Mind the gap: analysis of two pilot projects of a home telehealth service for persons with complex conditions in a Swedish hospital

BMC Health Services Research

Research Article

Petra Danapfel¹  Carla Sacchi²  Karin Lodin³  Moa Malmqvist⁴  Rebecca Mosson⁴  Carolina Wannheden⁴  Jamie Linnéa Luckhaus⁵  Marta Roczniewska⁶  Pamela Mazzocato⁷  Karolina Andersson⁸  Lars Peter Rodmalm⁸ 

[1] Change Management and Processes Unit, Region Östergötland, Linköping, Sweden;Department of Business Studies, Uppsala University, Uppsala, Sweden;Department of Medicine, Karolinska Institutet, Stockholm, Sweden;Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden;Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden;Department of Women’s and Children’s Health, Uppsala Universitu, Uppsala, Sweden;Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden;Institute of Psychology, SWPS University of Social Sciences and Humanities, Warsaw, Poland;Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden;Research, Development, Education, and Innovation Unit, Södertälje Hospital, Södertälje, Sweden;Research, Development, Education, and Innovation Unit, Södertälje Hospital, Södertälje, Sweden;

关键词: Complexity;    Quality improvement;    Innovation;    Telehealth;    Heart failure;    COVID-19;   

DOI  :  10.1186/s12913-023-09409-4

 received in 2022-09-09, accepted in 2023-04-14,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundDeveloping and implementing home telehealth (HTH) services for patients with chronic conditions is a challenge. HTH services provide continuous and integrated care to patients, but very often pilot projects face non-adoption and abandonment issues. Change processes in healthcare are often complex and require learning to adapt to non-linear and unpredictable events. Complexity science can thus provide a complementary view to the predominant Quality Improvement (QI) approach in healthcare. In this study of two pilot projects in a Swedish hospital, we explore how a theory-driven approach can be used (a) to support the development of a self-monitoring HTH service in hospital care and (b) to evaluate staff and patients’ experiences from early adoption.MethodsTo plan and evaluate the service for the recipients (i.e., patients and healthcare providers), we used the Plan-Do-Study-Act (PDSA) tool in combination with two complexity-informed frameworks: the Non-adoption, Abandonment, Scale-up, Spread and Sustainability (NASSS) framework, and the joint Complexity Assessment Tool (CAT). The theory-informed development process led to two pilot projects of an HTH service for patients with heart failure and COVID-19. We collected data from multiple sources (project documents, a survey on readiness for change among staff, and semi-structured interviews with patients and staff) and analyzed the data using descriptive statistics and qualitative content analysis with a deductive approach.ResultsPatients and staff perceived the services as valuable as they enabled rapid feedback, and improved communication and collaboration between patients and healthcare providers. Yet, despite the extensive development efforts, there was a perceived gap between how individuals valued the service and the capacity of adopters, the organization, and the wider system to effectively integrate these services into routine care.ConclusionsThe combined use of PDSA, NASSS, and CAT can support the development and evaluation of HTH services that are perceived as valuable by individual patients and staff. For successful adoption, the value for individuals must be supported by organizational efforts to learn how to integrate new routines and tasks into clinical practice and daily life, and how to coordinate multiple providers within and outside the hospital walls.

【 授权许可】

CC BY   
© The Author(s) 2023

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