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Implement Sci. 2019 Dec 19;14(1):109. doi: 10.1186/s13012-019-0959-2.

Sustainment, Sustainability, and Spread Study (SSaSSy): protocol for a study of factors that contribute to the sustainment, sustainability, and spread of practice changes introduced through an evidence-based quality-improvement intervention in Canadian nursing homes.

Author information

1
Institute of Health Policy, Management & Evaluation, University of Toronto, Dalla Lana School of Public Health, 155 College Street, Suite 425, Toronto, Ontario, M5T 3M6, Canada. whit.berta@utoronto.ca.
2
Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, 1-198 Clinical Sciences Building, 11350 - 83 Avenue, Edmonton, Alberta, T6G 2P4, Canada.
3
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street - Suite 130, Toronto, Ontario, M5T 1P8, Canada.
4
Departments of Community Health Sciences and Emergency Medicine, Manitoba Centre for Health Policy, Manitoba Training Program for Health Services Research, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, Manitoba, R3E 3P5, Canada.
5
School of Health Policy & Management, Faculty of Health, York University, HNES 413, Toronto, Ontario, Canada.
6
Faculty of Nursing, University of Alberta, 5-305 Edmonton Clinic Health Academy (ECHA), 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada.
7
Institute of Health Policy, Management & Evaluation, University of Toronto, Dalla Lana School of Public Health, 155 College Street, Suite 425, Toronto, Ontario, M5T 3M6, Canada.
8
Department of Family Medicine, University of Alberta, Alzheimer Society of Canada Postdoctoral Fellow, 6-50 University Terrace, University of Alberta, Edmonton, Alberta, T6G 2T4, Canada.
9
O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3rd Floor Training Research and Wellness Building, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada.
10
Centre for Health Evaluation and Outcome Sciences (CH√ČOS), St. Paul's Hospital, 588-1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada.
11
Nova Scotia Centre on Aging, Department of Family Studies and Gerontology, Mount Saint Vincent University, Halifax, Nova Scotia, BEM 2J6, Canada.
12
Faculty of Health Disciplines, Athabasca University, 6th Floor, South Campus, 345 - 6 Avenue SE, Calgary, Alberta, T2G 4V1, Canada.
13
School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia - Okanagan, 1147 Research Road, Kelowna, British Columbia, V1V 1V7, Canada.
14
Translating Research in Elder Care (TREC), Faculty of Nursing, University of Alberta, 5-007D Edmonton Clinic Health Academy (ECHA), 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada.
15
Faculty of Nursing, University of Alberta, 5-183, Edmonton Clinic Health Academy, 11405 87 Ave, Edmonton, Alberta, T6G 1C9, Canada.

Abstract

BACKGROUND:

Implementation scientists and practitioners, alike, recognize the importance of sustaining practice change, however post-implementation studies of interventions are rare. This is a protocol for the Sustainment, Sustainability and Spread Study (SSaSSy). The purpose of this study is to contribute to knowledge on the sustainment (sustained use), sustainability (sustained benefits), and spread of evidence-based practice innovations in health care. Specifically, this is a post-implementation study of an evidence-informed, Care Aide-led, facilitation-based quality-improvement intervention called SCOPE (Safer Care for Older Persons (in long-term care) Environments). SCOPE has been implemented in nursing homes in the Canadian Provinces of Manitoba (MB), Alberta (AB) and British Columbia (BC). Our study has three aims: (i) to determine the role that adaptation/contextualization plays in sustainment, sustainability and spread of the SCOPE intervention; (ii) to study the relative effects on sustainment, sustainability and intra-organizational spread of high-intensity and low-intensity post-implementation "boosters", and a "no booster" condition, and (iii) to compare the relative costs and impacts of each booster condition.

METHODS/DESIGN:

SSaSSy is a two-phase mixed methods study. The overarching design is convergent, with qualitative and quantitative data collected over a similar timeframe in each of the two phases, analyzed independently, then merged for analysis and interpretation. Phase 1 is a pilot involving up to 7 units in 7 MB nursing homes in which SCOPE was piloted in 2016 to 2017, in preparation for phase 2. Phase 2 will comprise a quasi-experiment with two treatment groups of low- and high-intensity post-implementation "boosters", and an untreated control group (no booster), using pretests and post-tests of the dependent variables relating to sustained care and management practices, and resident outcomes. Phase 2 will involve 31 trial sites in BC (17 units) and AB (14 units) nursing homes, where the SCOPE trial concluded in May 2019.

DISCUSSION:

This project stands to advance understanding of the factors that influence the sustainment of practice changes introduced through evidence-informed practice change interventions, and their associated sustainability. Findings will inform our understanding of the nature of the relationship of fidelity and adaptation to sustainment and sustainability, and afford insights into factors that influence the intra-organizational spread of practice changes introduced through complex interventions.

KEYWORDS:

Evidence-based care practice; Long-term care; Nursing homes; Quality improvement; Sustainability

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