Keep On Keeping On: An Examination of the Sustainability Capacity of a Heart Health Improvement Program in Primary Care Clinics.

Abstract

Objective: Sustaining evidence-based interventions in health care delivery organizations are a well-known challenge. Failure to sustain evidence-based interventions wastes resources, diminishes access to high-quality care for patients and negatively affects quality outcomes, and leaves a residue of disillusionment among organizational members that hinder future efforts to implement other evidence-based interventions. The purpose of this study was to identify characteristics associated with sustainability capacity in a group of primary care clinics implementing the evidence-based heart health improvement program (HHIP).

Methods: We used mixed methods that included validated cross-sectional surveys and semi-structured interviews administered throughout 2023-2024 among 23 primary care clinics. Univariate and ordinary least squares regression models were used to describe the level of capacity across seven different dimensions of sustainability and their relationship with organizational characteristics. Quantitative relationships were considered statistically significant at P ≤ .05. A framework-guided analysis was applied to 6 interviews with clinic leaders and staff to identify thematic barriers to sustainability.

Results: Study participants reported relatively high levels of capacity to sustain the HHIP (range of 5.46-6.00, on a scale of 1-7), with the outcomes and effectiveness dimension rated highest and engaged staff rated lowest. The baseline level of organizational readiness to implement change was most consistently and positively related to sustainability capacity (5 of 7 dimensions). FQHCs (relative to non-FQHCs) and clinic leaders (relative to clinicians and clinic staff) were associated with higher ratings of 3 operationally focused dimensions of sustainability capacity (implementation and training, monitoring and evaluation, and outcomes and effectiveness).

Conclusions: Despite generally positive perceptions of clinic capacity to sustain the HHIP, our analysis highlights general opportunities to build capacity to sustain evidence-based practices in primary care settings (cultivate readiness to change among clinic members) and places where focused efforts may do the same (target organizational-cultural dimensions of sustainability capacity, non-FQHCs).