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Importance of Sustainability Planning for Rural Chronic Disease Management Programs

It is important to address sustainability early in the planning and implementation stages of chronic disease management programs. Programs are more likely to continue uninterrupted when sustainability is considered early. Rural programs planning for long-term sustainability should consider what strategies will be implemented to support program staff, resources, and partnerships. These strategies should be identified early, during program planning.

To achieve sustainability, rural chronic disease management programs often need to demonstrate that the program has had measurable impacts. This may include impacts on the lives of people served, the health system implementing the program, and the overall community. Examples of expected impacts of rural chronic disease management programs include improved health outcomes, decreased healthcare expenditures, and decreased healthcare utilization such as emergency room visits and hospitalizations. Long-term sustainability also depends on successful program implementation, which requires identifying and addressing barriers to service delivery.

Program leadership may benefit from additional information about sustainability planning from our other topic-specific toolkits:

Building a Business Case

The Centers for Disease Control and Prevention (CDC) provides a seven-part guide for building the business case for diabetes self-management education and support. Making a business case for a rural chronic disease management program is essential to demonstrating the overall value of the program and ensuring long-term sustainability. Programs can conduct evaluation activities to gather the information needed to demonstrate value.

Key Questions and Strategies for Sustainability

Key questions rural programs should consider when planning for sustainability include:

  • What strategies will be used to obtain input and buy-in from community and partner organizations?
  • What are the appropriate evaluation measures for assessing program outcomes or return on investment?
  • Who are the potential funders of program operations?
  • To what extent are program services reimbursable through insurance?
  • What are other potential revenue streams for the program?
  • What are long- and short-term sustainability strategies to achieve program goals?
  • What kinds of financial, staff, and in-kind resources are necessary for sustained program success?
  • How can we document and share information on program success and progress? What results are program funders most interested in learning?
  • How can we share results of program success in a way that resonates with funders?
  • What are potential challenges and barriers to implementation and what are the potential solutions to overcome these issues?

Rural chronic disease management programs may also consider some of these strategies for encouraging sustainability:

  • Establish a strong and engaged steering committee
  • Establish solid partnerships in the community
  • Maintain open and honest lines of communications between partners
  • Market the services to community members, providers, and other partners
  • Demonstrate program outcomes using data
  • Embrace flexibility when things do not go as planned

The Center for Public Health Systems Science developed the Program Sustainability Assessment Tool to provide a reliable sustainability assessment instrument that has demonstrated effectiveness when used with chronic disease programs. The tool can be used to support activities such as assembling a sustainability planning team, reviewing sustainability efforts, prioritizing actions, writing an action plan, and implementing the action plan.

Importance of Partnerships

Community partners play an important role in supporting the sustainability of rural chronic disease management programs. In some rural communities, partners provide in-kind resources, such as transportation to and from education classes, or physical space for program activities. Sustainability also depends on the ability of rural chronic disease management programs to continually engage new patients or participants. Building strong relationships and collaborating with social services agencies, senior centers, community-based organizations, schools, and other community-serving institutions can help maintain steady referrals to program services.

Resources to Learn More

Assessing Capacity for Sustainability of Effective Programs and Policies in Local Health Departments
Examines a sample of high and low-capacity local health departments by conducting interviews to determine what aspects of program development — organizational capacity, evaluation, adaptation, communication, and funding — led to sustainable programs.
Author(s): Tabak, R., Duggan, K., Smith, C., et al.
Citation: Journal of Public Health Management and Practice, 22(2), 129-137
Date: 2016

Diabetes Prevention Lifestyle Change Program: The Business Case for Inclusion as a Covered Health Benefit
Describes findings from the implementation of the Diabetes Prevention Lifestyle Change Program (DPLCP), an employer-sponsored lifestyle intervention program to prevent or delay the onset of type 2 diabetes in people with or at risk for prediabetes through dietary changes and increased physical activity. Discusses the reasons why offering DPLCP to employees is good for the company and employees by improving health outcomes, reducing loss of workdays, and decreasing healthcare costs.
Organization(s): Florida Health Care Coalition
Date: 1/2015