title: Association of intervention outcomes with practice capacity for change: subgroup analysis from a group randomized trial.
abstract: BACKGROUND
  The relationship between health care practices' capacity for change and the results and sustainability of interventions to improve health care delivery is unclear.
  
  
  METHODS
  In the setting of an intervention to increase preventive service delivery (PSD), we assessed practice capacity for change by rating motivation to change and instrumental ability to change on a one to four scale. After combining these ratings into a single score, random effects models tested its association with change in PSD rates from baseline to immediately after intervention completion and 12 months later.
  
  
  RESULTS
  Our measure of practices' capacity for change varied widely at baseline (range 2-8; mean 4.8 +/- 1.6). Practices with greater capacity for change delivered preventive services to eligible patients at higher rates after completion of the intervention (2.7% per unit increase in the combined effort score, p < 0.001). This relationship persisted for 12 months after the intervention ended (3.1%, p < 0.001).
  
  
  CONCLUSIONS
  Greater capacity for change is associated with a higher probability that a practice will attain and sustain desired outcomes. Future work to refine measures of this practice characteristic may be useful in planning and implementing interventions that result in sustained, evidence-based improvements in health care delivery.
authors.affiliation: Department of Medicine, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA. David.Litaker@va.gov
authors.forename: David
authors.initials: D
authors.lastname: Litaker
authors.forename: Mary
authors.initials: M
authors.lastname: Ruhe
authors.forename: Sharon
authors.initials: S
authors.lastname: Weyer
authors.forename: Kurt C
authors.initials: KC
authors.lastname: Stange