1 Sustainability and Scale-Up Amy Drahota, Ph.D. Department of Psychology Michigan State University
Definitions 2 • Sustainability • “(1) after a defined period of time, (2) a program, clinical intervention, and/or implementation strategies continue to be delivered and/or (3) individual behavior change (i.e., clinician, patient) is maintained; (4) the program and individual behavior change may evolve or adapt while (5) continuing to produce benefits for individuals/ systems” (Moore et al., 2017. Developing a comprehensive definition of sustainability, Implementation Science, 12:110) • Scale up • “ Deliberate efforts to increase the impact of health service innovations successfully tested in pilot or experimental projects so as to benefit more people and to foster policy and program development on a lasting basis” (Rabin & Brownson, 2017. Terminology for Dissemination and Implementation Research, In D&I Research in Health)
Interesting Themes by Presentation 3 • Alaro’s analysis of NCI’s Center Global Health portfolio • Exploring how to best support/promote D&I research globally through training and funding • How can we utilize evidence-based D&I strategies to disseminate the scope, purpose, methods and analyses for D&I science research to those who are interested? • How can funders leverage funded research that presents a clear opportunity for D&I? – Rapid application cycle for D&I researchers to supplement just funded projects that have opportunity for D&I science – D&I training opportunities to NCI-funded researchers
Interesting Themes by Presentation 4 • Moucheraud’s evaluation of Alive & Thrive sustainability • The original project was conducted at scale – now to examine sustainability of the multi-level intervention • This research points to the need for better understanding of sustainability strategies – List of sustainment strategies, similar to Powell’s list of implementation strategies – Guidance on selecting the appropriate sustainment strategy for the particular target (government, agency leaders, providers)
Interesting Themes by Presentation 5 • Subramanian’s economic evaluation of scaling up integrated cancer screening • Innovative way to evaluate the cost/benefit to scale up an EBP • Slide 4: Complex interactions between cost and effectiveness – Concrete application of oft given advice from D&I: Develop interventions with the end user and end setting in mind – Potential tool to facilitate a discussion between researchers and stakeholders to guide plan for going to scale
Complex Interactions between Cost and Effectiveness 6 Key activities Cost of scale-up Effectiveness Potential impact of inadequate versus clinical trial impact resources for activity or (cost per screen)* component or = Cost (over diagnosis) Provider Training Quality Harms (over treatment) Outcomes (under diagnosis) Compliance with screening Patient education Adherence Outcomes Cost (treatment & patient time) Program Effectiveness Quality Monitoring & Access Program Cost-Effectiveness Program Evaluation Quality Adherence * Projected impact at scale up
Interesting Themes by Presentation 7 • Wynn’s economic evaluation of scale up costs • Utilizing a pilot study that gathers implementation costs to then predict the cost of scaling up EBPs across variable scenarios • Challenges to this work – Difficulty distinguishing intervention costs from implementation costs – How to determine that all of the cost variables have been included – Traditional statistical consultants of cost effectiveness may be reticent to utilize implementation costs
In Conclusion 8 • Continues to be a need for us to utilize evidence-based dissemination strategies on ourselves to reach our academic partners about the role of D&I to increase the public health impact for the ultimate benefit of individuals in need • Continues to be a need for precision in our selection of strategies to facilitate the uptake or continued use of EBPs • Guidance on match specific implementation or sustainment strategies may be available through cost evaluations
9 THANK YOU! • Amy Drahota, Ph.D. Michigan State University drahotaa@msu.edu
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