Sustainability and Scale-Up Amy Drahota, Ph.D. Department of - - PowerPoint PPT Presentation

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Sustainability and Scale-Up

Amy Drahota, Ph.D. Department of Psychology Michigan State University

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Definitions

• 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)

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Interesting Themes by Presentation

• 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
• pportunity 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

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Interesting Themes by Presentation

• 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)

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Interesting Themes by Presentation

• 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

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Complex Interactions between Cost and Effectiveness

Key activities Cost of scale-up versus clinical trial (cost per screen)* Effectiveness impact Potential impact of inadequate resources for activity or component Provider Training

 or =

Quality Cost (over diagnosis) Harms (over treatment) Outcomes (under diagnosis) Patient education



Adherence Compliance with screening Outcomes Cost (treatment & patient time) Quality Monitoring & Program Evaluation Program Effectiveness Program Cost-Effectiveness Access Quality Adherence



* Projected impact at scale up

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Interesting Themes by Presentation

• 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

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In Conclusion

• 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

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THANK YOU!

• Amy Drahota, Ph.D.

Michigan State University drahotaa@msu.edu