · Cited by 58 · see citing works
Creating Quality Improvement Culture in Public Health Agencies
Davis, M. V., Mahanna, E., Joly, B. M., et al. (2013) · American Journal of Public Health · doi:10.2105/ajph.2013.301413 · Cited by 38 · see citing works
Seale, J. P., Velasquez, M. M., Johnson, J. A., Shellenberger, S., von Sternberg, K. L., Dodrill, C. L., Boltri, J. M., Takei, R., Clark, D. C., & Grace, D. (2012) · Substance Abuse · doi:10.1080/08897077.2011.640187 · Cited by 24 · see citing works
Mining the Management Literature for Insights into Implementing Evidence-Based Change in Healthcare
Harlos, K., Tetroe, J., Graham, I. D., Bird, M., & Robinson, N. (2012) · Healthcare policy · doi:10.12927/hcpol.2012.23016 · Cited by 23 · see citing works
Lich, K. H., Frerichs, L., Fishbein, D. H., Bobashev, G., & Pentz, M. A. (2016) · Translational Behavioral Medicine · doi:10.1007/s13142-016-0390-z · Cited by 22 · see citing works
Armstrong, N., Herbert, G., & Brewster, L. (2016) · Family Practice · doi:10.1093/fampra/cmw049 · Cited by 19 · see citing works
Implementation of behavioral health interventions in real world scenarios: Managing complex change.
Clark, K. D., Miller, B. F., Green, L. A., deGruy, F. V., Davis, M. M., & Cohen, D. J. (2016) · Families Systems & Health · doi:10.1037/fsh0000239 · Cited by 18 · see citing works
Aldridge, W. A., Boothroyd, R. I., Fleming, W. O., Jarboe, K. L., Morrow, J., Ritchie, G. F., & Sebian, J. (2016) · Translational Behavioral Medicine · doi:10.1007/s13142-015-0351-y · Cited by 12 · see citing works
Change IS Possible: Reducing High-Risk Drinking Using a Collaborative Improvement Model
Lanter, P. L., Wolff, K. B., Johnson, L. C., Ercolano, E. M., Kilmer, J. R., & Provost, L. (2015) · Journal of American College Health · doi:10.1080/07448481.2015.1015021 · Cited by 7 · see citing works
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Bowser, D. M., Henry, B. F., & McCollister, K. E. (2021) · Implementation Science · doi:10.1186/s13012-021-01094-3 · Cited by 61 · see citing works
Hall, A., Shoesmith, A., Shelton, R. C., Lane, C., Wolfenden, L., & Nathan, N. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph182111414 · Cited by 20 · see citing works
Cooper, B. R., Hill, L. G., Parker, L., Jenkins, G. J., Shrestha, G., & Funaiole, A. (2022) · Implementation Science Communications · doi:10.1186/s43058-022-00303-4 · Cited by 7 · see citing works
“Strengths and limitations Our study contributes to the growing literature which uses QCA to understand and quantify complex implementation constructs [33, 41, 42, 57, 58].”
BackgroundMethodResultInfluential
- Authors
- King, D. K., Gonzalez, S. J., Hartje, J. A., Hanson, B. L., Edney, C., Snell, H., Zoorob, R. J., & Roget, N. A.
- Affiliations
- University of Alaska Anchorage (US)
- Baylor College of Medicine, Department of Family and Community Medicine, Houston, TX, USA
- University of Nevada, Reno (US)
- Meharry Medical College (US)
- Baylor College of Medicine (US)
- Corresponding author
- King, D K
- Venue
- Translational Behavioral Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2018-01-23
- Volume
- 8
- Issue
- 5
- Pages
- 776-784
- ISSN
- 1613-9860 (ISSN-L)
- 1869-6716
- OpenAlex
- W2794727020
- Cited by
- 17
- References
- 33
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 2 · 2023: 2 · 2022: 7 · 2021: 3 · 2020: 1
- FWCI
- 1.53
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- Translational Behavioral Medicine (publishedVersion)
- PubMed (publishedVersion)
- ScholarWorks - UA (University of Alaska System) (submittedVersion)
- Funders
- U.S. Department of Health and Human Services
- Centers for Disease Control and Prevention (U84DD000882, U84DD000886, U84DD000888)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
- Keywords
- alcohol screening and brief intervention, primary care, alcohol abuse, evidence-based practice dissemination, organizational capacity, funding stability, strategic planning, program evaluation, implementation fidelity, USPSTF recommendations
- MeSH terms
- Humans, Pilot Projects, Primary Health Care, Multicenter Studies as Topic, Program Evaluation, Process Assessment, Health Care, Alcohol-Related Disorders, Evidence-Based Practice
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