title: Sustainability of evidence-based healthcare: research agenda, methodological advances, and infrastructure support.
abstract: BACKGROUND
  Little is known about how well or under what conditions health innovations are sustained and their gains maintained once they are put into practice. Implementation science typically focuses on uptake by early adopters of one healthcare innovation at a time. The later-stage challenges of scaling up and sustaining evidence-supported interventions receive too little attention. This project identifies the challenges associated with sustainability research and generates recommendations for accelerating and strengthening this work.
  
  
  METHODS
  A multi-method, multi-stage approach, was used: (1) identifying and recruiting experts in sustainability as participants, (2) conducting research on sustainability using concept mapping, (3) action planning during an intensive working conference of sustainability experts to expand the concept mapping quantitative results, and (4) consolidating results into a set of recommendations for research, methodological advances, and infrastructure building to advance understanding of sustainability. Participants comprised researchers, funders, and leaders in health, mental health, and public health with shared interest in the sustainability of evidence-based health care.
  
  
  RESULTS
  Prompted to identify important issues for sustainability research, participants generated 91 distinct statements, for which a concept mapping process produced 11 conceptually distinct clusters. During the conference, participants built upon the concept mapping clusters to generate recommendations for sustainability research. The recommendations fell into three domains: (1) pursue high priority research questions as a unified agenda on sustainability; (2) advance methods for sustainability research; (3) advance infrastructure to support sustainability research.
  
  
  CONCLUSIONS
  Implementation science needs to pursue later-stage translation research questions required for population impact. Priorities include conceptual consistency and operational clarity for measuring sustainability, developing evidence about the value of sustaining interventions over time, identifying correlates of sustainability along with strategies for sustaining evidence-supported interventions, advancing the theoretical base and research designs for sustainability research, and advancing the workforce capacity, research culture, and funding mechanisms for this important work.
authors.affiliation: George Warren Brown School of Social Work, Washington University in St. Louis, One Brookings Drive, Campus, Box 1196, St. Louis, MO, USA. ekp@wustl.edu.
authors.forename: Enola
authors.initials: E
authors.lastname: Proctor
authors.affiliation: George Warren Brown School of Social Work, Washington University in St. Louis, One Brookings Drive, Campus, Box 1196, St. Louis, MO, USA. dluke@wustl.edu.
authors.forename: Douglas
authors.initials: D
authors.lastname: Luke
authors.affiliation: Bridgespan Group, 2 Copley Pl #3700b, Boston, MA, USA. annaliese@go.wustl.edu.
authors.forename: Annaliese
authors.initials: A
authors.lastname: Calhoun
authors.affiliation: School of Social Service Administration, The University of Chicago, 969 E. 60th Street, Chicago, IL, USA. cmcmillen@uchicago.edu.
authors.forename: Curtis
authors.initials: C
authors.lastname: McMillen
authors.affiliation: George Warren Brown School of Social Work, Washington University in St. Louis, One Brookings Drive, Campus, Box 1196, St. Louis, MO, USA. rbrownson@wustl.edu.
authors.forename: Ross
authors.initials: R
authors.lastname: Brownson
authors.affiliation: George Warren Brown School of Social Work, Washington University in St. Louis, One Brookings Drive, Campus, Box 1196, St. Louis, MO, USA. Stacey.mccrary@wustl.edu.
authors.forename: Stacey
authors.initials: S
authors.lastname: McCrary
authors.affiliation: George Warren Brown School of Social Work, Washington University in St. Louis, One Brookings Drive, Campus, Box 1196, St. Louis, MO, USA. Mpadek2@brownschool.wustl.edu.
authors.forename: Margaret
authors.initials: M
authors.lastname: Padek
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration*; D055317:Evidence-Based Practice; D006801:Humans; D016730:Program Development; D015397:Program Evaluation; D057170:Translational Research, Biomedical / Q000379:methods / Q000458:organization & administration