Telehealth Deployment Research Articles

Telehealth Consultation for Malaysian Citizens' Willingness to Pay Assessed by the Double-Bounded Dichotomous Choice Method.

Re-envisioning healthcare in technology tools includes robust utilisation of telehealth, improvement in access, quality, care efficiencies and cost-effectiveness of healthcare services. In reality, the technology's potential to transform healthcare may be limited by the ability to pay for it. This study aims to estimate Malaysian citizens' willingness to pay (WTP) for telehealth consultations and determine the factors contributing to it. This is vital to inform decision-making about expansion, preferences and deployment of a pricing strategy for telehealth services. A random sample of 220 adult Malaysians was surveyed using social network services (SNS). Three different WTP bid arrays were identified and each respondent received a randomly drawn bid price. The WTP fee for using the telehealth consultation for 30 min was measured and estimated using a Double-Bounded Dichotomous Choice (DBDC) and the Random Utility Logit Model. The median WTP was estimated to be RM58 (JPY2,198), RM78 (JPY2,956) for 132 respondents' willingness to use telehealth consultation and RM26 (JPY985) for 51 respondents who were unwilling. Further analysis found that WTP is correlated with the perception and willingness of the respondents to use it. Despite most respondents being willing to pay for telehealth consultations, sociodemographic characteristics and affordability influenced the process of making decisions about WTP for telehealth consultation. This finding suggests that the private sector can play a crucial role in the deployment of telehealth. However, there may be a need to consider affordability and how to increase access and use of telehealth services.

Strategies to Bridge Equitable Implementation of Telehealth.

During the COVID-19 pandemic, the rapid scaling of telehealth limited the extent to which proactive planning for equitable implementation was possible. The deployment of telehealth will persist in the postpandemic era, given patient preferences, advances in technologies, growing acceptance of telehealth, and the potential to overcome barriers to serve populations with limited access to high-quality in-person care. However, aspects and unintended consequences of telehealth may leave some groups underserved or unserved, and corrective implementation plans that address equitable access will be needed. The purposes of this paper are to (1) describe equitable implementation in telehealth and (2) integrate an equity lens into actionable equitable implementation.

Telehealth services in an outpatient nephrology clinic during the COVID-19 pandemic: a patient perspective.

In response to the COVID-19 pandemic, new policy waivers permitted reimbursement of telehealth services in urban settings. The aim of this study was to assess patient satisfaction with telehealth services during the COVID-19 pandemic in an outpatient urban nephrology practice. Patients who had virtual encounters were asked to complete an online survey regarding their experiences with telehealth services. Twenty-one percent of eligible patients completed the survey. Patients (83.6%) reported overall positive experiences with telehealth and want to see a hybrid healthcare model in the future (80.1%). Additionally, most patients found telehealth appointments convenient to make and telehealth encounters convenient to conduct. Ethnicity, age, gender, and insurance type did not have a statistically significant impact on satisfaction ratings. Technical issues were not encountered by 79.5% of patients and patients were willing to use the video feature. However, if they had technical issues, patient satisfaction ratings were negatively impacted. Telehealth services are beneficial to patients with regards to convenience, decreased transportation costs and time, increased accessibility to healthcare, and decreased overall opportunity costs. However, challenges still remain with the deployment of telehealth and will be dependent on patients' digital health literacy, access to broadband internet and devices, and legislation and/or regulations. Limitations of the study, including small sample size and surveying patients from a nephrology practice, may prevent it from being generalizable. Additional studies with a larger sample size and multiple specialties may be needed to generalize patients' satisfaction with telehealth services.

Utilizing telehealth intervention to support patients with cardiovascular diseases in Jordan: A qualitative study

IntroductionTelemedicine is one of the new technological solutions used to facilitate treatment and intervention in patients with Cardiovascular Diseases (CVD). Nevertheless, the utilization of telehealth in Jordan is under-researched. PurposeTo explore the perspectives and experiences of patients with cardiovascular disease (CVD) and healthcare providers on how telehealth can help manage critical and long-term CVD health problems. MethodA qualitative, descriptive approach was employed, whereby individual interviews were conducted with 12 healthcare providers and 12 cardiac patients from Abdali and Prince Hamzah Hospitals in Jordan. The derived data were analyzed using thematic analysis, according to the method expounded by Braun and Clarke (2014). ResultsThe analysis of collected data revealed that telehealth deployment exhibited several advantages from the participants' perspectives, these can be divided into the following six themes: mitigating associated risks, qualified and friendly staff, streamlined work processes, effective and structured services, accessibility and privacy of patient information, affordable and convenient services. ConclusionThe current study suggests that telehealth can be helpful and convenient in many aspects of the health care services for patients with CVD, mainly during the crucial times of the COVID pandemic. With this study, stakeholders and Jordanian managers can better understand the telehealth advantages. This will enable them to improve the quality of care in their health organizations in the future.

Enabling Rural Telehealth for Older Adults in Underserved Rural Communities: Focus Group Study

Telehealth is often suggested to improve access to health care and has had significant publicity worldwide during the COVID-19 pandemic. However, limited studies have examined the telehealth needs of underserved populations such as rural communities. This study aims to investigate enablers for telehealth use in underserved rural populations to improve access to health care for rural older adults. In total, 7 focus group discussions and 13 individual interviews were held across 4 diverse underserved rural communities. A total of 98 adults aged ≥55 years participated. The participants were asked whether they had used telehealth, how they saw their community's health service needs evolving, how telehealth might help provide these services, and how they perceived barriers to and enablers of telehealth for older adults in rural communities. Focus group transcripts were thematically analyzed. The term telehealth was not initially understood by many participants and required an explanation. Those who had used telehealth reported positive experiences (time and cost savings) and were likely to use telehealth again. A total of 2 main themes were identified through an equity lens. The first theme was trust, with 3 subthemes-trust in the telehealth technology, trust in the user (consumer and health provider), and trust in the health system. Having access to reliable and affordable internet connectivity and digital devices was a key enabler for telehealth use. Most rural areas had intermittent and unreliable internet connectivity. Another key enabler is easy access to user support. Trust in the health system focused on waiting times, lack of and/or delayed communication and coordination, and cost. The second theme was choice, with 3 subthemes-health service access, consultation type, and telehealth deployment. Access to health services through telehealth needs to be culturally appropriate and enable access to currently limited or absent services such as mental health and specialist services. Accessing specialist care through telehealth was extremely popular, although some participants preferred to be seen in person. A major enabler for telehealth was telehealth deployment by a fixed community hub or on a mobile bus, with support available, particularly when combined with non-health-related services such as internet banking. Overall, participants were keen on the idea of telehealth. Several barriers and enablers were identified, particularly trust and choice. The term telehealth is not well understood. The unreliable and expensive connectivity options available to rural communities have limited telehealth experience to phone or patient portal use for those with connectivity. Having the opportunity to try telehealth, particularly by using video, would increase the understanding and acceptance of telehealth. This study highlights that local rural communities need to be involved in designing telehealth services within their communities.

Uncovering healthcare staff attitudes to the rapid deployment of telehealth in Victoria, 2020-2021: a 12-month telehealth experience.

Telehealth was widely adopted in health services during the COVID-19 pandemic. It is unknown what the attitudes and ongoing needs of healthcare staff are after a rapid implementation of telehealth. To evaluate staff attitudes to telehealth utilisation after a rapid implementation. A health service-wide bespoke survey was sent to all clinicians, managers and administration staff in June-July 2021. We evaluated attitudes to: (i) telehealth application in the model of care; and (ii) the barriers and enablers to use of telehealth. Descriptive statistics were used for quantitative data, and content analysis for the textual data. One hundred and thirty-four respondents completed the survey (response rate=22.5% of healthdirect users (71/315), and3.2% of total healthcare staff population). Most commonly, telehealth was identified as being important (78%) and safe (79%) by clinicians, and important (100%) and encouraged (88%) by managers. In contrast, telehealth was identified as not the same as face to face (56%; 50%), but easy to add to usual work arrangements (43%; 44%) by clinicians and managers respectively. The most common enablers of telehealth were: (i) having others use the same telehealth platform (74.3%; 100%); and (ii) completing training (68.9%; 72.7%) by clinicians and managers respectively. The most common barriers were having: (i) reliable Internet connectivity (39.2%; 45.5%) by clinicians and managers, respectively; (ii) the right equipment (clinician 37.8%); and (iii) a private area (managers 36.3%). Despite training and having support from colleagues to implement telehealth, ongoing needs were identified that may promote uptake in specific health settings.

Nursing Workflow Change in a COVID-19 Inpatient Unit Following the Deployment of Inpatient Telehealth: Observational Study Using a Real-Time Locating System.

BackgroundThe COVID-19 pandemic prompted widespread implementation of telehealth, including in the inpatient setting, with the goals to reduce potential pathogen exposure events and personal protective equipment (PPE) utilization. Nursing workflow adaptations in these novel environments are of particular interest given the association between nursing time at the bedside and patient safety. Understanding the frequency and duration of nurse-patient encounters following the introduction of a novel telehealth platform in the context of COVID-19 may therefore provide insight into downstream impacts on patient safety, pathogen exposure, and PPE utilization.ObjectiveThe aim of this study was to evaluate changes in nursing workflow relative to prepandemic levels using a real-time locating system (RTLS) following the deployment of inpatient telehealth on a COVID-19 unit.MethodsIn March 2020, telehealth was installed in patient rooms in a COVID-19 unit and on movable carts in 3 comparison units. The existing RTLS captured nurse movement during 1 pre- and 5 postpandemic stages (January-December 2020). Change in direct nurse-patient encounters, time spent in patient rooms per encounter, and total time spent with patients per shift relative to baseline were calculated. Generalized linear models assessed difference-in-differences in outcomes between COVID-19 and comparison units. Telehealth adoption was captured and reported at the unit level.ResultsChange in frequency of encounters and time spent per encounter from baseline differed between the COVID-19 and comparison units at all stages of the pandemic (all P<.001). Frequency of encounters decreased (difference-in-differences range –6.6 to –14.1 encounters) and duration of encounters increased (difference-in-differences range 1.8 to 6.2 minutes) from baseline to a greater extent in the COVID-19 units relative to the comparison units. At most stages of the pandemic, the change in total time nurses spent in patient rooms per patient per shift from baseline did not differ between the COVID-19 and comparison units (all P>.17). The primary COVID-19 unit quickly adopted telehealth technology during the observation period, initiating 15,088 encounters that averaged 6.6 minutes (SD 13.6) each.ConclusionsRTLS movement data suggest that total nursing time at the bedside remained unchanged following the deployment of inpatient telehealth in a COVID-19 unit. Compared to other units with shared mobile telehealth units, the frequency of nurse-patient in-person encounters decreased and the duration lengthened on a COVID-19 unit with in-room telehealth availability, indicating “batched” redistribution of work to maintain total time at bedside relative to prepandemic periods. The simultaneous adoption of telehealth suggests that virtual care was a complement to, rather than a replacement for, in-person care. However, study limitations preclude our ability to draw a causal link between nursing workflow change and telehealth adoption. Thus, further evaluation is needed to determine potential downstream implications on disease transmission, PPE utilization, and patient safety.

Access to telehealth services for colorectal cancer patients in the United States during the COVID-19 pandemic

BackgroundThe COVID-19 pandemic yielded rapid telehealth deployment to improve healthcare access, including for surgical patients. MethodsWe conducted a secret shopper study to assess telehealth availability for new patient and follow-up colorectal cancer care visits in a random national sample of Commission on Cancer accredited hospitals and investigated predictive facility-level factors. ResultsOf 397 hospitals, 302 (76%) offered telehealth for colorectal cancer patients (75% for follow-up, 42% for new patients). For new patients, NCI-designated Cancer Programs offered telehealth more frequently than Integrated Network (OR: 0.20, p = 0.01), Academic Comprehensive (OR: 0.18, p = 0.001), Comprehensive Community (OR: 0.10, p < 0.001), and Community (OR: 0.11, p < 0.001) Cancer Programs. For follow-up, above average timeliness of care hospitals offered telehealth more frequently than average hospitals (OR: 2.87, p = 0.04). ConclusionsWe identified access disparities and predictive factors for telehealth availability for colorectal cancer care during the COVID-19 pandemic. These factors should be considered when constructing telehealth policies.

Digital Divide in the Rural Healthcare Market in the United States: Health Equity and Inclusiveness

The digital divide has been extensively discussed in context with consumer shopping behavior and population health based on race and ethnic groups (Kwon &amp;amp; Kim, 2021; Qian, 2022). However, it has been rarely explored in terms of health disparity between rural area and the rest of the population. The pandemic provides a good opportunity for us to review the extent of telehealth practice in rural areas which play an important role in many aspects of our life. Telehealth if and when properly utilized could address health inequity that exists between rural communities and urban settings. Healthcare inclusiveness will be a by-product from telehealth deployment in rural communities. The purpose of this article is to present the current status of telehealth in rural areas of the United States and recommend a long-term solution to make telehealth a sustainable program. A short case study supplements this study. Our study finds that telehealth in rural area brought many potential customers to healthcare market especially those who were unable to receive care under traditional settings due to transportation, cost and lack of information readily available to the community. This study also uncovered that telehealth literacy training in the rural areas is a major pathway to successful utilization of telehealth potential. Due to a lack of comprehensive literature in rural telehealth, this study used current status of rural population and healthcare infrastructure in the United States as a source of study methodology.

Non-English Language Preference Associated With Decreased Rheumatology Telehealth Use During the COVID-19 Pandemic.

ObjectiveThe study objective was to assess sociodemographic disparities in telehealth use among patients in an urban adult rheumatology clinic during the coronavirus disease 2019 (COVID‐19) pandemic.MethodsIn this retrospective cohort study, patient‐level sociodemographic data associated with all rheumatology visits in the following two periods were reviewed: pre‐COVID‐19 (March 1, 2019 to February 28, 2020) and COVID‐19 (April 1, 2020 to March 31, 2021). Data were extracted from the electronic health record. Multivariable logistic regression analyses were performed to determine sociodemographic factors associated with video visits during the COVID‐19 period.ResultsIn the pre‐COVID‐19 period, 1503 patients completed 3837 visits (100% in person). In the COVID‐19 period, 1442 patients completed 3406 visits: 41% in person, 30% video, and 29% telephone only. Several factors were associated with decreased video use: preference for Spanish language (adjusted odds ratio [aOR] 0.27, 95% confidence interval [CI] 0.15‐0.47) or other non‐English languages (aOR 0.34, 95% CI 0.21‐0.55), Black or African American race/ethnicity (aOR 0.50, 95% CI 0.35‐0.73), Medicaid payer, and increasing age.ConclusionDecreased video visit use among rheumatology patients was associated with non‐English language preference, minority race/ethnicity, increasing age, and indicators of low income. Rapid deployment and expansion of telehealth during the COVID‐19 pandemic likely has improved access for some but widened preexisting disparities for others. As medical care evolves toward ongoing digital care delivery, clarifying and addressing causes of telehealth disparities is essential for delivering equitable health care.

Telehealth for rehabilitation and recovery after stroke: State of the evidence and future directions.

The aim of this rapid review and opinion paper is to present the state of the current evidence and present future directions for telehealth research and clinical service delivery for stroke rehabilitation. We conducted a rapid review of published trials in the field. We searched Medline using key terms related to stroke rehabilitation and telehealth or virtual care. We also searched clinical trial registers to identify key ongoing trials. The evidence for telehealth to deliver stroke rehabilitation interventions is not strong and is predominantly based on small trials prone to Type 2 error. To move the field forward, we need to progress to trials of implementation that include measures of adoption and reach, as well as effectiveness. We also need to understand which outcome measures can be reliably measured remotely, and/or develop new ones. We present tools to assist with the deployment of telehealth for rehabilitation after stroke. The current, and likely long-term, pandemic means that we cannot wait for stronger evidence before implementing telehealth. As a research and clinical community, we owe it to people living with stroke internationally to investigate the best possible telehealth solutions for providing the highest quality rehabilitation.

Comfort With Telehealth Among Residents of an Underserved Urban Area.

Background:Deployment of telehealth has been touted as a means of reducing health disparities in underserved groups. However, efforts to reduce regulatory barriers have not been associated with greater telehealth uptake. The goal of this study was to examine engagement with technology among low-income people of color living in Newark, New Jersey.Methods:Using surveys and focus groups, we examined study participants’ daily use of technology (eg, Internet) and comfort with telehealth services (eg, use of teleconferencing for medication refills) before and after COVID-related social distancing mandates went into effect.Results:Use of technology was significantly lower in the pre-COVID period. However, prior months’ use of technology had a weak but significant correlation with comfort with telehealth (r = .243, P = .005) in bivariate analyses and was the only significant predictor in multivariate analyses. Analyses of focus group discussions confirmed that lack of experience with technology and distrust of the security and privacy of digital systems were the most important barriers to comfort with telehealth in our sample.Conclusion:Our study found that approximately 20% of people in this under-resourced community lacked access to basic technologies necessary for successful deployment of telehealth services. The study’s timing provided an unexpected opportunity to compare experiences and attitudes relating to telehealth in 2 regulatory environments. Although uptake of telehealth services increased with the Federal governments’ relaxation of regulatory barriers, there was not a similar increase in comfort with telehealth use. Investments in broadband access and equipment should be accompanied by educational programs to increase day-to-day use of and comfort with associated technologies which would improve consumer confidence in telehealth.

A “Not So Quiet” Revolution: Systemic Benefits and Challenges of Telehealth in the Context of COVID-19 in Quebec (Canada)

The COVID-19 pandemic has had a major impact on health and social service systems (HSSS) worldwide. It has put tremendous pressure on these systems, threatening access, continuity, and the quality of patient care and services. In Quebec (Canada), the delivery of care and services has radically changed in a short period of time. During the pandemic, telehealth has been widely deployed and used, notwithstanding the decades-long challenges of integrating this service modality into the Quebec HSSS. Adopting a narrative-integrative approach, this article describes and discusses Quebec's experience with the deployment and utilization of telehealth in the context of COVID-19. Firstly, we introduced the achievements and benefits made with the use of telehealth. Secondly, we discussed the challenges and concerns that were revealed or accentuated by the sanitary crisis, such as: (1) training and information; (2) professional and organizational issues; (3) quality of services and patient satisfaction; (4) cost, remuneration, and funding; (5) technology and infrastructure; (6) the emergence of private telehealth platforms in a public HSSS; (7) digital divide and equity; and (8) legal and regulatory issues. Finally, the article presents recommendations to guide future research, policies and actions for a successful integration of telehealth in the Quebec HSSS as well as in jurisdictions and countries facing comparable challenges.

309-OR: Mean CGM Values Before and During COVID-19 Pandemic Demonstrate Noninferiority of Telehealth in Pediatric T1D

Aim: The COVID-19 pandemic called for rapid deployment of telehealth. To assess utility of telehealth in pediatric T1D, we compared CGM glucose values in youth with T1D using CGM before and during the pandemic.Methods: The EHR provided visit frequency and CGM metrics. Data during pandemic (3/16/20 to 10/29/20) were compared with data from the same calendar months in 2019. Youth (N=469) using CGM and seen in both periods were included based on pre-pandemic characteristics: age 1-18 yr, T1D duration ≥6 mo (if age <6) or ≥1 yr (if age ≥6 yr). CGM metrics included mean and SD glucose, coefficient of variation (CV), and glucose management index (GMI). Each youth’s CGM data were averaged in each time period and compared in paired analyses.Results: Youth (46% male) had a mean age 12.4±3.5 yr, T1D duration 6.1±3.6 yr, HbA1c 7.8±0.9%; 80% were pump-treated. Pre-pandemic, 0.1% of visits were telehealth, increasing to 99.6% during pandemic. Mean number of visits during each 7-mo period increased from 2.5 in 2019 to 2.7 in 2020 (p=.006). CGM metrics generally improved during the pandemic period (Table). Those whose visit frequency increased with telehealth had the greatest improvement in CGM glucose, from 192±72 to 183±67 (p<.001).Conclusions: Telehealth allowed increased visit frequency and improved CGM glucose metrics, supporting non-inferiority and potential benefit of telehealth for youth with T1D using CGM.View largeDownload slideView largeDownload slide DisclosureT. Kaushal: None. L. J. Tinsley: None. L. K. Volkening: None. C. Turcotte: None. L. M. Laffel: Consultant; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Dexcom, Inc., Dompe, Insulogic LLC, Janssen Pharmaceuticals, Inc., Laxmi Therapeutic Devices, LifeScan, Lilly Diabetes, Medtronic, Provention Bio, Inc. FundingNational Institutes of Health (K12DK094721, P30DK036836)

Rapid telehealth implementation into an otolaryngology practice during the COVID-19 pandemic.

ObjectiveReport outcomes of rapid implementation of telehealth across an academic otolaryngology‐head and neck surgery department during the COVID‐19 pandemic.MethodsThis is a retrospective, single‐institution study of rapid deployment of telehealth during the COVID‐19 pandemic. Characteristics of patients were compared between those who agreed and those who declined telehealth care. Reasons for declining telehealth visits were ascertained. Characteristics of telehealth visits were collected and patients were asked to complete a post‐visit satisfaction survey.ResultsThere was a 68% acceptance rate for telehealth visits. In multivariable analysis, patients were more likely to accept telehealth if they were being seen in the facial plastics subspecialty clinic (odds ratio [OR] 59.55, 95% confidence interval [CI] 2.21‐1607.52; P = .015) compared to the general otolaryngology clinic. Patients with Medicare (compared to commercial insurance) as their primary insurance were less likely to accept telehealth visits (OR 0.10, 95% CI 0.01‐0.77; P = .027). Two hundred and thirty one patients underwent telehealth visits; most visits (69%) were for established patients and residents were involved in 38% of visits. There was an 85% response rate to the post‐visit survey. On a scale of one to ten, the median satisfaction score was 10 and 99% of patients gave a score of 8 or higher. Satisfaction scores were higher for new patient visits than established patient visits (P = .020).ConclusionRapid implementation of telehealth in an academic otolaryngology‐head and neck surgery department is feasible. There was high acceptance of and satisfaction scores with telehealth.Level of Evidence3.

Telemedicine and COVID-19

The COVID-19 pandemic has within months turned the world upside down. SRS-COV-2 is making us look at how health-care services are being delivered, and how this needs to radically change. Every country is reporting an exponential increase in Telemedicine utilization, as fallout of the enormous stress on health-care systems globally. The notification of the Telemedicine Practice Guidelines by the Government of India has also contributed to the rapid adoption of Remote Health Care. This review focuses on deployment of Telehealth in the pandemic milieu, illustrating how a crisis is turning into an opportunity to provide remote health care. Necessity for “contactless” health care and physical distancing has led to acceptance of Telehealth by all stakeholders, from lingering in the periphery for two decades to center stage.

Rapid Deployment of Chiropractic Telehealth at 2 Worksite Health Centers in Response to the COVID-19 Pandemic: Observations from the Field

ObjectiveThe purpose of this paper is to describe the rapid deployment of telehealth, particularly real time video conference, for chiropractic services as a response to COVID-19. MethodsTwo health centers at 2 campuses of a large California corporation have chiropractic care integrated into physical medicine services. Care was suspended beginning on March 17, 2020 to prevent spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among patients and staff. On March 19, the Governor of California issued a stay at home order. With musculoskeletal problems being common in the employee patient population, telehealth services were quickly developed to continue chiropractic care for patients. Using existing infrastructure, several members of the health center team developed chiropractic telehealth operations within 2 days. ResultsMusculoskeletal telehealth services included examinations, risk assessment, advice, and rehabilitative exercises. These telehealth visits facilitated care that would have otherwise been unavailable to employees. Patients reported that the appointments were helpful, addressed their concerns, and provided a safe method to see their doctor. Regular interprofessional teamwork and relations between the clinic operator and client company were key contributors to operationalizing this service in our integrated healthcare environment. ConclusionWe were able to quickly implement real time video conferencing and other forms of telehealth for chiropractic services at 2 worksite health centers. This paper includes information and insights to providers about setting up similar telehealth systems so they may also provide this benefit for patients in their communities during pandemics or disasters.

Using Telehealth as a Tool for Rural Hospitals in the COVID-19 Pandemic Response.

Using Telehealth as a Tool for Rural Hospitals in the COVID-19 Pandemic Response.

Participatory Approaches to Improve Integrated Care Programs: Methods, Experiences, and Early Results Applying Methods from Implementation Research

Background: Innovative process improvements in integrated care programs are increasingly implemented in daily practice by improving certain service elements e.g. safety, person-centeredness, or patient selection to achieve program sustainability and/or program upscaling. Because of the often complex nature of these initiatives, it is challenging to prove effectiveness. We use evidence-based methods from implementation research to monitor and to evaluate integrated care programs during process improvement actions, and to understand if and how implemented actions affect the program in an operational setting. In implementation research, it is important to consider all aspects of the implementation of the program, including the context in which it is being implemented, perspectives of all relevant stakeholders in particular the end users, as well as the organizational processes around the programs. Implementation research also promotes the systematic application of research findings in practice Peters et al 2013. The projects Advancing Care Coordination and Telehealth deployment at Scale ACT@Scale1, Sustainable Tailored Integrated Care for Older People in Europe SUSTAIN2, and DementiaNet3 all apply participatory approaches where local stakeholders design and implement local improvements. The projects all use cyclic improvement processes with the ambition to achieve rapid flow of evidence to practice and to disseminate knowledge and good practices at national and European level. The projects cover a wide variety of integrated care programs running in different settings, having different target populations e.g., chronically ill, multi-morbid, frail elderly, and mental health, and implement different improvement actions. Despite these differences, many common denominators exist, which will be elaborated in this session. Aims and objectives: The overall aim of this session is to provide an overview of implementation research methodologies and to provide examples how to implement and evaluate quality improvement actions in integrated care. Each project will present their experiences with and preliminary results of applying participatory approaches in clinical daily practice, covering different contexts and populations. Common denominators and differences will be discussed. In the discussion part, generalisability of these experiences for other European projects on integrated care will be highlighted. Format timing, speakers, discussion, group work, etc: During the session, the different participatory approaches applied in ACT@Scale, SUSTAIN and DementiaNet will be presented. The authors will further share their experiences applying the participatory approach, using concrete examples and results from actual program improvement actions. After the presentations, common lessons learned in the projects will be identified and discussed with the audience. Target Audience: This workshop targets all stakeholders from clinical management and researcher background who are involved or interested in integrated care improvement methods. Sharing of your own experiences in the open discussion is an integral part of this session. Learnings / Take away: After this session, participants will: 1. have insight in different implementation research approaches for improvement processes in integrated care; 2. will be informed about how to apply these methods and what the pros, cons, barriers and enablers are; and 3. Gain ideas on how to translate and apply lessons learned to their own practice.

Comparing sustainability and business models of scaling up care programmes within EU regions

Introduction: The aim of this study is to compare sustainability and business models of fourteen programmes scaling up after successful regional implementation, between EU regions. This study arises from the ACT@Scale Advancing Care Coordination and Telehealth deployment at Scale Programme which has received funding from the European Union, in the framework of the Health Programme. The work leading to these results is funded by the European Community’s Health Programme under grant agreement 709770. The ACT@Scale programme is fully aligned with the European Innovation Partnership in Active and Healthy Ageing objectives to deploy integrated care for chronically ill patients. Methods: This study used a mixed-methods approach: 1 semi-structured online surveys directed at programme leaders and managers were used for information on reimbursement methods, financial flows and drivers for scaling up; 2 documentation on the progress of scaling up was studied including Key Performance Indicators KPIs as programme costs; 3 expert interviews and workshops were held with programme managers to discuss barriers and plans for improvement. Results: The survey showed that the fourteen programmes vary regarding health care system, reimbursement and business model. The majority have established a ”medium maturity” on sustainability. Eight programmes expect a change in funding within three years and explore alternative business models. Regarding the KPI’s, programme costs vary considerably even between programmes with many comparable elements of their business models as their target group, key resources, partners and activities. The workshops and interviews showed that also programmes that are clinically effective struggle with sustainability. Discussion: The differences in maturity on sustainability may be influenced by the number of years a programme has been running, the allocated staff capacity and the funding model. Comparing the characteristics of the programmes with the outcomes of the expert interviews and workshops, they coincide in two considerations. Programmes in a taxed based health system, experience barriers like resistance due to top down decisions of scaling up the programme, fixed budgets with limited capacity, and uncertainty by changing health policies and budgets. Programmes in health systems based on compulsory social insurance and voluntary insurance, experience barriers as tight and yearly budgets and fragmentated funding. Conclusions: The studied integrated care and telehealth programmes share scaling up ambitions and often elements of the business model. Programmes differ in terms of barriers encountered, health care systems, reimbursement and business models. Lessons learned: Integrated care and telehealth programmes scaling up need to adapt their business models to the health system and local context and meet the expectations of all stakeholders with respect to quality of care, health outcomes and costs. Health policy needs to develop lasting reimbursement and payment models that reward programmes that meet these expectations. Limitations: Half of the programmes provided incomplete data on programme costs. One programme was discontinued as a result from policy decisions. Future research: Deeper understanding is needed regarding the relation between health systems and sustainable business models, leading to health policies that support programmes to scale up. We acknowledge the contribution of all the researchers participating in ACT@Scale.