Scaling up eConsult for access to specialists in primary healthcare across four Canadian provinces: study protocol of a multiple case study

Health Research Policy and Systems

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[1] 0000 0000 9064 6198, grid.86715.3d, Centre de recherche Charles-Le Moyne – Saguenay-Lac-Saint-Jean sur les innovations en santé, Université de Sherbrooke, Longueuil Campus, 150 Place Charles-Le Moyne, Office 200, J4K0A8, Longueuil, Canada;0000 0000 9064 6198, grid.86715.3d, Centre de recherche du CHUS, Université de Sherbrooke, Sherbrooke, Canada;0000 0000 9130 6822, grid.25055.37, Department of Family Medicine, Memorial University, St-John, Canada;0000 0001 2112 1125, grid.265705.3, Département des sciences administratives, Université du Québec en Outaouais, Gatineau, Canada;0000 0001 2157 2938, grid.17063.33, Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum, Research Institute, Sinai Health System, University of Toronto, Institute of Health Policy, Management and Evaluation, Toronto, Canada;0000 0001 2182 2255, grid.28046.38, C.T. Lamont Primary Health Care Research Center, Bruyère Research Institute, Department of Family Medicine, University of Ottawa, Ottawa, Canada;0000 0001 2182 2255, grid.28046.38, Department of Medicine, University of Ottawa, Division of Endocrinology/Metabolism, The Ottawa Hospital, University of Ottawa, Ottawa, Canada;0000 0004 1936 8390, grid.23856.3a, Faculté des sciences infirmières, Université Laval, Québec, Canada;0000 0004 1936 8649, grid.14709.3b, Department of Family Medicine, McGill University, Montréal, Canada;0000 0004 1936 8649, grid.14709.3b, Family Medicine Center, St-Mary’s Hospital, McGill University, Montréal, Canada;0000 0004 1936 9609, grid.21613.37, Department of Family Medicine, University of Manitoba, Winnipeg, Canada;Women’s College Hospital, Institute for Health System Solutions and Virtual Care, Toronto, Canada;

关键词: Access to healthcare;    eConsult;    scaling up;    primary care;    electronic consultation;    process research;    implementation;    diffusion of innovation;    policy;   

DOI  :  10.1186/s12961-019-0483-5

来源: publisher

【 摘 要 】

BackgroundCanada has been referred to as the land of ‘perpetual pilot projects’. Effective innovations often remain small in scale, with limited impact on health systems. Several innovations have been developed in Canada to tackle important challenges such as poor access to services and excessive wait times – one of the most promising innovations that has been piloted is eConsult, which is a model of asynchronous communication that allows primary care providers to electronically consult with specialists regarding their patients’ medical issues. eConsult pilot projects have been shown to reduce wait times for specialist care, prevent unnecessary referrals and reduce health system costs. eConsult has been spread throughout Ontario as well as to certain regions in Manitoba, Quebec, and Newfoundland and Labrador.Our aim is to understand and support the scale-up process of eConsult in Ontario, Quebec, Manitoba, and Newfoundland and Labrador. Our specific objectives are to (1) describe the main components of eConsult relevant to the scale-up process in each province; (2) understand the eConsult scale-up process in each province and compare across provinces; (3) identify policy issues and strategies to scaling up eConsult in each province; and (4) foster cross-level and cross-jurisdictional learning on scaling up eConsult.MethodsWe will conduct a qualitative multiple case study to investigate the scaling up of eConsult in four Canadian provinces using a grey literature review, key stakeholder interviews (10 interviews/province), non-participant observations, focus groups and deliberative dialogues. We will identify the main components of eConsult to be scaled up using logic models (obj. 1). Scaling up processes will be analysed using strategies adapted from process research (obj. 2). Policy issues and strategies to scale-up eConsult will be analysed thematically (obj. 3). Finally, a symposium will foster pan-Canadian learning on the process of scaling up eConsult (obj. 4).DiscussionThis study will likely increase learning and support evidence-based policy-making across participating provinces and may improve the capacity for a pan-Canadian scale-up of eConsult, including in provinces where eConsult has not yet been implemented. This work is essential to inform how similar innovations can reshape our health systems in the evolving information age.

【 授权许可】

CC BY