Barriers and Facilitators to the Implementation of Family-Centered Technology in Complex Care: Feasibility Study

Cloud Care: A Feasibility Study of Cloud-Based Care Plans for Children With Medical Complexity

BACKGROUND AND OBJECTIVES

Cloud-based information systems can support team-based content management of care plans for children with medical complexity (CMC), yet we have limited knowledge of the feasibility of these systems. We aimed to examine the feasibility of Cloud Care, a novel cloud-based longitudinal care plan system, among a diverse group of caregivers and health care providers caring for CMC.

METHODS

We conducted a 3-year, prospective, feasibility study between May 2019 and July 2022 in which caregivers and health care providers of CMC received access to Cloud Care for 4 to 32 months. We assessed the practicality, acceptability, demand, integration, and adaptation of the system using a combination of web analytics and survey data.

RESULTS

Of those invited, 29 of 43 (67%) CMC/caregivers and 459 of 462 (99.5%) providers enrolled in the study. Among enrolled participants, 90% of primary caregivers and 47% of providers accessed the system at least once (ie, adoption rate), and 59% of primary caregivers and 11% of providers edited content at least once. Of the 11 caregivers and 42 providers who accessed Cloud Care and completed a survey, over 82% of caregivers and 45% of providers perceived the system was easy to use.

CONCLUSIONS

Study adoption rates highlight the desire for a curated, dynamic care plan for CMC. Engagement in collaborative management of care plan information in a cloud-based system was promising among caregivers, but low among providers. Optimizing the design, accessibility, and usability of existing information systems to create and collaboratively maintain care plans warrants continued exploration.

Community Caregivers' Perspectives on Health IT Use for Children With Medical Complexity: Qualitative Interview Study

BACKGROUND

Children with medical complexity represent a unique pediatric population requiring extensive health care needs and care coordination. Children with medical complexities have multiple significant chronic health problems that affect multiple organ systems and result in functional limitations and high health care needs or use. Often, there is a need for medical technology and total care for activities of daily living, much of which is provided at home by family and caregivers. Health IT (HIT) is a broad term that includes various technologies, such as patient portals, telemedicine, and mobile health apps. These tools can improve the care of children with medical complexity by enhancing communication, information exchange, medical safety, care coordination, and shared decision-making. In this study, we identified children with medical complexity as children aged <21 years who have >3 chronic health conditions. Community caregivers contribute to the care management of children with medical complexity, serving as advocates and coordinators, primary sources of information about children's needs, and facilitators of access to care. They are often the first point of contact for the families of children with medical complexity, particularly in vulnerable communities, including families in rural areas, low-income households, and non-English-speaking immigrant populations.

OBJECTIVE

This study aims to introduce the HIT needs and preferences for children with medical complexity from the perspective of community caregivers. By including their perspective on HIT development, we can better appreciate the challenges they face, the insights they offer, and the ways in which they bridge gaps in care, support, and resources.

METHODS

We conducted semistructured interviews (n=12) with formal community caregivers of children with medical complexity populations from a parent advocacy network on the US East Coast. Interviews were audio recorded via Zoom and then transcribed. An inductive thematic analysis was conducted to reveal HIT challenges and preferences for improving the care of children with medical complexity.

RESULTS

We categorized the interview results into themes and subthemes. There are four main themes: (1) telehealth transforming care for children with medical complexity during the COVID-19 pandemic, (2) suggested tools and technologies for care for children with medical complexity, (3) HIT feature preferences, and (4) transition to adult care. Each theme had multiple subthemes capturing all details related to design features of needed technologies.

CONCLUSIONS

The study emphasizes the need to develop and enhance HIT for the care of children with medical complexity. The identified themes can serve as design guidelines for designers by establishing a foundation for user-centered HIT tools to effectively support children with medical complexity and their families. Telehealth and mobile health apps could improve care management and quality of life for children with medical complexity.

Current Implementation of Digital Health in Chronic Disease Management: Scoping Review

BACKGROUND

Approximately 1 in 3 adults live with multiple chronic diseases. Digital health is being harnessed to improve continuity of care and management of chronic diseases. However, meaningful uptake of digital health for chronic disease management remains low. It is unclear how these innovations have been implemented and evaluated.

OBJECTIVE

This scoping review aims to identify how digital health innovations for chronic disease management have been implemented and evaluated: what implementation frameworks, methods, and strategies were used; how successful these strategies were; key barriers and enablers to implementation; and lessons learned and recommendations shared by study authors.

METHODS

We used the Joanna Briggs Institute methodology for scoping reviews. Five databases were searched for studies published between January 2015 and March 2023: PubMed, Scopus, CINAHL, PsycINFO, and IEEE Xplore. We included primary studies of any study design with any type of digital health innovations for chronic diseases that benefit patients, caregivers, or health care professionals. We extracted study characteristics; type of digital health innovation; implementation frameworks, strategies, and outcome measures used; barriers and enablers to implementation; lessons learned; and recommendations reported by study authors. We used established taxonomies to synthesize extracted data. Extracted barriers and enablers were grouped into categories for reporting. Descriptive statistics were used to consolidate extracted data.

RESULTS

A total of 252 studies were included, comprising mainly mobile health (107/252, 42.5%), eHealth (61/252, 24.2%), and telehealth (97/252, 38.5%), with some studies involving more than 1 innovation. Only 23 studies (23/252, 9.1%) reported using an implementation science theory, model, or framework; the most common were implementation theories, classic theories, and determinant frameworks, with 7 studies each. Of 252 studies, 144 (57.1%) used 2 to 5 implementation strategies. Frequently used strategies were "obtain and use patient or consumer feedback" (196/252, 77.8%); "audit and provide feedback" (106/252, 42.1%); and piloting before implementation or "stage implementation scale-up" (85/252, 33.7%). Commonly measured implementation outcomes were acceptability, feasibility, and adoption of the digital innovation. Of 252 studies, 247 studies (98%) did not measure service outcomes, while patient health outcomes were measured in 89 studies (35.3%). The main method used to assess outcomes was surveys (173/252, 68.7%), followed by interviews (95/252, 37.7%). Key barriers impacting implementation were data privacy concerns and patient preference for in-person consultations. Key enablers were training for health care workers and personalization of digital health features to patient needs.

CONCLUSIONS

This review generated a summary of how digital health in chronic disease management is currently implemented and evaluated and serves as a useful resource for clinicians, researchers, health system managers, and policy makers planning real-world implementation. Future studies should investigate whether using implementation science frameworks, including how well they are used, would yield better outcomes compared to not using them.

Development and validation of a Japanese version of The Quality of Discharge Teaching Scale-Parent Form (JQDTS-PF): A cross-sectional observational study

BACKGROUND

Advances in medical care have enabled home treatment and advanced medical care for children with chronic illnesses. Nurses are not only required to teach their caregivers skills but also understand the families' needs and identify their anxieties in discharge teaching. However, no measure is currently available in Japan to evaluate the quality of discharge teaching provided by nurses. Therefore, this study aimed to develop a Japanese version of the Quality of Discharge Teaching Scale Parent-Form (JQDTS-PF) developed by Weiss et al. METHODS: A Japanese version of the scale was created after obtaining permission from the original author. The questionnaire was then distributed to caregivers of children discharged from hospitals in Japan who required some form of medical care after discharge.

FINDINGS

The study population comprised 113 respondents (response rate: 93.3%). The reliability of the scale was 0.88 for "need," 0.86 for "receive," and 0.93 for "delivery." Significant positive correlations were found between the JQDTS-PF subscale and the Japanese version of Readiness for Hospital Discharge Scale (JRHDS-PF). Significant correlations were also found between child and family characteristics and subscales of the JQDTS-PF.

DISCUSSION

The developed Japanese version of the scale was found to be sufficiently reliable. Validity of the scale was also sufficiently confirmed by correlation analysis, which yielded results similar to those of previous studies.

APPLICATION TO PRACTICE

This scale would be useful in improving and evaluating the quality of discharge teaching by nurses in Japan in the future.

Perceived barriers and facilitators of implementing a sustained smartphone-based telemonitoring program for pregnant women at high-risk for pre-eclampsia in the public and private sectors in Pakistan

Background

In Pakistan, a smartphone-based telemonitoring (TM) program (Raabta) has been designed to support pregnant women with high risk for preeclampsia (HRPE) in Pakistan. However, implementing TM interventions is often challenging, particularly in low-resource settings, given the complexity of healthcare environments and variations in public and private health sectors. This study explores the potential barriers and facilitators for a sustained implementation of the Raabta program in public and private sector hospitals in Pakistan.

Methods

Using a qualitative description design, 57 semi-structured interviews with a diverse group of participants including patients from the public (n = 15) and private sector hospitals (n = 17), obstetricians from the public (n = 5) and private sector hospitals (n = 7), decision-makers (n = 7) and telehealth experts (n = 6). Participants were recruited using purposive and snowball sampling techniques. Interview transcripts were deductively analyzed using the Consolidated Framework for Implementation Research (CFIR) domains.

Results

Based on the CFIR domains, the findings included: (1) Raabta being perceived as user-friendly even for patients with low digital and language literacy; (2) Outer settings: Limited health and digital literacy, poor language proficiency, and cultural norms can influence the willingness and ability of public sector patients to use the Raabta; (3) Inner settings: The private health sector is well-equipped for the Raabta implementation, while the public health sector faces challenges related to physical space, limited human and financial resources, and physician resistance; (4) Individual characteristics: Majority participants demonstrated positive attitudes toward the Raabta program and expressed confidence in using it (5) Process: Recommendations included adopting a nurse-led model for the private sector, leveraging paramedics for monitoring the Raabta dashboard, integrating Raabta with existing digital platforms, and establishing an advisory committee for program sustainability.

Conclusion

Raabta implementation may be more feasible in the private sector due to patient demographics, health and digital literacy, cultural norms, financial resources, physician readiness, and hospital infrastructure.

Building the foundation for a community-generated national research blueprint for inherited bleeding disorders: research priorities in health services; diversity, equity, and inclusion; and implementation science

BACKGROUND

The National Hemophilia Foundation (NHF) conducted extensive all-stakeholder inherited bleeding disorder (BD) community consultations to inform a blueprint for future research. Sustaining and expanding the specialized and comprehensive Hemophilia Treatment Center care model, to better serve all people with inherited BDs (PWIBD), and increasing equitable access to optimal health emerged as top priorities.

RESEARCH DESIGN AND METHODS

NHF, with the American Thrombosis and Hemostasis Network (ATHN), convened multidisciplinary expert working groups (WG) to distill priority research initiatives from consultation findings. WG5 was charged with prioritizing health services research (HSR); diversity, equity, and inclusion (DEI); and implementation science (IS) research initiatives to advance community-identified priorities.

RESULTS

WG5 identified multiple priority research themes and initiatives essential to capitalizing on this potential. Formative studies using qualitative and mixed methods approaches should be conducted to characterize issues and meaningfully investigate interventions. Investment in HSR, DEI and IS education, training, and workforce development are vital.

CONCLUSIONS

An enormous amount of work is required in the areas of HSR, DEI, and IS, which have received inadequate attention in inherited BDs. This research has great potential to evolve the experiences of PWIBD, deliver transformational community-based care, and advance health equity.

Building the foundation for a community-generated national research blueprint for inherited bleeding disorders: facilitating research through infrastructure, workforce, resources and funding

BACKGROUND

The National Hemophilia Foundation (NHF) conducted extensive, inclusive community consultations to guide prioritization of research in coming decades in alignment with its mission to find cures and address and prevent complications enabling people and families with blood disorders to thrive.

RESEARCH DESIGN AND METHODS

With the American Thrombosis and Hemostasis Network, NHF recruited multidisciplinary expert working groups (WG) to distill the community-identified priorities into concrete research questions and score their feasibility, impact, and risk. WG6 was charged with identifying the infrastructure, workforce development, and funding and resources to facilitate the prioritized research. Community input on conclusions was gathered at the NHF State of the Science Research Summit.

RESULTS

WG6 detailed a minimal research capacity infrastructure threshold, and opportunities to enable its attainment, for bleeding disorders centers to participate in prospective, multicenter national registries. They identified challenges and opportunities to recruit, retain, and train the diverse multidisciplinary care and research workforce required into the future. Innovative collaborative approaches to trial design, resource networking, and funding to surmount obstacles facing research in rare disorders were elucidated.

CONCLUSIONS

The innovations in infrastructure, workforce development, and resources and funding proposed herein may contribute to facilitating a National Research Blueprint for Inherited Bleeding Disorders.

Patient-centered pharmacovigilance: priority actions from the inherited bleeding disorders community

Pharmacovigilance, the science and practice of monitoring the effects of medicinals and their safety, is the responsibility of all stakeholders involved in the development, manufacture, regulation, distribution, prescription, and use of drugs and devices. The patient is the stakeholder most impacted by and the greatest source of information on safety issues. It is rare, however, for the patient to take a central role and exert leadership in the design and execution of pharmacovigilance. Patient organizations in the inherited bleeding disorders community are among the most established and empowered, particularly in the rare disorders. In this review, two of the largest bleeding disorders patient organizations, Hemophilia Federation of America (HFA) and National Hemophilia Foundation (NHF), offer insights into the priority actions required of all stakeholders to improve pharmacovigilance. The recent and ongoing increase in incidents raising safety concerns and a therapeutic landscape on the cusp of unprecedented expansion heighten the urgency of a recommitment to the primacy of patient safety and well-being in drug development and distribution.

Plain Language Summary

Patients at the center of product safety Every medical device and therapeutic product has potential benefits and harms. The pharmaceutical and biomedical companies that develop them must demonstrate that they are effective, and the safety risks are limited or manageable, for regulators to approve them for use and sale. After the product has been approved and people are using it in their daily lives, it is important to continue to collect information about any negative side effects or adverse events; this is called pharmacovigilance. Regulators, like the United States (US) Food and Drug Administration, the companies that sell and distribute the products, and healthcare professionals who prescribe them are all required to participate in collecting, reporting, analyzing, and communicating this information. The people with the most firsthand knowledge of the benefits and harms of the drug or device are the patients who use them. They have an important responsibility to learn how to recognize adverse events, how to report them, and to stay informed of any news about the product from the other partners in the pharmacovigilance network. Those partners have a crucial responsibility to provide clear, easy-to-understand information to patients about any new safety concerns that come to light. The community of people with inherited bleeding disorders has recently encountered problems with poor communication of product safety issues, prompting two large US patient organizations, National Hemophilia Foundation and Hemophilia Federation of America, to hold a Safety Summit with all the pharmacovigilance network partners. Together they developed recommendations to improve the collection and communication of information about product safety so that patients can make well-informed, timely decisions about their use of drugs and devices. This article presents these recommendations in the context of how pharmacovigilance is supposed to work and some of the challenges encountered by the community.