This article is part of a series on U.S. Department of Veterans Affairs Quality Enhancement Research Initiative (QUERI), edited by (Internal Series) Cheryl B Stetler, Brian S Mittman, Joseph Francis. (Journal Series) Martin P Eccles, Ian Graham .

Debate

Measuring persistence of implementation: QUERI Series

Candice C Bowman¹ , Elisa J Sobo² , Steven M Asch³ and Allen L Gifford⁴ for the HIV/Hepatitis Quality Enhancement Research Initiative

¹Health Services Research & Development, VA San Diego Healthcare System, San Diego, California, USA

²Department of Anthropology, San Diego State University, San Diego, California, USA

³Center for the Study of Healthcare Provider Behavior, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA

⁴Center for Health Quality, Outcomes, and Economic Research, VA New England Healthcare System, Bedford, Massachusetts, USA

author email corresponding author email

Implementation Science 2008, 3:21doi:10.1186/1748-5908-3-21

Published:	22 April 2008

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).