Designing a multifaceted telehealth intervention for a rural population using a model for developing complex interventions in nursing

Abstract

Background: Telehealth interventions offer an evidenced-based approach to providing cost-effective care, education, and timely communication at a distance. Yet, despite its widespread use, telehealth has not reached full potential, especially in rural areas, due to the complex process of designing and implementing telehealth programs. The objective of this paper is to explore the use of a theory-based approach, the Model for Developing Complex Interventions in Nursing, to design a pilot telehealth intervention program for a rural population with multiple chronic conditions. Methods: In order to develop a robust, evidenced based intervention that suits the needs of the community, stakeholders, and healthcare agencies involved, a design team comprised of state representatives, telehealth experts, and patient advocates was convened. Each design team meeting was guided by major model constructs (i.e., problem identification, defining the target population and objectives, measurement theory selection, building and planning the intervention protocol). Overarching the process was a review of the literature to ensure that the developed intervention was congruent with evidence-based practice and underlying the entire process was scope of practice considerations. Results: Ten design team meetings were held over a six-month period. An adaptive pilot intervention targeting home and community-based Medicaid Waiver Program participants in a rural environment with a primary objective of preventing re-institutionalizations was developed and accepted for implementation. To promote intervention effectiveness, asynchronous (i.e., remote patient monitoring) and synchronous (i.e., nursing assessment of pain and mental health and care coordination) telehealth approaches were selected to address the multiple comorbidities of the target population. An economic evaluation plan was developed and included in the pilot program to assess intervention cost efficiency. Conclusions: The Model for Developing Complex Interventions in Nursing provided a simple, structured process for designing a multifaceted telehealth intervention to minimize re-institutionalization of participants with multiple chronic conditions. This structured process may promote efficient development of other complex telehealth interventions in time and resource constrained settings. This paper provides detailed examples of how the model was operationalized.

Preservation of Person-Centered Care Through Videoconferencing for Patient Follow-up During the COVID-19 Pandemic: Case Study of a Multidisciplinary Care Team

“…An example is the Norwegian Directorate of eHealth making changes to the reimbursement of videoconferencing in response to its increased and necessary use during the COVID- 19 pandemic [9]. This is in accordance with previous studies that have shown that introducing video consultations is a complex change that disrupts long-established processes and routines [10,11].…”

“…Efficiency and cost savings have been important focus areas in recent years [11,27]; however, saving the patient's time should be just as valuable. Previous research demonstrates that telemedicine can be used to replace referrals to an outpatient clinic, thus reducing travel and unnecessary hospital visits, especially for those living in remote areas [10,11]. Using video meetings eliminates the risk of costly cancellations, such as those due to bad weather such as snowstorms leading to closed roads and cancelled flights; this is a constant risk in northern Norway, where the winter is approximately 6 months long.…”

“…Nevertheless, in recent years, telemedicine has attracted considerable interest as a means of delivering care to patients with long-term conditions [11,12]. The use of videoconferencing in the management of chronic diseases such as chronic obstructive pulmonary disease, diabetes, and depression has potential for improving health care services [1].…”

“…Despite this, current health care systems are designed for acute short-term needs, and they struggle to address the increasing number of persons with complex long-term needs. Therefore, there is significant interest in the potential of technology such as telemedicine for improving care and reducing costs in these patient populations, as well as in using technology to diminish the burden that individuals face as they manage multiple chronic conditions while adjusting to independent life in the community [10,11,27].…”

Awareness and Attitudes Towards Telemedicine Among Medical Students in the United States

“…It has roots that go far back hundreds of years, with the first documented telehealth encounter taking place in the late 1800s [ 1 ]. TM is defined as the transmission of medical information from one site to another via electronic communications to improve a patient’s clinical health status [ 2 ]. Despite the many barriers, there are multiple factors driving the growth and diffusion of TM: value-based healthcare; development of new products and technologies such as speech recognition, automation, artificial intelligence, and 5G wireless technology; TM-friendly regulation, policy, and reimbursement; and increasing TM adoption by employers, hospitals, and payers/health insurance.…”