title: How is the sustainability of chronic disease health programmes empirically measured in hospital and related healthcare services?-a scoping review.
abstract: 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.
  
  
  
  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.
  
  
  
  Programmes included preventing or managing chronic conditions including diabetes, heart disease, depression, respiratory disease, cancer, obesity, dental hygiene and multiple chronic diseases.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: The University of Melbourne, Melbourne School of Population and Global Health, Centre for Health Policy, Melbourne Health Centre for Excellence in Neuroscience, Ballarat, Victoria, Australia.
authors.forename: Linda
authors.initials: L
authors.lastname: Francis
authors.affiliation: Centre for Health Policy, The University of Melbourne, Melbourne School of Population and Global Health, Parkville, Victoria, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Dunt
authors.affiliation: Translational Public Health Unit, Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia Head Public Health: Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, Victoria, Australia.
authors.forename: Dominique A
authors.initials: DA
authors.lastname: Cadilhac
mesh_terms: D002908:Chronic Disease / Q000517:prevention & control* / Q000628:therapy; D006266:Health Education; D006293:Health Promotion; D006761:Hospitals; D006801:Humans; D009935:Organizational Affiliation; D017063:Outcome Assessment, Health Care; D015397:Program Evaluation / Q000379:methods* / Q000639:trends; D009626:Terminology as Topic