title: Bridging implementation and institutionalization within organizations: proposed employment of continuous quality improvement to further dissemination.
abstract: OBJECTIVE
  Although organizations may initially adopt and implement interventions, the institutionalization of these interventions does not always occur. The purpose of this article is to provide an example describing the breakdown in the dissemination process using an accepted conceptualization and measurement of institutionalization. We also suggest an approach for understanding the movement of the intervention through the dissemination process to improve the likelihood of institutionalization.
  
  
  METHODS
  Through the Controlling Asthma in American Cities Project in St. Louis, the institutionalization of evidence-based interventions was measured in multiple settings. Specifically, data from three school districts were measured and presented. External implementation and financial support for the intervention were phased out and internal support by the districts was phased in after 2 years of implementation. Representatives for the districts and the schools were asked to complete the Levels of Institutionalization (LoIn) scales instrument measuring the institutionalization of these interventions.
  
  
  RESULTS
  The LoIn scale data demonstrate increasing Routinization and saturation mean scores for all school districts in the first 2 years, with decreasing scores in district A in year 3. District A did not have external facilitation of implementation and support in year 3, which is Reflected in the decreasing scores. Institutionalization did not occur in the conduct of formal evaluation, the presence of job descriptions, and the presence of similar and permanent funding in all three districts.
  
  
  CONCLUSIONS
  We propose an approach to help identify and measure processes of dissemination through continuous quality improvement, increasing the likelihood that interventions are institutionalized.
authors.affiliation: Saint Louis University School of Public Health, 3545 Lafayette Ave, Room 300, St. Louis, MO 63104, USA. wilsonkdj@gmail.com
authors.forename: Kristin D
authors.initials: KD
authors.lastname: Wilson
authors.forename: Richard S
authors.initials: RS
authors.lastname: Kurz
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000517:prevention & control / Q000628:therapy; D002487:Centers for Disease Control and Prevention, U.S.; D002648:Child; D002675:Child, Preschool; D004059:Diffusion of Innovation; D019317:Evidence-Based Medicine; D006302:Health Services Research / Q000379:methods*; D006801:Humans; D033181:Information Dissemination; D019982:Organizational Case Studies; D009936:Organizational Innovation; D011785:Quality Assurance, Health Care; D012574:Schools / Q000458:organization & administration; D014481:United States; D014504:Urban Health