Implementation of an innovative web-based conference table for community-dwelling frail older people, their informal caregivers and professionals: a process evaluation

Abstract

BackgroundDue to fragmentation of care, continuity of care is often limited in the care provided to frail older people. Further, frail older people are not always enabled to become involved in their own care. Therefore, we developed the Health and Welfare Information Portal (ZWIP), a shared Electronic Health Record combined with a communication tool for community-dwelling frail older people and primary care professionals. This article describes the process evaluation of its implementation, and aims to establish (1) the outcomes of the implementation process, (2) which implementation strategies and barriers and facilitators contributed to these outcomes, and (3) how its future implementation could be improved.MethodsMixed methods study, consisting of (1) a survey among professionals (n = 118) and monitoring the use of the ZWIP by frail older people and professionals, followed by (2) semi-structured interviews with purposively selected professionals (n = 12).Results290 frail older people and 169 professionals participated in the ZWIP. At the end of the implementation period, 55% of frail older people and informal caregivers, and 84% of professionals had logged on to their ZWIP at least once. For professionals, the exposure to the implementation strategies was generally as planned, they considered the interprofessional educational program and the helpdesk very important strategies. However, frail older people’s exposure to the implementation strategies was less than intended. Facilitators for the ZWIP were the perceived need to enhance interprofessional collaboration and the ZWIP application being user-friendly. Barriers included the low computer-literacy of frail older people, a preference for personal communication and limited use of the ZWIP by other professionals and frail older people. Interviewees recommended using the ZWIP for other target populations as well and adding further strategies that may help frail older people to feel more comfortable with computers and the ZWIP.ConclusionsThis study describes the implementation process of an innovative e-health intervention for community-dwelling frail older people, informal caregivers and primary care professionals. As e-health is an important medium for overcoming fragmentation of healthcare and facilitating patient involvement, but its adoption in everyday practice remains a challenge, the positive results of this implementation are promising.

Development of an Interdisciplinary Team Communication Framework and Quality Metrics for Home-Based Medical Care Practices

“…Findings: Improved communication between home-based primary care providers and inpatient providers of all disciplines; facilitated timely and accurate transfer of critical patient information; did not decrease hospital length of stay or readmission rate. Robben et al, 2012 18 Describe process evaluation of implementation of a shared EMR combined with a communication tool for community-dwelling older adults and PCPs.…”

“…Robben et al, 2012 18 Describe process evaluation of implementation of a shared EMR combined with a communication tool for community-dwelling older adults and primary care providers (PCPs).…”

Multicomponent Program to Reduce Functional Decline in Frail Elderly People: A Cluster Controlled Trial

“…In addition, team members were able to communicate virtually through a secure, Web-based health and welfare information portal. 25 Proactive, individually tailored care plans were formulated for each participant upon enrollment in the program; these plans were based on individual health-related goals and needs as assessed with the EASY-Care TOS. Care plans were revised during the team meetings at least every 6 months and stored in the information portal.…”

The CareWell-primary care program: design of a cluster controlled trial and process evaluation of a complex intervention targeting community-dwelling frail elderly

“…Second, it focuses on extensive collaboration between health care professionals in primary care for elders; not only GPs and community nurses are involved, but also elderly care physicians to contribute their specific geriatric expertise, and, to be stressed, gerontological social workers in order to achieve comprehensive integration of welfare issues in the care for the elderly, that commonly has a focus on medical aspects of care. Last, it uses a secured, easily accessible web-based health and information portal (ZWIP) [24], in which care plans and guidelines are stored in patients’ files, that facilitate interdisciplinary consultation and communication complementary to the ‘live’ multidisciplinary meetings.…”

“…Face-to-face multidisciplinary team meetings will be held at least twice a year for each frail elder, in which care plans will be reviewed and adapted. In addition, the team members will be able to virtually communicate at all times within a secured web based health and welfare information portal (ZWIP) [24]. This portal combines a shared Electronic Health Record with a communication tool for primary care professionals, which is accessible to all involved caregivers through a secured login procedure.…”