How is the sustainability of chronic disease health programmes empirically measured in hospital and related healthcare services?—a scoping review
Authors : Linda Francis, David Dunt, Dominique A Cadilhac
Abstract
Objectives
Programmes to address chronic disease are a focus of governments worldwide. Despite growth in ‘implementation science’, there is a paucity of knowledge regarding the best means to measure sustainability. The aim of this review was to summarise current practice for measuring sustainability outcomes of chronic disease health programmes, providing guidance for programme planners and future directions for the academic field.
Settings A scoping review of the literature spanning 1985–2015 was conducted using MEDLINE, CINAHL, PsychINFO and The Cochrane Library limited to English language and adults. Main search terms included chronic disease, acute care, sustainability, institutionalisation and health planning. A descriptive synthesis was required. Settings included primary care, hospitals, mental health centres and community health.
Participants Programmes included preventing or managing chronic conditions including diabetes, heart disease, depression, respiratory disease, cancer, obesity, dental hygiene and multiple chronic diseases.
Primary and secondary outcome measures Outcome measures included clarifying a sustainability definition, types of methodologies used, timelines for assessment, criteria levels to determine outcomes and how methodology varies between intervention types.
Results Among 153 abstracts retrieved, 87 were retained for full article review and 42 included in the qualitative synthesis. Five definitions for sustainability outcome were identified with ‘maintenance of programme activities’ most frequent. Achieving sustainability was dependent on inter-relationships between various organisational and social contexts supporting a broad scale approach to evaluation. An increasing trend in use of mixed methods designs over multiple time points to determine sustainability outcomes was found.
Conclusions Despite the importance and investment in chronic disease programmes, few studies are undertaken to measure sustainability. Methods to evaluate sustainability are diverse with some emerging patterns in measurement found. Use of mixed methods approaches over multiple time points may serve to better guide measurement of sustainability. Consensus on aspects of standardised measurement would promote the future possibility of meta-analytic syntheses.
Citation: Linda Francis, David Dunt, Dominique A Cadilhac How is the sustainability of chronic disease health programmes empirically measured in hospital and related healthcare services?—a scoping review
BMJ Open 2016;6:e010944 doi:10.1136/bmjopen-2015-010944
Received: 4 January 2016 Revised: 15 March 2016 Accepted: 17 March 2016 Published: 31 May 2016
Copyright: This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Contributors LF is the first author and performed the initial review of publications. DD and DAC assessed abstracts or full articles to confirm eligibility for full review. DD and DAC contributed to the writing of the draft and revisions of the manuscript for intellectual content, and supervised the research process of the review.
Funding This work is supported by the NHMRC Centre for Research Excellence Grant 1001216. DAC was supported by a fellowship from the National Health and Medical Research Council (NHMRC; 1063761 co-funded by National Heart Foundation).
Competing interests None declared.
