User-Centered Adaptation of an Existing Heart Failure Telemonitoring Program to Ensure Sustainability and Scalability: Qualitative Study

Patrick Ware; Heather J Ross; Joseph A Cafazzo; Audrey Laporte; Kayleigh Gordon; Emily Seto

doi:10.2196/11466

User-Centered Adaptation of an Existing Heart Failure Telemonitoring Program to Ensure Sustainability and Scalability: Qualitative Study

JMIR Cardio. 2018 Dec 6;2(2):e11466. doi: 10.2196/11466.

Authors

Patrick Ware^{1

2}, Heather J Ross^{3

4

5}, Joseph A Cafazzo^{1

2

6}, Audrey Laporte^{1

7}, Kayleigh Gordon^{1

2}, Emily Seto^{1

2}

Affiliations

¹ Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
² Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada.
³ Ted Rogers Centre for Heart Research, University Health Network, Toronto, ON, Canada.
⁴ Department of Medicine, University of Toronto, Toronto, ON, Canada.
⁵ Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada.
⁶ Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada.
⁷ Canadian Centre for Health Economics, Toronto, ON, Canada.

PMID: 31758774
PMCID: PMC6857927
DOI: 10.2196/11466

Abstract

Background: Telemonitoring interventions for the management of heart failure have seen limited adoption in Canadian health systems, but isolated examples of telemonitoring programs do exist. An example of such a program was launched in a specialty heart failure clinic in Toronto, Canada, and a recent implementation evaluation concluded that reducing the cost of delivering the program is necessary to ensure its sustainability and scalability.

Objective: The objectives of this study were to (1) understand which components of the telemonitoring program could be modified to reduce costs and adapted to other contexts while maintaining program fidelity and (2) describe the changes made to the telemonitoring program to enable its sustainability within the initial implementation site and scalability to other health organizations.

Methods: Semistructured interviews probed the experiences of patients (n=23) and clinicians (n=8) involved in the telemonitoring program to identify opportunities for cost reduction and resource optimization. Ideas for adapting the program were informed by the interview results and prioritized based on (1) potential impact for sustainability and scalability, (2) feasibility, and (3) perceived risks to negatively impacting the program's ability to yield desired health outcomes.

Results: A total of 5 themes representing opportunities for cost reduction were discussed, including (1) Bring Your Own Device (BYOD), (2) technical support, (3) clinician role, (4) duration of enrollment, and (5) intensity of monitoring. The hardware used for the telemonitoring system and the modalities of providing technical support were found to be highly adaptable, which supported the decision to implement a BYOD model, whereby patients used their own smartphone, weight scale, and blood pressure cuff. Changes also included the development of a website aimed at reducing the burden on a technical support telehealth analyst. In addition, the interviews suggested that although it is important to have a clinician who is part of a patient's circle of care monitoring telemonitoring alerts, the skill level and experience were moderately adaptable. Thus, a registered nurse was determined to be more cost-effective and was hired to replace the existing nurse practitioners in the frontline management of telemonitoring alerts and take over the technical support role from a telehealth analyst.

Conclusions: This study provides a user-centered example of how necessary cost-reduction actions can be taken to ensure the sustainability and scalability of telemonitoring programs. In addition, the findings offer insights into what components of a telemonitoring program can be safely adapted to ensure its integration in various clinical settings.

Keywords: diffusion of innovation; heart failure; mHealth; telemonitoring.

©Patrick Ware, Heather J Ross, Joseph A Cafazzo, Audrey Laporte, Kayleigh Gordon, Emily Seto. Originally published in JMIR Cardio (http://cardio.jmir.org), 06.12.2018.