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Health Services Research & Development

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2005 HSR&D National Meeting Abstract

1082 — Sustainability and Spread of Chronic Illness Improvement

Author List:
Wu Shinyi
Wu Shinyi
Pearson MarjorieL
Shortell StephenM
Mendel PeterJ
Marsteller JillA
Lin MichaelK
Keeler EmmettB

This study assessed the sustainability and spread of chronic care model (CCM) implementation efforts initiated during QI collaboratives and examined the relationships between CCM implementation intensity and QI sustainability and spread.

Observational study of data collected by the RAND/Berkeley Improving Chronic Illness Care Evaluation (ICICE) on 42 organizations participating in four chronic care collaboratives. To examine if their change activities were sustained and spread, we interviewed key contact persons in each organization one year after the collaborative and qualitatively coded the interview transcripts to create variables for the post-collaborative status of their QI activities (continued and expanded, maintained at collaborative level only, or declined) and their reported success at spread (any and type). We then used ordinal regression models with single predictor to examine whether successful QI sustainability and spread were associated with the intensity (quantity and depth) of the organizations' CCM implementation during the collaborative, controlling for organization type, disease focus, and the organization's baseline congruence with CCM.

The majority of organizations (57%) reported continuing and expanding their QI efforts after the collaborative. Seventy-nine percent reported successfully spreading these changes: 42% within their site, 30% to additional sites, and 27% to other conditions. The intensity of implementation during the collaborative was positively associated with both sustainability and spread (p<.05). The best single predictor models for sustainability included the depth of CCM implementation overall or the depth of changes to obtain health system support, followed by depth in information system support. The best prediction models for spread included the quantity of changes to improve decision support or the quantity of changes overall.

One year later, large proportions of organizations report sustaining and spreading changes initiated during a QI collaborative. The intensity of the implementation during the collaborative relates to successful sustainability and spread. Efforts to acquire health system support and build information support are particularly critical to sustaining QI activities, while increased decision support capabilities can facilitate successful spread. To maximize continuation and spread of CCM changes, organizations should be encouraged to implement changes at high intensity (in both quantity and depth) during the initial intervention period.


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