Innovative Health Care Delivery Research Articles

How advanced is your digital public health system? A qualitative analysis of suitable indicators

Abstract Background Revealing the full potential of digital public health (DiPH) systems necessitates a wide-ranging tool to assess their maturity. Essential domains that need to be considered include the literacy and interest in DiPH tool application by society and the workforce and the legal and ICT maturity of DiPH systems. No review has investigated indicators on these national DiPH system maturity (DiPHSM) domains yet. Our narrative review and qualitative analysis aimed to map the landscape of indicators related to DiPHSM measurement and rank them based on their importance for such assessments. Methods As original indicators were not published in scientific databases but as grey literature, we used DuckDuckGo to apply a pre-defined search strategy for 11 countries from all continents classified as having reached level 4 of 5 in the Global Digital Health Monitor. Of the 1484 identified references, 137 were included which named 15806 indicators. Consensus on importance was defined as at least 3 or 4 authors rating an indicator as important. Results We recognized 180 indicators on different constructs with importance for DiPHSM analysis, including the availability and use of Smartphones, computers, the Internet or the DiPH intervention, the existence of skilled workforce, infrastructure (investment), and interoperability between interventions, the secondary use of health data, a DiPH strategy and controlling agency, or the application of big data and artificial intelligence for health data collection, analysis, and sharing. Conclusions Our study holds the potential to develop more comprehensive tools for DiPHSM assessments. Further examination is required to analyze the suitability and applicability of all identified indicators for diverse healthcare settings. By working towards a uniform evaluation of DiPHSM, we foster informed decision-making among healthcare planners and practitioners, improve resource distribution, and continue to drive innovation in healthcare delivery. Key messages • Maturity assessment tools need to consider the complexity of DiPH systems. Thereby, DiPH system evaluations need to be accompanied by analyses of the legal, ICT, and literacy perspective maturities. • New methods are needed to systematically assess and use multidisciplinary grey literature for research.

Fertility Preservation for Iatrogenic Infertility: Patient Barriers and Opportunities for the Reproductive Medicine Workforce.

Iatrogenic infertility can result from medically necessary treatments that reduce fertility potential such as gonadotoxic chemotherapy and radiation but also brain and pelvic surgery, biologics for autoimmune disease, and hormone therapy. Fertility preservation (FP) involves freezing embryos, oocytes, ovarian tissue, sperm, or testicular tissue for future procreation and may be the only option for some patients who hope to use their autologous gametes for future reproduction. Although there is a growing awareness to refer patients at risk for iatrogenic infertility to reproductive specialists, patients seeking FP continue to face a multitude of barriers. The most prohibitive factor is cost, but poor accessibility to specialty care, lack of education of providers and patients, and stigmatization around reproductive health may all lead to delayed referrals.We discuss several opportunities for the reproductive medicine workforce to help address barriers to FP. One method to make FP more accessible to patients in a shorter timeframe would be to make it more affordable through improved insurance coverage. Currently, there is no active federal legislation mandating that insurance plans cover FP; however, there have been several success stories at the state level. Additionally, education of providers and patients through multispecialty collaboration and targeted campaigns, can have a profound impact on expediting referral for fertility care. Promising new technologies and innovation in healthcare delivery are also on the horizon.Unaddressed fertility concerns are very distressing to patients and detrimental to their quality of life. Urologists can contribute significantly to improving the care for these patients clinically and through advocacy and education.

The Digital Clinic: Testing the Feasibility of an Innovative Digital Mental Health Care Delivery Model Designed to Increase Access to Care (Preprint)

The Digital Clinic: Testing the Feasibility of an Innovative Digital Mental Health Care Delivery Model Designed to Increase Access to Care (Preprint)

Technological Developments, Exercise Training Programs, and Clinical Outcomes in Cardiac Telerehabilitation in the Last Ten Years: A Systematic Review.

Cardiovascular diseases (CVDs) are associated with very high rates of re-hospitalization and mortality worldwide, so the complexity of these pathologies requires frequent access to hospital facilities. The guidelines also emphasize the importance of cardiac rehabilitation (CR) programs, which have demonstrated a favorable effect on outcomes, and cardiac telerehabilitation (CTR) could represent an innovative healthcare delivery model. The aim of our review is to study how technologies used in rehabilitation have changed over time and also to understand what types of rehabilitation programs have been used in telerehabilitation. We searched randomized controlled trials (RCTs) in three electronic databases, PubMed, Web of Science, and Scopus, from January 2015 to January 2024, using relevant keywords. Initially, 502 articles were found, and 79 duplicates were identified and eliminated with EndNote. In total, 16 RCTs fulfilled the pre-defined criteria, which were analyzed in our systematic review. The results showed that after CTR, there was a significant improvement in main outcome measures, as well as in relation to technological advances. Moreover, compared to center-based rehabilitation, CTR can offer further advantages, with better cost-effectiveness, the breakdown of geographical barriers, and the improvement of access to treatment for the female population, which is traditionally more socially committed.

Advancing Digital Health Equity: An Interdisciplinary Educational Approach to Digital Health Access and Inclusivity.

The innovatively structured BCIT Digital Health program is designed to build digital-care capacity within the healthcare workforce to improve outcomes across healthcare communities and optimize clinical transformation. An equity-oriented focus and an active commitment to reducing health disparities puts the patient voice at the centre of the program. To improve accessibility in digital health, the program focuses on inclusivity strategies such as capacity building, Indigenous perspectives, equity-oriented care and providing training to build an effective digital healthcare system. By combining clinical expertise with technological competencies and anchoring it all in a commitment to equity, this program will help reshape the future of innovative and equitable healthcare delivery.

On the path to UHC, digital healthcare transformation with Karnataka’s online referral framework

BackgroundKarnataka, a trailblazer in Universal Health Coverage (UHC) initiatives, has implemented various features under the Ayushman Bharat-PMJAY-Arogya Karnataka scheme to improve the access to health. This study provides a thorough exploration of Karnataka’s innovative Online Referral System (ORS) within the framework of achieving UHC.MethodsThe study analyses the performance of the ORS using cross-sectional data from June 2022 to November 2023, providing insights into the distribution of referrals, strategic purchasing from private healthcare providers, and the top medical procedures referred. The article delves into the unique features of Karnataka’s Online Referral System, implemented in 2019, which has streamlined the referral process and enhanced communication among healthcare providers.ResultsThe findings underscore the positive impact of Karnataka’s ORS on healthcare efficiency, patient satisfaction, easy access to care and strategic purchasing from private healthcare providers. ORS demonstrates improved efficiency in referrals, mitigating the challenges associated with traditional manual process and is an important aspect in improving healthcare services. The system also provides insights on the specialities requiring more capacity building, the volume, completeness, and processing of referrals through the ORS.ConclusionKarnataka’s innovative ORS, presents a transformative solution for improving healthcare access, coordination, and outcomes, reinforcing Karnataka’s commitment to continuous innovation in healthcare delivery and progress towards Universal Health care. The system also offers valuable insights into specialties that require increased access, identifies gaps in the healthcare system, and outlines areas that need strengthening. The article concludes by advocating for the replication of Karnataka’s ORS model across India and suggests potential avenues for further research and improvement.

The Intersection of Successful Aging and Family Caregiving.

For the millions of older adults who rely on the support of a family caregiver, successful aging is not an individual achievement but a cooperative process between a care receiver and a caregiver. Yet, family caregivers are rarely incorporated into theoretical models of successful aging. Family caregivers also play an essential role in recent healthcare delivery movements that seek to better align care delivery with successful aging. Greater reliance on family caregivers by the US healthcare system is occurring as an increasingly vocal constituency is tasking policymakers with developing and implementing federal and state health policies that would help build the national infrastructure needed to support them. This paper provides a critical discussion of how family caregivers actualize successful aging for older adults. We highlight the key role of family caregivers in healthcare delivery innovations aimed at facilitating successful aging and discuss policies that support family caregivers. As successful aging continues to evolve as a dominating framework in the literature, we conclude with key recommendations for how research, policy, and practice efforts in successful aging can be more inclusive and supportive of family caregivers.

Impact of medical innovations on quality of care in low income settings

Access to high-quality healthcare remains a challenge in low-income settings, primarily due to resource constraints and limited access to medical innovations. This systematic review examines the impact of medical innovations on the quality of care in low-income settings. Through a comprehensive analysis of relevant literature, this paper highlights the various medical innovations that have been implemented in low-income settings and evaluates their effectiveness in improving healthcare outcomes and patient satisfaction. The review identifies three broad categories of medical innovations: technological innovations, innovative healthcare delivery models, and novel treatment modalities. Technological innovations encompass a wide range of advancements, including telemedicine, mobile health (mHealth) applications, and point-of-care diagnostics. These innovations have shown promise in improving access to healthcare services, enhancing diagnostic accuracy, and facilitating remote monitoring and follow-up care in low-resource settings. Innovative healthcare delivery models, such as community health worker programs, task shifting, and mobile clinics, have also been implemented to overcome barriers to healthcare access in low-income settings. These models prioritize community engagement, decentralization of services, and task delegation to non-physician healthcare providers to expand coverage and reach underserved populations. Furthermore, novel treatment modalities, including affordable and portable medical devices, point-of-care testing kits, and low-cost medications, have been developed to address the specific healthcare needs of low-income populations. These innovations aim to improve treatment efficacy, reduce treatment costs, and minimize the burden of disease in resource-limited settings. The review synthesizes evidence from a diverse range of studies to assess the impact of these medical innovations on healthcare outcomes and patient satisfaction. Key findings suggest that while medical innovations hold promise in enhancing quality of care, several challenges including limited resources, infrastructure constraints, and training requirements need to be addressed to maximize their impact. The paper concludes by emphasizing the importance of tailored approaches and sustainable strategies for implementing medical innovations in low-income settings. By fostering partnerships, leveraging existing infrastructure, and investing in capacity building initiatives, stakeholders can effectively integrate medical innovations into healthcare delivery systems and improve access to high-quality care for underserved populations. This systematic review contributes to the growing body of literature on healthcare innovation and provides valuable insights for policymakers, healthcare providers, and researchers seeking to address the healthcare needs of low-income populations and achieve health equity on a global scale.

Innovations in health care delivery for patients with cirrhosis.

Innovations in health care delivery for patients with cirrhosis.

International perspectives on measuring national digital public health system maturity through a multidisciplinary Delphi study

Unlocking the full potential of digital public health (DiPH) systems requires a comprehensive tool to assess their maturity. While the World Health Organization and the International Telecommunication Union released a toolkit in 2012 covering various aspects of digitalizing national healthcare systems, a holistic maturity assessment tool has been lacking ever since. To bridge this gap, we conducted a pioneering Delphi study, to which 54 experts from diverse continents and academic fields actively contributed to at least one of three rounds. 54 experts participated in developing and rating multidisciplinary quality indicators to measure the maturity of national digital public health systems. Participants established consensus on these indicators with a threshold of 70% agreement on indicator importance. Eventually, 96 indicators were identified and agreed upon by experts. Notably, 48% of these indicators were found to align with existing validated tools, highlighting their relevance and reliability. However, further investigation is required to assess the suitability and applicability of all the suggestions put forward by our participants. Nevertheless, this Delphi study is an essential initial stride toward a comprehensive measurement tool for DiPH system maturity. By working towards a standardized assessment of DiPH system maturity, we aim to empower decision-makers to make informed choices, optimize resource allocation, and drive innovation in healthcare delivery. The results of this study mark a significant milestone in advancing DiPH on a global scale.

Patient-Centered Innovation: Involving Patients in Open Social Innovation.

Involving patients in the health-care delivery innovation has many benefits. Open social innovation (OSI) presents a fitting lens to examine and advance patient engagement in innovation. OSI offers a participatory approach to innovation, in which diverse groups of participants collaboratively generate ideas and scale solutions on complex social challenges. This study: (1) describes a pilot application of OSI, in which individuals serving on a hospital's patients and family advisory councils (PFACs) were invited to participate in an innovation contest; and (2) explores the extent to which patients' beliefs about their role in innovation relate to their participation in the contest. We conducted an innovation contest that invited PFAC members to share ideas that would improve patient experiences and then vote on and select the ideas that they wanted to see move forward. We measured patients' beliefs about their role in innovation in a survey before the contest. Twenty individuals submitted 27 ideas. Patients who expressed preference for more involvement in innovation were more likely to participate. Using OSI may help expand patient engagement in innovation, particularly among those who want to be more involved but do not feel authorized to voice ideas in traditional advisory committees. OSI spurred collaboration among patients, clinicians, quality improvement staff, hospital administrators, and other stakeholders in idea generation, elaboration, and implementation. More experimentation and research are needed to understand how OSI can be leveraged to capture patients' voice and incorporate them in care delivery innovation.

Post-discharge Follow-up Care: Nurses' Experience of Fostering Continuity of Care: A Qualitative Study

Background In contemporary healthcare, ensuring continuity of care beyond hospitalization is imperative for optimizing patient outcomes. Post-discharge Follow-up Care (PFC) has emerged as a crucial component in this endeavor, especially with the integration of virtual platforms. Objective This study aims to thoroughly investigate nurses' experiences in providing Post-discharge Follow-up Care (PFC) to improve its implementation. Methods A descriptive qualitative study was conducted to explore nurses’ experiences of conducting nurse-led follow-up care. This study was conducted at University Hospital, involving nine nurses with experience in administering PFC. Data were collected through focus group interviews. Thematic analysis was performed to identify recurring patterns and themes within the data. Results The thematic analysis yielded four overarching themes: 1) “Caring nurse virtually,” emphasizing nurses' dedication to compassionate virtual care, 2) “Constraints and limitations of continuing care,” highlighting challenges in resource management and coordination, 3) “Continuous documentation and coordination,” underscoring their vital role in seamless patient care, and 4) “Nurses’ expectation of technology features,” showing nurses' hopes for advanced features to enhance PFC. Conclusion This study provides deep insights into the experiences of nurses in delivering PFC through virtual platforms. It underscores the significance of maintaining emotional connections with patients, even in a virtual environment. The challenges faced in resource management and coordination highlight areas for potential improvement. Additionally, the study highlights the crucial role of accurate documentation and inter-team coordination in ensuring the continuity and quality of care. The nurses' expectations for technological advancements emphasize the need for ongoing innovation in healthcare delivery. These findings collectively contribute to the ongoing evolution of virtual follow-up care practices, ultimately enhancing patient outcomes and experiences beyond the hospital setting.

Innovation Diffusion Across 13 Specialties and Associated Clinician Characteristics.

Diffusion of innovations, defined as the adoption and implementation of new ideas, processes, products, or services in health care, is both particularly important and especially challenging. One known problem with adoption and implementation of new technologies is that, while organizations often make innovations immediately available, organizational actors are more wary about adopting new technologies because these may impact not only patients and practices but also reimbursement. As a result, innovations may remain underutilized, and organizations may miss opportunities to improve and advance. As innovation adoption is vital to achieving success and remaining competitive, it is important to measure and understand factors that impact innovation diffusion. Building on a survey of a national sample of 654 clinicians, our study measures the extent of diffusion of value-enhancing care delivery innovations (i.e., technologies that not only improve quality of care but has potential to reduce care cost by diminishing waste, Faems et al., 2010) for 13 clinical specialties and identifies healthcare-specific individual characteristics such as: professional purview, supervisory responsibility, financial incentive, and clinical tenure associated with innovation diffusion. We also examine the association of innovation diffusion with perceived value of one type of care delivery innovation - artificial intelligence (AI) - for assisting clinicians in their clinical work. Responses indicate that less than two-thirds of clinicians were knowledgeable about and aware of relevant value-enhancing care delivery innovations. Clinicians with broader professional purview, more supervisory responsibility, and stronger financial incentives had higher innovation diffusion scores, indicating greater knowledge and awareness of value-enhancing, care delivery innovations. Higher levels of knowledge of the innovations and awareness of their implementation were associated with higher perceptions of the value of AI-based technology. Our study contributes to our knowledge of diffusion of innovation in healthcare delivery and highlights potential mechanisms for speeding innovation diffusion.

A Retrospective Analysis of the Disruptions in the HIV Continuum of Care During the COVID-19 Pandemic: Lessons From a Clinic-Based Study.

The COVID-19 pandemic profoundly affected healthcare services, including HIV patient care. This study assessed the impact of the pandemic on diverse aspects of care for individuals living with HIV (PLWH). Patient data from 2019 to 2021 were collected using the Cascades template, provided by the New York State Department of Health, focusing on viral testing and suppression outcomes. Age, ethnicity, sex, and race were considered variables and analyzed via chi-square analysis, logistic regression model, and F test. The pandemic significantly reduced viral testing in 2020 due to restrictions and closures, but telemedicine and tele-pharmacy helped maintain care. Age was a crucial factor, predicting higher viral testing and suppression odds for older individuals, but no significant differences were observed between patient gender, race, or ethnicity in obtaining viral testing or achieving suppression. While limitations existed, this study provides insights into sustaining care during crises, highlighting the importance of innovative healthcare delivery methods and age-sensitive approaches for PLWH.

Lupus Nephritis in Northeastern India: Navigating the complex landscape of clinical challenges and emerging healthcare opportunities

Systemic Lupus Erythematosus (SLE) is a complex autoimmune disease with varied manifestations, significantly impacting women and potentially leading to Lupus Nephritis (LN), a major cause of morbidity and mortality. The review article explores the unique challenges and opportunities in managing lupus nephritis (LN) in North Eastern India, a region characterised by diverse ethnicities, cultures, and socioeconomic challenges. With a higher than average prevalence of systemic lupus erythematosus (SLE) and lupus nephritis (LN), the region presents distinct epidemiological patterns, likely influenced by genetic, environmental, and lifestyle factors. The management and prognosis of LN are further complicated by the region's geographical and infrastructural limitations, including access to specialised healthcare and socioeconomic barriers, which impacts the patient’s outcome. Despite the challenges, there are emerging opportunities for improvement through innovations in healthcare delivery, governmental and non-governmental initiatives aimed at enhancing healthcare access, and the adaptation of treatment guidelines to the local context. This review article underscores the importance of region-specific research and healthcare strategies to improve care and outcome for lupus nephritis (LN) patients in North Eastern India, thus contributing to the broader understanding of the disease in diverse populations and settings.

EFFECT OF COVID-19 PANDEMIC ON OCCUPATIONAL THERAPY PRACTICE AND IMPLEMENTATION OF TELEREHABILITATION INCLUDING HEALTH SECTORS IN AL AHSA CITY

Introduction and Aim: COVID-19 has turned into a worldwide public health emergency involving 223 nations and regions, and it has had a significant impact on public and health service delivery systems [1]. Tele-rehabilitation has developed as a potential strategy for virtually supervising the delivery of a physical, occupational, speech, and other therapies targeted at treating motor, mental, and neuropsychiatric deficiencies caused by sensory and motor impairments [3]. The transition to telerehabilitation offers a wealth of learning opportunities. This viewpoint offers an overview of how a learning health care system (LHS) approach to telerehabilitation research might foster innovation in health care delivery and lead to new scientific findings [4]. Telerehabilitation benefits minimize the need for patients and providers to travel and in-home rehabilitation services can save travel costs and caregiver strain. Patients with mobility issues will appreciate the convenience [5]. The aim of the study was to determine the COVID-19 pandemic effect on occupational therapy practice and use of telerehabilitation in Al-Ahsa. Method: COVID-19 pandemic effect on occupational therapy practice and use of telerehabilitation in Al-Ahsa assessed by the questionnaire. The purpose of the questionnaire to measure the Effect of Covid-19 pandemic on occupational therapy practice and implementation of telerehabilitation including government hospitals, private hospitals, and clinics in ALAHSA city. We shared the link by distributing it through social media. This study was conducted in Al-Ahsa including government hospitals, private hospitals, and clinics. The data collected from SPSS. 20 questions used to assess different aspects of COVID-19 pandemic effect on occupational therapy practice and use of telerehabilitation in Al-Ahsa with five options (Strongly Agree – Agree – Neutral – Disagree – Strongly Disagree. In addition, it is cross-sectional because the study collected data at giving point across the study. Result: There are 108 participants in this study. All of the participants were from Saudi Arabia in Al-Ahsa that met the inclusion criteria in This study. The number of male participants in the research was 85 (78.70%) . Also, the ages of the participants ranged from 16 to 58 and the average age is 30,23. We found that most of the participants agreed that telerehabilitation was effective and had many benefits for patients where the percentage of answers strongly agree and agree in all questions was high. Furthermore, the ages of the participants in the research are all of them from adolescence and adulthood, as the use of electronic technology to conduct therapeutic and rehabilitative sessions is almost non-existent for people in the late adulthood stage. Conclusion: We found that telerehabilitation is effective and benefits both the therapist and the patient. Also, the percentage of use of telerehabilitation by late adult patients was very low. Telerehabilitation had some problems and defects, and we hope that they will be resolved and the remote treatment system will be fully developed.

Perceived satisfaction with nursing care

Patient satisfaction has become a crucial indicator of quality of care, influencing treatment compliance and patient loyalty. Key factors, such as communication, empathy, and nursing staff safety, play an essential role in user satisfaction. Dimensions affecting user satisfaction include tangibility of facilities, reliability of care, and responsiveness. This article also examines the relationship between user satisfaction and socioeconomic variables such as gender, age, academic level, and length of hospitalization. It highlights the importance of collecting patient feedback through surveys and evaluations to identify areas for improvement and promote innovation in health care delivery. In summary, user satisfaction is a crucial indicator in modern health care that drives continuous improvement in the quality of care in Latin America and around the world.

U.S. Rural Hospital Care Quality and the Effects of Hospital Closures on the Health Status of Rural Vulnerable Populations: An Integrative Literature Review

Introduction. Hospital and emergency department closures are emblematic of America’s changing healthcare delivery system, which often places rural vulnerable communities at further risk for poor health outcomes. Employing the Vulnerable Populations Conceptual Model (VPCM), we aimed to synthesize the existing research addressing care quality in these facilities and the impacts of their closures on affected communities and health status. Materials and Methods. We conducted a modified integrative literature review (outlined by Whittemore and Knafl), comparing and contrasting articles via an organizational matrix. We identified articles through three databases and ancestral searches. We included English-written, peer-reviewed articles published from 2010 forward. We excluded international and nonresearch articles that focused on the closure of specific departments (other than emergency departments). Our final sample included 26 primary research studies (24 quantitative and two qualitative). We scored the articles according to their scientific rigor and data relevance, then deductively coded them according to the VPCM constructs. Results. We identified two overarching themes from the literature: (1) association of rural hospital care and patient health outcomes and (2) access to hospital care-effects of closures and openings on rural vulnerable populations. Subthemes reflected access to care and other resources, relative risks associated with time-sensitive health events, and health outcomes. Discussion and Conclusion. We found that rural hospitals provide access to essential health services and emergency care in these vulnerable, underserved communities. Their loss may increase adverse outcomes in affected communities and the overall health system. However, our review was limited by the retrospective, nonexperimental nature of most included articles, and more data quantifying these effects and the impact of confounding factors are needed. Multidisciplinary stakeholders must jointly address declining access to hospital and emergency care by sustainably addressing social determinants of health, quality assurance, innovative healthcare delivery systems, and rural hospital funding.

Smart city healthcare delivery innovations: a systematic review of essential technologies and indicators for developing nations

BackgroundIn recent times, the concept of smart cities has gained remarkable traction globally, driven by the increasing interest in employing technology to address various urban challenges, particularly in the healthcare domain. Smart cities are proving to be transformative, utilizing an extensive array of technological tools and processes to improve healthcare accessibility, optimize patient outcomes, reduce costs, and enhance overall efficiency.MethodsThis article delves into the profound impact of smart cities on the healthcare landscape and discusses its potential implications for the future of healthcare delivery. Moreover, the study explores the necessary infrastructure required for developing countries to establish smart cities capable of providing intelligent health and care services. To ensure a comprehensive analysis, we employed a well-structured search strategy across esteemed databases, including PubMed, OVID, EMBASE, Web of Science, and Scopus. The search scope encompassed articles published up to November 2022, resulting in a meticulous review of 22 relevant articles.ResultsOur findings provide compelling evidence of the pivotal role that smart city technology plays in elevating healthcare delivery, forging a path towards improved accessibility, efficiency, and quality of care for communities worldwide. By harnessing the power of data analytics, Internet of Things (IoT) sensors, and mobile applications, smart cities are driving real-time health monitoring, early disease detection, and personalized treatment approaches.ConclusionSmart cities possess the transformative potential to reshape healthcare practices, providing developing nations with invaluable opportunities to establish intelligent and adaptable healthcare systems customized to their distinct requirements and limitations. Moreover, the implementation of smart healthcare systems in developing nations can lead to enhanced healthcare accessibility and affordability, as the integration of technology can optimize resource allocation and improve the overall efficiency of healthcare services. It also may help alleviate the burden on overburdened healthcare facilities by streamlining patient care processes and reducing wait times, ensuring that medical attention reaches those in need more swiftly.

Digitally supported health care; evaluation approaches to a complex intervention embedded in a tria

Abstract Many important health care interventions do not fit the classic RCT paradigm. Drug trials have struggled with issues of non-compliance and selective withdrawal. Surgical researchers have done extensive work on incorporating operator skills and experience into trial settings. Working on innovative models of care delivery related issues arise. As part of an EU funded multi-centre stepped-wedge trial, GERONTE, of nurse-led, digitally supported, health care coordination for older people with cancer and other significant co-morbidity, we have developed and tested an outline of a novel method of evaluation, drawing on realist evaluation. There are three pieces, first the central trial outcome, quality of life, for those in the trial, analysed by intention-to-treat. Second an economic evaluation, based on care pathways, and collecting costs during the control and intervention phases in 16 centres, in 3 countries. Third, a realist evaluation of implementation, with 3 phases in each site, the first of which is underway. 1) Readiness to implement GERONTE, and documenting current practice, and identifying barriers and facilitators for change with clinical staff, technical staff and administrators; 2) Experience of implementation as the intervention is brought in over the course of the study; 3) Experience in keeping GERONTE running after the initial implementation phase. Early results show great site to site variability, in practice and in resources, but common barriers are data handling and sharing. In each phase, guided by ideas from participatory rapid appraisal, we stress the rapid feedback to participants, of their response, and the synthesis of responses to support successful implementation. One aim is to prepare an implementation guide to support future deployments of GERONTE and similar projects, drawing on lessons from all 16 sites, and filling a gap in the literature. GERONTE is funded by the Horizon 2020 research and innovation programme under grant agreement No 945218. Key messages • Innovative health care delivery, such as integrated care, requires complex assessment approaches, designed for the specific innovation. • Site-to-site variability in the implementation of novel care pathways and approaches is the norm, and needs to be considered at design stage.