Effects of Person-Centered Care Using a Digital Platform and Structured Telephone Support for People With Chronic Obstructive Pulmonary Disease and Chronic Heart Failure: Randomized Controlled Trial

Effectiveness of Co-Creation for Chronic Disease Management: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

ObjectiveCo-creation is crucial for fostering active patient engagement in health management. However, the efficacy of co-creation in chronic disease management varies, and there is a lack of detailed description regarding co-creation practice. This study aimed to explore the effectiveness of co-creation on health outcomes and cost-effectiveness, detailing its implementation.Data SourcePubMed, Embase, Scopus, Cochrane Library and Web of Science.Study Inclusion and Exclusion CriteriaWe included peer-reviewed randomized controlled trials, published in English, that analyzed the effects of co-creation on physical health, participation outcomes, psychological health, self-efficacy and cost-effectiveness.Data ExtractionTwo researchers independently screened the articles and assessed the quality of the 16 included studies using a pre-prepared checklist.Data SynthesisMeta-analyses were conducted to summarize the characteristics, outcomes, and risk of bias of the included studies.ResultsThe results showed that co-creation significantly enhanced patients' physical health (P = 0.006) and participation outcomes (P = 0.009). Subgroup analysis revealed that co-creation combined with theory was better than co-creation without theory in improving physical health (P = 0.007). However, no significant difference was observed between the two groups regarding psychological health, self-efficacy and cost-effectiveness (P = 0.29) (P = 0.11) (P = 0.50).ConclusionCo-creation effectively improved patients' physical health and participation outcomes, without affecting psychological health, self-efficacy, and cost-effectiveness. Social determinants were found to play a more crucial role in influencing physical health of patients. Additionally, age disparities might impact the cost-effectiveness of co-creation. Future research should explore the influence of intergenerational co-creation on health promotion.

Person-Centred Care: State-of-the-Art and Future Perspectives

PURPOSE OF REVIEW

Many countries prioritise the implementation of person-centred care. This study examines the progression of research in person-centred care, specifically focusing on using complex interventions within intricate contexts. It aims to explore how previous experiences can inform and shape subsequent projects. The review was based on five studies from our research group, encompassing 1099 patients, resulting in 41 peer-reviewed scientific publications. Most studies focused on patients suffering from chronic heart failure, as well as patients with chronic obstructive pulmonary disease. Additionally, interventions for acute coronary syndrome and common mental disorders were also considered. Analyses included the development of a logical model for person-centred care, an overview of partnership operationalisation, and the establishment of evaluation criteria for the trials. The analyses involved creating a coherent model for person-centred care, examining partnership operationalisation, and establishing trial evaluation criteria.

RECENT FINDINGS

Sequential trials build upon their predecessors and add new elements. The studies conducted by clinicians in usual care and in-house by research staff were complementary, providing a deeper understanding of the efficacy and effectiveness of person-centred care. Initiating, working, and safeguarding a partnership between patient and staff was possible, whether through in-person or remote communication. Evaluations followed modern research standards and incorporated past study insights for a more thorough approach. This study highlights how the cumulative experience from previous research in person-centred care informs the design and analyses of subsequent projects through an iterative learning process, particularly important for complex interventions in various health care contexts.

Effectiveness of digital health interventions for chronic conditions management in European primary care settings: Systematic review and meta-analysis

BACKGROUND

The past decade has seen rapid digitalization of healthcare, significantly transforming healthcare delivery. However, the impact of these technologies remains unclear, with notable gaps in evidence regarding their effectiveness, especially in primary care settings.

OBJECTIVE

This systematic review assesses the effectiveness of digital health interventions versus interventions without digital components implemented over the last 10 years in European primary care settings for managing chronic diseases.

METHODS

Following Cochrane guidelines, we conducted a systematic review with meta-analysis. We searched multiple databases for randomized controlled trials. Inclusion criteria encompassed studies on digital health interventions for chronic disease management in primary care settings in Europe, evaluating outcomes such as hospitalizations, quality of life, and clinical measures. Data extraction and quality assessment were independently conducted by two authors, with discrepancies resolved by a third author. The certainty of the evidence was judged according to the Grading of Recommendations, Assessment, Development, and Evaluation approach.

RESULTS

From 9829 records, 23 studies were included, with most studies conducted in the UK and Spain. The most investigated conditions were type 2 diabetes and hypertension. Interventions mainly focused on patient monitoring, self-care education, and digital communication tools. The risk of bias was low to moderate for most studies. Meta-analyses showed no significant differences between digital health interventions and usual care for hospitalizations, depressive symptoms, anxiety, HbA1c, diastolic blood pressure, weight, or quality of life, except for a small improvement in systolic blood pressure.

CONCLUSION

Digital health interventions have not yet demonstrated substantial benefits over traditional care for chronic disease management in European primary care. While some improvements were noted, particularly in systolic blood pressure, the impact remains limited. Further research is needed to enhance the effectiveness of digital health interventions, address current methodological limitations, and explore tailored approaches for both specific patient populations and multimorbid populations.

The State of the Art of eHealth Self-Management Interventions for People With Chronic Obstructive Pulmonary Disease: Scoping Review

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a common chronic incurable disease. Treatment of COPD often focuses on symptom management and progression prevention using pharmacological and nonpharmacological therapies (eg, medication, inhaler use, and smoking cessation). Self-management is an important aspect of managing COPD. Self-management interventions are increasingly delivered through eHealth, which may help people with COPD engage in self-management. However, little is known about the actual content of these eHealth interventions.

OBJECTIVE

This literature review aimed to investigate the state-of-the-art eHealth self-management technologies for COPD. More specifically, we aimed to investigate the functionality, modality, technology readiness level, underlying theories of the technology, the positive health dimensions addressed, the target population characteristics (ie, the intended population, the included population, and the actual population), the self-management processes, and behavior change techniques.

METHODS

A scoping review was performed to answer the proposed research questions. The databases PubMed, Scopus, PsycINFO (via EBSCO), and Wiley were searched for relevant articles. We identified articles published between January 1, 2012, and June 1, 2022, that described eHealth self-management interventions for COPD. Identified articles were screened for eligibility using the web-based software Rayyan.ai. Eligible articles were identified, assessed, and categorized by the reviewers, either directly or through a combination of methods, using Atlas.ti version 9.1.7.0. Thereafter, data were charted accordingly and presented with the purpose of giving an overview of currently available literature while highlighting existing gaps.

RESULTS

A total of 101 eligible articles were included. This review found that most eHealth technologies (91/101, 90.1%) enable patients to self-monitor their symptoms using (smart) measuring devices (39/91, 43%), smartphones (27/91, 30%), or tablets (25/91, 27%). The self-management process of "taking ownership of health needs" (94/101, 93.1%), the behavior change technique of "feedback and monitoring" (88/101, 87%), and the positive health dimension of "bodily functioning" (101/101, 100%) were most often addressed. The inclusion criteria of studies and the actual populations reached show that a subset of people with COPD participate in eHealth studies.

CONCLUSIONS

The current body of literature related to eHealth interventions has a strong tendency toward managing the physical aspect of COPD self-management. The necessity to specify inclusion criteria to control variables, combined with the practical challenges of recruiting diverse participants, leads to people with COPD being included in eHealth studies that only represent a subgroup of the whole population. Therefore, future research should be aware of this unintentional blind spot, make efforts to reach the underrepresented population, and address multiple dimensions of the positive health paradigm.

Audio-Based Care for Managing Chronic Conditions in Adults: A Systematic Review

BACKGROUND

There is a lack of consensus on the effectiveness of audio-based care to manage chronic conditions. This knowledge gap has implications for health policy decisions and for health equity, as underserved populations are more likely to access care by telephone.

OBJECTIVES

We compared the effectiveness of audio-based care to usual care for managing chronic conditions (except diabetes).

DESIGN

We used systematic review methods to synthesize available evidence.

STUDIES

We searched for English-language articles reporting on randomized controlled trials (RCTs) of adults diagnosed with a chronic condition published since 2012.

OUTCOMES

We abstracted data on clinical outcomes, patient-reported health and quality of life, health care access and utilization, care quality and experience, and patient safety.

RESULTS

We included 40 RCTs evaluating audio-based care for a variety of chronic conditions, including cancer, heart failure, neurological disease, respiratory disease, musculoskeletal conditions, kidney disease, and others. There was significant heterogeneity across conditions and interventions. We generally found low to very low certainty of evidence of comparable effectiveness in the use of audio-based care to replace other care. Audio care as a supplement exhibited greater effectiveness in some outcomes, with generally low to very low certainty of evidence for most outcomes but moderate certainty for 2 groups of study outcomes.

CONCLUSIONS

More research is needed to identify the conditions, populations, and intervention design combinations that improve outcomes and to determine when audio-based care can effectively replace other synchronous care.

Unleashing innovation in first-line healthcare: The barriers to realizing platform openness

PURPOSE

Digital platforms are essential for fostering innovation in first-line healthcare. These platforms require openness, allowing external parties to utilize, enhance, or profit from them. Yet, knowledge about barriers to realizing platform openness is lacking. This research investigates the barriers to realizing platform openness in first-line healthcare.

METHOD

This research employed a qualitative exploratory approach. We collected data through thirteen semi-structured interviews with platform experts, application developers, and healthcare practitioners. As a study setting, we focused on Dutch first-line healthcare. We then analyzed the data using thematic analysis.

RESULT

We identify barriers in three main categories that hinder platform openness: technology-related (e.g., redundancy in development work), business-related (e.g., profit-maximizing strategy), and healthcare-related (e.g., reluctance to change).

SCIENTIFIC CONTRIBUTION

We contribute to the platform literature in medical informatics by being among the first to examine openness barriers that hinder platform-based innovation. We thus explain why platform implementations often do not result in substantial improvements in healthcare delivery despite their transformative impact in other industries.

The long-term effect of an m-health tool on self-care in patients with heart failure: a pre-post interventional study with a mixed-method analysis

AIMS

The aims of this study were (i) to evaluate the effects of using an m-health tool on self-care behaviour at 3 and 12 months and (ii) to explore the experiences and perceptions of heart failure (HF) patients about the m-health tool.

METHODS AND RESULTS

In this pre-post interventional study with a mixed-method analysis, 71 patients diagnosed with HF [49% female, mean age 76.7 years, New York Heart Association (NYHA) II 31%, NYHA III 69%] were enrolled and had the m-health tool installed in their home for 1 year. The tool consisted of a pre-programmed tablet including a weighing scale and interactive education about HF self-care. At baseline, and at 3 and 12 months, self-care was assessed using the European Heart Failure Self-care Behaviour (EHFScB-9) Scale, an eight-item self-administered questionnaire assessing the experiences of the m-health tool. The mean EHFScB-9 at baseline was 63.8 ± 2.8 and it improved to 67.6 ± 7.6 after 3 months (P < 0.05). After 1 year, the score had decreased to 63.2 ± 7.1 (P = 0.68). Most patients rated the tool as 'good', both at 3 months (92%) and after 12 months (93%). Some found the system to be unnecessary to some degree, and this number increased between 3 and 12 months (P < 0.001). Most patients felt that m-health increased their feelings of security, and 85% responded that the system increased their family members' sense of security.

CONCLUSION

The m-health tool significantly improved patients' self-care behaviour after 3 months, but this effect did not persist after 1 year. For achieving long-term effects and outcomes, additional and regularly updated self-care support may be needed.

REGISTRATION

ClinicalTrials.gov: NCT04955600.

Effectiveness of integrated person-centered interventions for older people's care: Review of Swedish experiences and experts' perspective

Older adults have multiple medical and social care needs, requiring a shift toward an integrated person-centered model of care. Our objective was to describe and summarize Swedish experiences of integrated person-centered care by reviewing studies published between 2000 and 2023, and to identify the main challenges and scientific gaps through expert discussions. Seventy-three publications were identified by searching MEDLINE and contacting experts. Interventions were categorized using two World Health Organization frameworks: (1) Integrated Care for Older People (ICOPE), and (2) Integrated People-Centered Health Services (IPCHS). The included 73 publications were derived from 31 unique and heterogeneous interventions pertaining mainly to the micro- and meso-levels. Among publications measuring mortality, 15% were effective. Subjective health outcomes showed improvement in 24% of publications, morbidity outcomes in 42%, disability outcomes in 48%, and service utilization outcomes in 58%. Workshop discussions in Stockholm (Sweden), March 2023, were recorded, transcribed, and summarized. Experts emphasized: (1) lack of rigorous evaluation methods, (2) need for participatory designs, (3) scarcity of macro-level interventions, and (4) importance of transitioning from person- to people-centered integrated care. These challenges could explain the unexpected weak beneficial effects of the interventions on health outcomes, whereas service utilization outcomes were more positively impacted. Finally, we derived a list of recommendations, including the need to engage care organizations in interventions from their inception and to leverage researchers' scientific expertise. Although this review provides a comprehensive snapshot of interventions in the context of Sweden, the findings offer transferable perspectives on the real-world challenges encountered in this field.

Telehealth interventions in occupational therapy with older adults: Results from a scoping review targeting better health promotion

INTRODUCTION

Telehealth interventions have the potential to enhance access to care and improve efficiency while reducing the burden on patients. Although telehealth interventions are well accepted and adopted in physical therapy, their usage in occupational therapy for older adults is less common, and limited information exists regarding their setting and context.

OBJECTIVE

To provide an inventory and synthesis of telehealth interventions in occupational therapy for older adults.

METHOD

For published studies on telehealth-based occupational therapy interventions in older adults between 2000 and 2022, six databases were reviewed. Data extraction and analysis were guided by the taxonomies developed by Tulu, McColl and Law and informed by the Canadian Model of Occupational Performance and Engagement.

FINDINGS

Twenty-three studies on telehealth interventions in occupational therapy for older adults were identified, mostly from North American authors (n = 11; 47.8%) and randomised clinical trials (n = 9; 39.1%). Most participants had a health problem (n = 20; 87.0%), mainly stroke (n = 9; 39.1%). Interventions focussed primarily on symptom management education (n = 12; 52.2%) of community-dwelling adults with health conditions, using videoconferencing systems or applications (n = 14; 60.7%). Interventions were delivered from the healthcare centre (n = 6; 26.1%) to the person's home (n = 18; 78.3%) synchronously (n = 19; 82.6%). About one third (n = 8; 34.8%) of the studies specified the therapist's location.

CONCLUSION

Published studies on telehealth interventions in occupational therapy with older adults have mainly focussed on the synchronous training and education of participants using videoconferencing systems or applications. According to these studies, the scope of interventions is limited and could be expanded, for example, through occupational development and environmental modification. To better understand and describe best practices in the use of telehealth in occupational therapy, future studies should provide more details about the interventions performed, the technology used and the environmental settings of the therapist.

Self-efficacy and healthcare costs in patients with chronic heart failure or chronic obstructive pulmonary disease

AIMS

This study aims to explore possible associations between self-efficacy and healthcare and drug expenditures (i.e. direct costs) in patients with chronic heart failure (CHF) or chronic obstructive pulmonary disease (COPD) in a study investigating the effects of person-centred care delivered by telephone.

METHODS AND RESULTS

This exploratory analysis uses data from an open randomized controlled trial conducted between January 2015 and November 2016, providing remote person-centred care by phone to patients with CHF, COPD, or both. Patients hospitalized due to worsening of CHF or COPD were eligible for the study. Randomization was based on a computer-generated list, stratified for age ≥ 75 and diagnosis. At a 6 month follow-up, 118 persons remained in a control group and 103 in an intervention group. The intervention group received person-centred care by phone as an addition to usual care. Trial data were linked to register data on healthcare and drug use. Group-based trajectory modelling was applied to identify trajectories for general self-efficacy and direct costs. Next, associations between self-efficacy trajectories and costs were assessed using regression analysis. Five trajectories were identified for general self-efficacy, of which three indicated different levels of increasing or stable self-efficacy, while two showed a decrease over time in self-efficacy. Three trajectories were identified for costs, indicating a gradient from lower to higher accumulated costs. Increasing or stable self-efficacy was associated with lower direct costs (P = 0.0013).

CONCLUSIONS

The findings show that an increased or sustained self-efficacy is associated with lower direct costs in patients with CHF or COPD. Person-centred phone contacts used as an add-on to usual care could result in lower direct costs for those with stable or increasing self-efficacy.

Physical activity with person-centered guidance supported by a digital platform or with telephone follow-up for persons with chronic widespread pain: Health economic considerations along a randomized controlled trial

OBJECTIVES

The aim was to investigate the resource use and costs associated with the co-creation of a physical activity plan for persons with chronic widespread pain (CWP) followed by support through a digital platform, compared to telephone follow-up.

METHODS

In this 12-month cost comparison study following up results after a randomized controlled trial, individuals with CWP, aged 20-65 years, were recruited at primary healthcare units in Western Sweden. All participants developed a person-centered health-enhancing physical activity plan together with a physiotherapist. Participants were then randomized to either an intervention group (n  =  69) who had a follow-up visit after 2 weeks and was thereafter supported through a digital platform, or an active control group (n  =  70) that was followed up through one phone call after a month. Costs to the health system were salary costs for the time recorded by physiotherapists when delivering the interventions.

RESULTS

The reported time per person (2.8 h during the 12 months) corresponded to costs of SEK 958 (range: 746-1,517) for the initial visits and follow-up (both study groups), and an additional 2.5 h (corresponding to a mean SEK 833; range: 636-1,257) for the time spent in the digital platform to support the intervention group.

CONCLUSION

After co-creation of a physical activity plan, it was more costly to support persons through a digital platform, compared to telephone follow-up.

Digital Transformation in the Diagnostics and Therapy of Cardiovascular Diseases: Comprehensive Literature Review

BACKGROUND

The digital transformation of our health care system has experienced a clear shift in the last few years due to political, medical, and technical innovations and reorganization. In particular, the cardiovascular field has undergone a significant change, with new broad perspectives in terms of optimized treatment strategies for patients nowadays.

OBJECTIVE

After a short historical introduction, this comprehensive literature review aimed to provide a detailed overview of the scientific evidence regarding digitalization in the diagnostics and therapy of cardiovascular diseases (CVDs).

METHODS

We performed an extensive literature search of the PubMed database and included all related articles that were published as of March 2022. Of the 3021 studies identified, 1639 (54.25%) studies were selected for a structured analysis and presentation (original articles: n=1273, 77.67%; reviews or comments: n=366, 22.33%). In addition to studies on CVDs in general, 829 studies could be assigned to a specific CVD with a diagnostic and therapeutic approach. For data presentation, all 829 publications were grouped into 6 categories of CVDs.

RESULTS

Evidence-based innovations in the cardiovascular field cover a wide medical spectrum, starting from the diagnosis of congenital heart diseases or arrhythmias and overoptimized workflows in the emergency care setting of acute myocardial infarction to telemedical care for patients having chronic diseases such as heart failure, coronary artery disease, or hypertension. The use of smartphones and wearables as well as the integration of artificial intelligence provides important tools for location-independent medical care and the prevention of adverse events.

CONCLUSIONS

Digital transformation has opened up multiple new perspectives in the cardiovascular field, with rapidly expanding scientific evidence. Beyond important improvements in terms of patient care, these innovations are also capable of reducing costs for our health care system. In the next few years, digital transformation will continue to revolutionize the field of cardiovascular medicine and broaden our medical and scientific horizons.

Supporting Collaboration in Rehabilitation Trajectories With Information and Communication Technologies: Scoping Review

BACKGROUND

Despite a surge in health information and communication technology (ICT), there is little evidence of lowered cost or increased quality of care. ICT may support patients, health care providers, and other stakeholders through complex rehabilitation trajectories by offering digital platforms for collaboration, shared decision-making, and safe storage of data. Yet, the questions on how ICT can become a useful tool and how the complex intersection between producers and users of ICT should be solved are challenging.

OBJECTIVE

This study aims to review the literature on how ICTs are used to foster collaboration among the patient, the provider, and other stakeholders.

METHODS

This scoping review follows the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Studies were identified by searching MEDLINE (OVID), Embase (OVID), CINAHL (EBSCOhost), AMED (EBSCOhost), and Scopus. Unpublished studies were extracted from OAIster, Bielefeld Academic Search Engine, ProQuest Dissertations and Theses, NARIC, and Google Scholar. Eligible papers addressed or described a remote dialogue between stakeholders using ICT to address goals and means, provide decision support, or evaluate certain treatment modalities within a rehabilitation context. Due to the rapid development of ICTs, searches included studies published in the period of 2018-2022.

RESULTS

In total, 3206 papers (excluding duplicates) were screened. Three papers met all inclusion criteria. The papers varied in design, key findings, and key challenges. These 3 studies reported outcomes such as improvements in activity performance, participation, frequency of leaving the house, improved self-efficacy, change in patients' perspective on possibilities, and change in professionals' understanding of patients' priorities. However, a misfit between the participants' needs and the technology offered, complexity and lack of availability of the technology, difficulties with implementation and uptake, and lack of flexibility in setup and maintenance reduced the value of ICT for those involved in the studies. The low number of included papers is probably due to the complexity of remote collaboration with ICT.

CONCLUSIONS

ICT has the potential to facilitate communication among stakeholders in the complex and collaborative context of rehabilitation trajectories. This scoping review indicates that there is a paucity of research considering remote ICT-supported collaboration in health care and rehabilitation trajectories. Furthermore, current ICT builds on eHealth literacy, which may differ among stakeholders, and the lack of sufficient eHealth literacy and ICT knowledge creates barriers for access to health care and rehabilitation. Lastly, the aim and results of this review are probably most relevant in high-income countries.

Person-Centeredness in Digital Primary Healthcare Services-A Scoping Review

Background: Transformation toward digital services offers unique opportunities to meet the challenges of responding to changing public healthcare needs and health workforce shortages. There is a knowledge gap regarding digital health and person or patient-centered care. Aim: The aim of the current scoping review was to obtain an overview of existing research on person or patient centeredness in digital primary healthcare services. Design: A scoping review following the five stages by Arksey and O'Malley. Methods: Literature searches were conducted in the databases PubMed, Scopus (Elsevier), APA PsychInfo (Ovid), Embase (Ovid), Cinahl (Ovid) and Cochrane Library in June 2022. The Preferred Reporting Items for Systematic reviews and Meta-Analyzes extension for Scoping Reviews (PRISMA-ScR) Checklist was followed. Results: The electronic database searches identified 782 references. A total of 116 references were assessed in full text against the inclusion and exclusion criteria. Finally, a total of 12 references were included. The included papers represent research from 2015 to 2021 and were conducted in eight different countries, within a variety of populations, settings and digital solutions. Four themes providing knowledge about current research on patient or person centeredness and digital primary health care were identified: 'Accessibility', 'Self-management', 'Digitalization at odds with patient centeredness' and 'Situation awareness'. The review underlines the need for further research on these issues.

Integrating health promotion with and for older people - eHealth (IHOPe) - evaluating remote integrated person-centred care : Protocol of a randomised controlled trial with effectiveness, health economic, and process evaluation

BACKGROUND

Healthcare and welfare systems worldwide are unprepared to accommodate the growing population of older people. Simultaneously, the cost of reactive care for older people is increasing. However, healthcare systems in many countries are reforming towards integrated and person-centred care with a focus on health promotion and proactive actions. The Integrating Health Promotion with and for Older People - eHealth (IHOPe) project aims to describe and evaluate a person-centred e-support intervention that promotes a sustainable partnership between community-dwelling frail older people and health and social care professionals.

METHODS

The IHOPe project is designed as a randomised controlled trial comparing a control group receiving standard care with an intervention group receiving standard care and add-on person-centred care through telephone support and a digital platform. The primary outcome measure is a composite score of changes in general self-efficacy and the need for unscheduled hospital care. The project is conducted in Gothenburg, Sweden. At least 220 participants aged ≥ 75 years will be included after being screened using a frailty instrument. The study design, intervention components, digital platform, and questionnaires were developed in close collaboration with an advisory group of inter-professional researchers, stakeholders, clinicians, and older representatives. Data will mainly be collected through questionnaires at baseline and 3, 6, and 12 months after inclusion in the study. Recruitment is ongoing and should be completed during 2023. Data will be analysed using quantitative and qualitative methods. The evaluation will include effectiveness, process, and health economics. The study was approved by the Regional Ethical Review Board in Gothenburg, Sweden (Dnr 2019-05364, Dnr 2020-03550, Dnr 2021-03255).

DISCUSSION

The findings will expand our knowledge of remotely integrated person-centred care for frail older people. Thereby, the IHOPe project is expected to fill highlighted knowledge gaps on intervention evaluations including the triad of person-centred, digital, and integrated care elements, as well as economic evaluations of remote health services for frail older people. The study is ongoing, and the results are not completed but if they turn out to be positive, implementation is not limited to time or location.

TRIAL REGISTRATION

ClinicalTrial.gov: NCT04416815. Registered 07/06/2021.

An IT Platform Supporting Rectal Cancer Tumor Board Activities: Implementation Process and Impact Analysis

Colorectal cancer (RC) is the third most common cancer, with an increasing incidence in recent years. Digital health solutions supporting multidisciplinary tumor boards (MTBs) could improve positive outcomes for RC patients. This paper describes the implementation process of a digital solution within the RC-MTB and its impact analysis in the context of the Fondazione Policlinico 'A. Gemelli' in Italy. Adopting a two-phase methodological approach, the first phase qualitatively describes each phase of the implementation of the IT platform, while the second phase quantitatively describes the analysis of the impact of the IT platform. Descriptive and inferential analyses were performed for all variables, with a p-value < 0.05 being considered statistically significant. The implementation of the platform allowed more healthcare professionals to attend meetings and resulted in a decrease in patients sent to the RC-MTB for re-staging and further diagnostic investigations and an increase in patients sent to the RC-MTB for treatment strategies. The results could be attributed to the facilitated access to the platform remotely for specialists, partly compensating for the restrictions imposed by the COVID-19 pandemic, as well as to the integration of the platform into the hospital's IT system. Furthermore, the early involvement of healthcare professionals in the process of customizing the platform to the specific needs of the RC-MTB may have facilitated its use and contributed to the encouraging quantitative results.