Implementation of eHealth to Support Assessment and Decision-making for Residents With Dementia in Long-term Care: Systematic Review

Abstract

Background As dementia progresses, symptoms and concerns increase, causing considerable distress for the person and their caregiver. The integration of care between care homes and health care services is vital to meet increasing care needs and maintain quality of life. However, care home access to high-quality health care is inequitable. eHealth can facilitate this by supporting remote specialist input on care processes, such as clinical assessment and decision-making, and streamlining care on site. How to best implement eHealth in the care home setting is unclear. Objective The aim of this review was to identify the key factors that influence the implementation of eHealth for people living with dementia in long-term care. Methods A systematic search of Embase, PsycINFO, MEDLINE, and CINAHL was conducted to identify studies published between 2000 and 2020. Studies were eligible if they focused on eHealth interventions to improve treatment and care assessment or decision-making for residents with dementia in care homes. Data were thematically analyzed and deductively mapped onto the 6 constructs of the adapted Consolidated Framework for Implementation Research (CFIR). The results are presented as a narrative synthesis. Results A total of 29 studies were included, focusing on a variety of eHealth interventions, including remote video consultations and clinical decision support tools. Key factors that influenced eHealth implementation were identified across all 6 constructs of the CFIR. Most concerned the inner setting construct on requirements for implementation in the care home, such as providing a conducive learning climate, engaged leadership, and sufficient training and resources. A total of 4 novel subconstructs were identified to inform the implementation requirements to meet resident needs and engage end users. Conclusions Implementing eHealth in care homes for people with dementia is multifactorial and complex, involving interaction between residents, staff, and organizations. It requires an emphasis on the needs of residents and the engagement of end users in the implementation process. A novel conceptual model of the key factors was developed and translated into 18 practical recommendations on the implementation of eHealth in long-term care to guide implementers or innovators in care homes. Successful implementation of eHealth is required to maximize uptake and drive improvements in integrated health and social care.

Co-design of a theory-based implementation plan for a holistic eHealth assessment and decision support framework for people with dementia in care homes

“…It was informed by findings from a systematic review of the published evidence on the determinants of implementation for eHealth interventions, for holistic assessment and decision-making for people with dementia in care homes. 12 We used the consolidated criteria for reporting qualitative studies (COREQ)-32 item checklist to facilitate transparency and promote comprehensive reporting 20 (see Supplemental Table 1).…”

“…Questions asked in the workshop were informed by the key determinants of implementation identified in the systematic review. 12 Although it provided a set of factors relevant to implementing eHealth in care homes, these were derived from many papers from different countries, utilising a range of eHealth interventions. It was therefore necessary to pursue these potential determinants in relation to the EMBED-Care Framework and identify which of them were relevant for implementing this specific type of eHealth in this context.…”

“…The group was presented with features pertaining specifically to eHealth which had been found to influence implementation success from the systematic review. 12 These included customizable features, inbuilt reminders for use and compatibility with technology currently in use.…”

“… 11 Barriers to successful adoption of eHealth in the care home are common and wide-ranging, and include incompatibility between the intervention and care home processes, an overly complex intervention protocol and inadequate training and support for users. 12 …”

Domesticating Social Alarm Systems in Nursing Homes: Qualitative Study of Differences in the Perspectives of Assistant Nurses

“…Studies in different fields have shed light on the contribution of assistant nurses to technology implementation. The main concerns include assistant nurses’ perceptions toward specific technology [ 25 , 26 ], their agency and roles in technology implementation [ 15 , 27 , 28 ], the diversity of interactions between assistant nurses and the selected technology [ 29 , 30 ], decision-making and learning process [ 12 , 31 ], ethical problems that are related to safety or autonomy [ 32 ], and the process where assistant nurses assigning meaning to the selected system [ 33 ]. These studies provide valuable insights into uncovering the social aspects of appropriating a new technology.…”