Rollout Strategy Research Articles

Evaluation of long-term benefits and cost-effectiveness of nation-wide colorectal cancer screening strategies in China in 2020–2060: a modelling analysis

Evidence on the long-term benefits and cost-effectiveness of colorectal cancer (CRC) screening strategies in China remains limited. This modelling study aims to address this issue for various CRC screening strategies in China between 2020 and2060. Using a previously developed microsimulation model (MIMIC-CRC) with Chinese epidemiological data, we evaluated four CRC screening strategies targeting population aged 45-74 years: no screening, colonoscopy every 10years, biennial faecal immunochemical testing (FIT), and a roll-out FIT screening strategy. Screening coverage (invitation) rates from 5% to 100% were analysed. Single-cohort analysis of 100,000 individuals was conducted to estimate the relative cost-effectiveness of each strategy. A multiple-cohort analysis of 100,000 people aged 40+ over 2020-2060 was conducted to project nation-wide long-term benefits and cost-effectiveness. In single-cohort analysis, all strategies yielded reductions in CRC incidence and mortality compared to no screening, with colonoscopy outperforming FIT-based strategies at the same invitation rates. In multiple-cohort analysis, among people over 40 years of age in China over 2020-2060, compared to no screening, at invitation rate of 5%, screening by colonoscopy, biennial FIT and roll-out FIT-based approach were estimated to avert 1.2, 0.4, and 0.3 million incident CRCs and 0.2, 0.1, and 0.1 million CRC-related deaths, respectively, compared to no screening (25.4 million incident CRCs and 4.4 million CRC-related deaths), and this preventive effect enlarged as the screening coverage rate increased. At full coverage, colonoscopy achieved the largest reductions (38.2% lower incidence and 43.2% lower mortality) but required the most resources. Biennial FIT and roll-out FIT-based approach screening was slightly less effective but had significant reduced colonoscopy needs (reduction of 83.8% and 85.2%, respectively) and overall cost (reduction of 23.4% and 37.8%, respectively) compared to colonoscopy screening. Nation-wide implementation of screening would be effective in reducing the burden of CRC in China. Biennial FIT and roll-out FIT-based screening strategies could prevent incident CRC cases and CRC-related deaths with considerably fewer resources than colonoscopy screening. Efforts should be made to increase the screening coverage in China. Chinese Academy of Medical Science Innovation Fund for Medical Science (2022-I2M-1-0031); National Natural Science Foundation of China (82173606; 82273726); Beijing Nova Program of Science and Technology (20230484397).

Impact of the first year of COVID-19 vaccination strategy in Brazil: an ecological study

ObjectivesNo consensus exists about the best COVID-19 vaccination strategy to be adopted by low-income and middle-income countries. Brazil adopted an age-based calendar strategy to reduce mortality and the burden on...

Everything, everywhere, all at once

The development and early distribution of the COVID-19 vaccine was both a singular achievement and missed opportunity. In this paper, I argue that the consensus regarding the goals of an effective and morally responsible vaccine distribution program were often eschewed in favor of a reversion to the problematic pre-pandemic healthcare distribution practices. I examine the goals of vaccine planning in terms of the public health, economic and social impacts of a distribution plan against the “first come, first served” strategies that were ultimately employed. I maintain that the failure to implement a coherent top- -down vaccine policy resulted in a proliferation of vaccine distribution programs that undermined efforts to combat the virus while also increasing pre-existing inequities in the healthcare system. The distribution of the vaccine according to a phased rollout strategy for individual groups often limited access to the vaccine for those most likely to suffer the worst outcomes of the disease. Future pandemic planning must learn from these outcomes and employ new technologies to limit the contagion and target at-risk groups most effectively.

Factors Influencing COVID-19 Vaccine Confidence and Uptake in Australian Adults.

In January 2021, Australia initiated a national COVID-19 vaccine rollout strategy but faced setbacks, leading to negative press and media controversy, which may have diminished vaccine confidence. This study aimed to assess the factors influencing vaccine confidence in Australian adults (≥18 years of age) following the administration of a COVID-19 vaccine. Conducted at Blacktown Hospital, Sydney, a cross-sectional survey with 1053 respondents gauged vaccine confidence and influencing factors. The results showed overall high confidence (mean score 33/40). Trusted sources included the Australian Department of Health (77.8%), NSW Health (76.7%), and general practitioners (53.7%), while social media was distrusted (5.9%). The motivations for vaccination varied: university-educated individuals prioritised personal health (X2 = 17.81; p < 0.001), while religious and/or older respondents (≥50 years of age) emphasised community (X2 = 11.69; p < 0.001) and family protection (X2 = 17.314; p < 0.001). Multivariate logistic regression revealed use of the Australian Department of Health website as a trusted source of COVID-19 information as the strongest predictor of high confidence (>30; OR 1.43; p = 0.041), while exposure to fake news decreased confidence (OR 0.71; p = 0.025). The study underscores the importance of reliable health information sources in bolstering vaccine confidence and highlights the detrimental effects of misinformation. Promoting awareness of trustworthy health channels is crucial to combat vaccine hesitancy in Australia.

Assessing the dynamics and impact of COVID-19 vaccination on disease spread: A data-driven approach

The COVID-19 pandemic has significantly impacted global health, social, and economic situations since its emergence in December 2019. The primary focus of this study is to propose a distinct vaccination policy and assess its impact on controlling COVID-19 transmission in Malaysia using a Bayesian data-driven approach, concentrating on the year 2021. We employ a compartmental Susceptible-Exposed-Infected-Recovered-Vaccinated (SEIRV) model, incorporating a time-varying transmission rate and a data-driven method for its estimation through an Exploratory Data Analysis (EDA) approach. While no vaccine guarantees total immunity against the disease, and vaccine immunity wanes over time, it is critical to include and accurately estimate vaccine efficacy, as well as a constant vaccine immunity decay or wane factor, to better simulate the dynamics of vaccine-induced protection over time. Based on the distribution and effectiveness of vaccines, we integrated a data-driven estimation of vaccine efficacy, calculated at 75% for Malaysia, underscoring the model's realism and relevance to the specific context of the country. The Bayesian inference framework is used to assimilate various data sources and account for underlying uncertainties in model parameters. The model is fitted to real-world data from Malaysia to analyze disease spread trends and evaluate the effectiveness of our proposed vaccination policy. Our findings reveal that this distinct vaccination policy, which emphasizes an accelerated vaccination rate during the initial stages of the program, is highly effective in mitigating the spread of COVID-19 and substantially reducing the pandemic peak and new infections. The study found that vaccinating 57–66% of the population (as opposed to 76% in the real data) with a better vaccination policy such as proposed here is able to significantly reduce the number of new infections and ultimately reduce the costs associated with new infections. The study contributes to the development of a robust and informative representation of COVID-19 transmission and vaccination, offering valuable insights for policymakers on the potential benefits and limitations of different vaccination policies, particularly highlighting the importance of a well-planned and efficient vaccination rollout strategy. While the methodology used in this study is specifically applied to national data from Malaysia, its successful application to local regions within Malaysia, such as Selangor and Johor, indicates its adaptability and potential for broader application. This demonstrates the model's adaptability for policy assessment and improvement across various demographic and epidemiological landscapes, implying its usefulness for similar datasets from various geographical regions.

Protocol for an implementation study of group metacognitive therapy for anxiety and depression in NHS cardiac rehabilitation services in England (PATHWAY-Beacons).

Cardiac rehabilitation (CR) services aim to improve heart disease patients' health and quality of life and reduce the risk of further cardiac events. Depression and anxiety are common among CR patients but psychological treatments have usually had small effects. In contrast, the recent NIHR-funded PATHWAY trial found that group Metacognitive Therapy (MCT) was associated with improvements in anxiety and depression when added to CR and was more effective than usual CR alone. The next stage is to test implementation of MCT within the National Health Service through the creation of a network of CR beacon sites. The study will test the quality of data capture following addition of a new MCT data-field to the national audit of cardiac rehabilitation (NACR), examine level of adoption at sites, examine mental health outcomes benchmarked against usual CR and the PATHWAY data, examine the enablers and barriers to implementation and the expected resource requirements. The study has been registered: NCT05956912 (13th July, 2023). Beacon sites will be recruited as preliminary adopters of group MCT from NHS CR services in England. A national invitation for expressions of interest from CR services will be issued and those meeting eligibility criteria will be considered for inclusion. Two staff at each site will receive training in MCT, and mixed-methods will be used to address questions concerning the quality of patient data recorded, level of adoption at sites, the characteristics of patients attending MCT, the impact of adding MCT to CR on mental health outcomes, and patient, healthcare staff and commissioner views of barriers/enablers to implementation. Exploration of implementation will be informed by Normalisation Process Theory. The study will support development of an NHS roll-out strategy, assess the mental health outcomes associated with MCT, examine treatment fidelity in real-world settings, and evaluate revised data collection structures that can be used to assess the impact of national-level implementation. NCT05956912; 13th July 2023.

COVID-19 vaccine hesitancy in rural and metropolitan Western Australia: A mid-rollout cross-sectional analysis of why it exists and potential solutions.

Vaccine hesitancy represents a state of uncertainty before a decision about vaccination is made. It can lead to limited vaccine uptake despite adequate supply and an efficacious product. Western Australia (WA) presents a unique challenge with a population widely spread across metropolitan and rural sites and diverse opinions regarding vaccination. To elicit and compare the common COVID-19 vaccine concerns in rural and metropolitan WA, and to identify proposed solutions to vaccine hesitancy. A voluntary online survey was distributed via social media over a 2-week period in August 2021 during Phase 2A of the National COVID-19 Vaccine Rollout Strategy. General practitioners and members of the public living in rural and metropolitan WA over the age of 18 were surveyed regarding COVID-19 vaccine concerns (blood clots; long- and short-term side effects; lack of testing; and other concerns) and suggested methods to address vaccine hesitancy. Data were analysed with a sequential mixed methods and thematic analysis approach. There were 468 general population respondents to our survey, of whom 19.0% (n = 89) lived rurally. A majority (52.6% [n = 246]) of general respondents expressed concerns about COVID-19 vaccine safety. The commonest concerns were long- and short-term side effects, blood clots and inadequate testing. There was a positive correlation between rurality and vaccine concerns; an inverse relationship between rurality and vaccine uptake; and an inverse relationship between vaccine concerns and uptake. Improved media coverage was the commonest solution suggested to address COVID-19 vaccine hesitancy. A significant proportion of respondents had concerns about vaccine safety; concerns were more common in rural respondents. Rural communities may benefit from location-targeted media campaigns with a focus on breaking down barriers specific to these members of the population. Vaccine access is more challenging, and consistent messaging from trusted sources is of utmost importance to improve uptake. COVID-19 vaccine hesitancy is more common in rural populations. Targeted media-based education regarding vaccine safety may improve COVID-19 vaccine uptake.

The effect of mixed vaccination rollout strategy: A modelling study.

Vaccines have measurable efficacy obtained first from vaccine trials. However, vaccine efficacy (VE) is not a static measure and long-term population studies are needed to evaluate its performance and impact. COVID-19 vaccines have been developed in record time and the currently licensed vaccines are extremely effective against severe disease with higher VE after the full immunization schedule. To assess the impact of the initial phase of the COVID-19 vaccination rollout programmes, we used an extended Susceptible - Hospitalized - Asymptomatic/mild - Recovered (SHAR) model. Vaccination models were proposed to evaluate different vaccine types: vaccine type 1 which protects against severe disease only but fails to block disease transmission, and vaccine type 2 which protects against both severe disease and infection. VE was assumed as reported by the vaccine trials incorporating the difference in efficacy between one and two doses of vaccine administration. We described the performance of the vaccine in reducing hospitalizations during a momentary scenario in the Basque Country, Spain. With a population in a mixed vaccination setting, our results have shown that reductions in hospitalized COVID-19 cases were observed five months after the vaccination rollout started, from May to June 2021. Specifically in June, a good agreement between modelling simulation and empirical data was well pronounced.

What is the role of primary care in the COVID-19 vaccine roll-out and the barriers and facilitators to an equitable vaccine roll-out? A rapid scoping review of nine jurisdictions

ObjectivesThis study aimed to: (1) examine the experience of nine global jurisdictions that engaged primary care providers (PCPs) to administer COVID-19 vaccines during the pandemic; (2) describe how vaccine hesitancy...

A qualitative examination of injury prevention strategy and education in Ladies Gaelic football: Understanding the preferences of players and coaches.

The high rates of injury in Ladies Gaelic football impact the wellbeing of players and are a major financial burden for the Ladies Gaelic Football Association. Effective injury prevention programmes have been developed for Gaelic games, but these are not currently widely adopted. The aim of this study was to qualitatively investigate adult Ladies Gaelic football players and coaches' preferences for injury prevention strategies and injury prevention education using a constructivist grounded-theory approach. Semi-structured interviews were conducted with 23 currently active Ladies Gaelic football coaches and adult players. The core strategy preferences discussed by participants were the properties of an injury prevention programme, the role of stakeholders, strategy logistics and the need for guidance and support. If the uptake and long-term adoption of an injury prevention programme is to be maximised, the preferences of the players and coaches who will ultimately utilise the programme must be understood and integrated into a wider implementation strategy developed around their needs. For education preferences, the core categories identified were the focus of education, who needs education, the format, educator, roll-out strategy, and time required. Future educational strategies must incorporate the preferences of stakeholders into their design if they are to be successful in spreading injury prevention knowledge and achieving change. To give injury prevention strategies, programmes, and education the best chances at successful adoption, it is crucial that the preferences of end-users are addressed and implemented.

Acquisition Function Choice in Bayesian Optimization via Partially Observable Markov Decision Process

Bayesian optimization is a popular technique in optimization of functions which are expensive to evaluate (e.g. in experimental optimization of complex and slow processes). Bayesian optimizers select the points in which the cost function is evaluated via optimizing a surrogate acquisition function. Such acquisition function is usually fixed, based on intuition, from several choices available in the literature. However, for a given problem, it is sometimes difficult to know which is the right one and, perhaps, a strategy combining them along the experiments sequence might provides better results. This paper explores a scenario-based optimization to estimate the best sequence of acquisition function choices in finite-horizon optimization problems under uncertainty, cast as a Partially Observable Markov Decision Process. Improvements over standard Bayesian optimization and a recent rollout strategy are illustrated in simulation.

Knowledge, attitudes and perceptions of a patient population on the COVID-19 vaccine rollout.

The coronavirus disease 2019 (COVID-19) pandemic has had dire effects on South Africa. Vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are critical in the fight against COVID-19. This study is necessary to optimise vaccine acceptance. To determine the knowledge, attitudes and perceptions of a patient population in South Africa on the COVID-19 vaccine rollout. This study was conducted via a retail pharmacy in Merebank, Wentworth and Bluff (Ward 68), which is in the eThekwini Metropolitan Municipality in the KwaZulu-Natal province. A quantitative study was conducted using an online self-administered questionnaire between April 2021 to September 2021. There were a total of 430 participants. Data were collected on Google Forms, recorded in Microsoft Excel and analysed using descriptive and inferential statistics. Knowledge of COVID-19 in the population was 81.86%. A total of 65% of participants stated that they would definitely take the COVID-19 vaccine, and 33.7% stated that they were hesitant to receive the vaccine. Reasons for hesitancies included concerns surrounding side effects of the vaccines, its safety and efficacy and the fast-tracking of the vaccine. Education campaigns need to be customised to provide the population with reliable and vetted vaccine information and address specific concerns or hesitancies present. Health care workers and the government need to work with religious leaders to improve public trust and confidence in the vaccine. To reach herd immunity and prevent increased morbidity rates, there needs to be a rise in vaccine acceptance across South Africa and globally. With the intention of ensuring a successful COVID-19 vaccine rollout strategy in South Africa, it is of great importance to address the reasons for vaccine hesitancy and to determine the knowledge, attitudes and perceptions of the population on the COVID-19 vaccines. This study will therefore aid in developing strategies aimed at improving vaccine education and awareness, thereby resulting in a greater uptake of the COVID-19 vaccine by the population.

The Effect of Mobile Payments on Retailer Firm Value: The Moderating Role of Promotions, Customer Segment, and Rollout Strategy

Mobile payment technology platforms are quickly gaining popularity. Despite this growth, academic research offers little insight into how adopting mobile payment technology impacts firm value. Further, extant studies are silent on the factors that determine the outcome of pursuing this strategy. Results from an event study of 152 announcements of mobile payments show an increase in firm value by an average of 1.03%, highlighting their effectiveness. Further analysis reveals characteristics of mobile payments that can augment this change in firm value. Specifically, positive firm value accrues when retailers promote the use of mobile payments to their customers. The authors also find that, compared with retailers whose target market comprises older customers, retailers targeting younger customers benefit more from adopting mobile payments. Finally, this study reveals an early-mover advantage, which is maximized in conjunction with an expansive, national rollout strategy. In fact, although a national rollout can be more beneficial early, the results show that for retailers that adopt mobile payments later, there is no difference between using an expansive rollout or a more limited, phased rollout strategy.

Leveraging artificial intelligence to optimize COVID-19 robust spread and vaccination roll-out strategies in Southern Africa.

The outbreak of coronavirus in the year 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) prompted widespread illness, death, and extended economic devastation worldwide. In response, numerous countries, including Botswana and South Africa, instituted various clinical public health (CPH) strategies to mitigate and control the disease. However, the emergence of variants of concern (VOC), vaccine hesitancy, morbidity, inadequate and inequitable vaccine supply, and ineffective vaccine roll-out strategies caused continuous disruption of essential services. Based on Botswana and South Africa hospitalization and mortality data, we studied the impact of age and gender on disease severity. Comparative analysis was performed between the two countries to establish a vaccination strategy that could complement the existing CPH strategies. To optimize the vaccination roll-out strategy, artificial intelligence was used to identify the population groups in need of insufficient vaccines. We found that COVID-19 was associated with several comorbidities. However, hypertension and diabetes were more severe and common in both countries. The elderly population aged ≥60 years had 70% of major COVID-19 comorbidities; thus, they should be prioritized for vaccination. Moreover, we found that the Botswana and South Africa populations had similar COVID-19 mortality rates. Hence, our findings should be extended to the rest of Southern African countries since the population in this region have similar demographic and disease characteristics.

Effectiveness of a COVID-19 Vaccine Rollout in a Highly Affected American Indian Community, San Carlos Apache Tribe, December 2020-February 2021.

COVID-19 has disproportionately affected American Indian Tribes, including the San Carlos Apache Tribe, which resides on 1.8 million acres in Arizona and has 16 788 official members. High vaccination rates among American Indian/Alaska Native people in the United States have been reported, but information on how individual Tribes achieved these high rates is scarce. We describe the COVID-19 epidemiology and vaccine rollout in the San Carlos Apache Tribe using data extracted from electronic health records from the San Carlos Apache Healthcare Corporation (SCAHC). By mid-December 2020, 19% of the San Carlos Apache population had received a positive reverse transcription polymerase chain reaction test for SARS-CoV-2, the virus that causes COVID-19. The Tribe prioritized for vaccination population groups with the highest risk for severe COVID-19 outcomes (eg, those aged ≥65 years, who had a 46% risk of hospitalization if infected vs 13% overall). SCAHC achieved high early COVID-19 vaccination rates in the San Carlos community relative to the state of Arizona (47.6 vs 25.2 doses per 100 population by February 27, 2021). These vaccination rates reflected several strategies that were implemented to achieve high COVID-19 vaccine access and uptake, including advance planning, departmental vaccine education sessions within SCAHC, radio and Facebook postings featuring Tribal leaders in the Apache language, and pop-up community vaccine clinics. The San Carlos Apache Tribe's vaccine rollout strategy was an early success story and may provide a model for future vaccination campaigns in other Tribal nations and rural communities in the United States.

Online model-based reinforcement learning for decision-making in long distance routes

In road transportation, long-distance routes require scheduled driving times, breaks, and rest periods, in compliance with the regulations on working conditions for truck drivers, while ensuring goods are delivered within the time windows of each customer. However, routes are subject to uncertain travel and service times, and incidents may cause additional delays, making predefined schedules ineffective in many real-life situations. This paper presents a reinforcement learning (RL) algorithm capable of making en-route decisions regarding driving times, breaks, and rest periods, under uncertain conditions. Our proposal aims at maximizing the likelihood of on-time delivery while complying with drivers’ work regulations. We use an online model-based RL strategy that needs no prior training and is more flexible than model-free RL approaches, where the agent must be trained offline before making online decisions. Our proposal combines model predictive control with a rollout strategy and Monte Carlo tree search. At each decision stage, our algorithm anticipates the consequences of all the possible decisions in a number of future stages (the lookahead horizon), and then uses a base policy to generate a sequence of decisions beyond the lookahead horizon. This base policy could be, for example, a set of decision rules based on the experience and expertise of the transportation company covering the routes. Our numerical results show that the policy obtained using our algorithm outperforms not only the base policy (up to 83%), but also a policy obtained offline using deep Q networks (DQN), a state-of-the-art, model-free RL algorithm.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody kinetics after BNT162B2 vaccination

Background: Phase 1a of Australia’s COVID-19 vaccine roll-out strategy included frontline healthcare workers who were eligible for two doses of BNT162b2 (Pfizer-BioNTech) vaccine. In November 2021, booster doses of BNT162b2 were also recommended 6 months after the second dose due to waning immunity.

Pivoting data and analytic capacity to support Ontario's COVID-19 response.

IntroductionHealth care systems have faced unprecedented challenges due to the COVID-19 pandemic. Access to timely population-based data has been vital to informing public health policy and practice.MethodsWe describe how ICES, an independent not-for-profit research and analytic institute in Ontario, Canada, pivoted existing research infrastructure and engaged health system stakeholders to provide near real-time population-based data and analytics to support Ontario’s COVID-19 pandemic response.ResultsSince April 2020, ICES provided the Ontario COVID-19 Provincial Command Table and public health partners with regular and ad hoc reports on SARS-CoV-2 testing and COVID-19 vaccine coverage. These reports: 1) helped identify congregate care/shared living settings that needed testing and prevention efforts early in the pandemic; 2) provided early indications of inequities in testing and infection in marginalized neighbourhoods, including areas with higher proportions of immigrants and visible minorities; 3) identified areas with high test positivity, which helped Public Health Units target and evaluate prevention efforts; and 4) contributed to altering the province’s COVID-19 vaccine roll-out strategy to target high-risk neighbourhoods and helping Public Health Units and community organizations plan local vaccination programs. In addition, ICES is a key component of the Ontario Health Data Platform, which provides scientists with data access to conduct COVID-19 research and analyses.Discussion and ConclusionICES was well-positioned to provide rapid analyses for decision-makers to respond to the evolving public health emergency, and continues to contribute to Ontario’s pandemic response by providing timely, relevant reports to health system stakeholders and facilitating data access for externally-funded COVID-19 research.

Spatial priority for COVID-19 vaccine rollout against limited supply

The COVID-19 vaccines are limited in supply which requires vaccination by priority. This study proposes a spatial priority-based vaccine rollout strategy for Bangladesh. Demographic, economic and vulnerability, and spatial connectivity – these four types of factors are considered for identifying the spatial priority. The spatial priority is calculated and mapped using a GIS-based analytic hierarchy process. Our findings suggest that both demographic and economic factors are keys to the spatial priority of vaccine rollout. Secondly, spatial connectivity is an essential component for defining spatial priority due to the transmissibility of COVID-19. A total of 12 out of 64 districts were found high-priority followed by 22 medium-priorities for vaccine rollout. The proposed strategy by no means suggests ending mass vaccination by descending age groups but an alternative against limited vaccine supply. The spatial priority of the vaccine rollout strategy proposed in this study might help to curb down COVID-19 transmission and to keep the economy moving. The inclusion of granular data and contextual factors can significantly improve the spatial priority identification which can have wider applications for other infectious and transmittable diseases and beyond.

Implementation Strategies to Improve Engagement With a Multi-Institutional Patient Portal: Multimethod Study.

BackgroundComprehensive multi-institutional patient portals that provide patients with web-based access to their data from across the health system have been shown to improve the provision of patient-centered and integrated care. However, several factors hinder the implementation of these portals. Although barriers and facilitators to patient portal adoption are well documented, there is a dearth of evidence examining how to effectively implement multi-institutional patient portals that transcend traditional boundaries and disparate systems.ObjectiveThis study aims to explore how the implementation approach of a multi-institutional patient portal impacted the adoption and use of the technology and to identify the lessons learned to guide the implementation of similar patient portal models.MethodsThis multimethod study included an analysis of quantitative and qualitative data collected during an evaluation of the multi-institutional MyChart patient portal that was deployed in Southwestern Ontario, Canada. Descriptive statistics were performed to understand the use patterns during the first 15 months of implementation (between August 2018 and October 2019). In addition, 42 qualitative semistructured interviews were conducted with 18 administrative stakeholders, 16 patients, 7 health care providers, and 1 informal caregiver to understand how the implementation approach influenced user experiences and to identify strategies for improvement. Qualitative data were analyzed using an inductive thematic analysis approach.ResultsBetween August 2018 and October 2019, 15,271 registration emails were sent, with 67.01% (10,233/15,271) registered for an account across 38 health care sites. The median number of patients registered per site was 19, with considerable variation (range 1-2114). Of the total number of sites, 55% (21/38) had ≤30 registered patients, whereas only 2 sites had over 1000 registered patients. Interview participants perceived that the patient experience of the portal would have been improved by enhancing the data comprehensiveness of the technology. They also attributed the lack of enrollment to the absence of a broad rollout and marketing strategy across sites. Participants emphasized that provider engagement, change management support, and senior leadership endorsement were central to fostering uptake. Finally, many stated that regional alignment and policy support should have been sought to streamline implementation efforts across participating sites.ConclusionsWithout proper management and planning, multi-institutional portals can suffer from minimal adoption. Data comprehensiveness is the foundational component of these portals and requires aligned policies and a key base of technology infrastructure across all participating sites. It is important to look beyond the category of the technology (ie, patient portal) and consider its functionality (eg, data aggregation, appointment scheduling, messaging) to ensure that it aligns with the underlying strategic priorities of the deployment. It is also critical to establish a clear vision and ensure buy-ins from organizational leadership and health care providers to support a cultural shift that will enable a meaningful and widespread engagement.