Yu-Rin Kim, Hyun-Kyung Kang
Trend Analysis of Average Frequency Using Toothbrushing per Day in South Korea: An Observational Study of the 2010 to 2018 KNHANES Data
International journal of environmental research and public health
veterans health administration vha united states largest learning health system diffusion excellence doe program largescale model diffusion identifies diffuses evidenceinformed practices across vha period 20162021 57 evidenceinformed practices implemented across 82 vha facilities setting provides unique opportunity understand sustainment determinants pathways objective characterize longitudinal pathways practices transition initial implementation longterm sustainment facility longitudinal mixedmethods evaluation 82 vha facilities eightytwo facility representatives chosen leadership pointsofcontact 57 doe practices eligible postimplementation interviews annual sustainment surveys primary outcomes implementation sustainment secondary outcomes institutionalization effectiveness anticipated sustainment four timepoints collected performed descriptive statistics directed content analysis using hailemariam et als factors influencing sustainment approximately five years postimplementation eg 2021 sustainment outcomes 82 facilities onethird fully sustained practice compared onethird fully sustain practice liminal stage neither sustained discontinued permanently discontinued remaining onethird facilities missing 2021 sustainment outcomes higher percentage facilities 70 inconsistent primary outcomes changing time compared facilities 30 consistent primary outcomes time thirtyfour percent facilities sustained practices reported resilience since overcame implementation sustainment barriers facilities sustained practices reported positive secondary outcomes compared sustain practice key factors facilitating practice sustainment included demonstrating practice effectivenessbenefit sufficient organizational leadership sufficient workforce adaptationalignment local context key factors hindering practice sustainment included insufficient workforce able maintain practice fidelityintegrity critical incidents related covid19 pandemic organizational leadership support sustainment practice ongoing support identified diverse pathways implementation sustainment data underscore initial implementation outcomes may determine longterm sustainment outcomes longitudinal evaluation contributes understanding impacts doe program including return investment achieving learning health system goals insights achieving highquality healthcare vha