AMDA Foundation - Sustainability

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Vol XII, Dec `05

Sustainability

Vol XII, Dec `05

Now that one of the LTC-QI Partnership's states is in the process of completing the last data collection period, project staff are increasingly thinking about sustainability. Below is a description of the project objectives and information about why sustainability is vital to this project's eventual and continued success.

Objectives

The LTC-QI Partnership has two objectives:

Our primary objective is to implement pain or pressure ulcer clinical practice guidelines (CPGs) in nursing homes in six states. We plan to measure the efficacy of CPG implementation by examining pain and pressure ulcer care processes; participating nursing homes conduct chart audits for both pain and pressure ulcer care processes (regardless of their randomization).
Our second objective--which is of particular interest to our funding agency, the Agency for Healthcare Research and Quality (AHRQ)--is to determine the extent to which improvement can be sustained after the intervention ends. Our third and final data collection period is designed to determine whether improvement is sustained six months after the intervention ends.

What is Sustainability?

Sustainability is the extent to which a project continues to produce the intended outcome at a steady or increasing level.

For the LTC-QI Partnership, the intended outcome is continued adherence to the CPGs; we hope to see the process measure scores stay the same or improve between the second and third data collection periods.

Long-Term Impact

Why does sustainability matter to the LTC-QI Partnership? Sustainability is of utmost concern to this project--and for all healthcare research--because it is how we evaluate the long-term efficacy of our intervention.

In research, our goal is to ensure that improvement lasts beyond the end of each project; if the outcomes immediately revert to the preintervention baseline, then the resources expended over the course of the project have no lasting impact on quality.
Continued Success

While CPG implementation is difficult and will require organizational behavior change, our intervention is designed to provide participating nursing homes with information and tools to implement CPGs as independently as possible.

The nursing homes do receive a short training at baseline, but the majority of the project is conducted independently, as nursing home staff incorporate the CPGs into their internal care processes and collect and submit their data to obtain their data feedback reports (see "Data Collection 101" above for information about data collection, including audit and feedback). Nurse mentors serve as resources and can provide assistance, when requested.

It is our hope that this intervention will continue to be effective after the LTCQI Partnership ends.