Dr Stephanie Ko, MBBS MMed MPH, is currently a Consultant of Advanced Internal Medicine at the National University Hospital. She is the Lead Clinician of NUHS@Home a technology-enabled hospital-at-home programme at the National University Healthcare System. Her research interests include the evaluation of clinical effectiveness and implementation new care delivery models, including hospital-at-home models and telehealth enabled programmes.
Hospital-at-home interventions have been shown to be clinically and cost-effective, and many healthcare systems internationally are investing in scaling-up such interventions. However, most existing studies are focusing on how effective the intervention is, rather than how to successfully scale it up. We report a study protocol for a theory-driven investigation of a hospital-at-home intervention. We propose a novel combination of two established implementation science frameworks – the EPIS framework and the Scale-Up framework – and apply it to a planned scale-up of a hospital-at-home intervention in Singapore.
EPIS offers a useful macro-framework by identifying contextual influences across the phases of Exploration, Preparation, Implementation, and Sustainment. The macro approach of EPIS needs to be further supported by an action-orientated framework of the scale-up process. The Scale-Up framework breaks down scaling-up into 4 phases: set-up, develop the scalable unit, test of scale-up, and go to full-scale. We will conduct an observational cohort study across 24 months (May 2022 to April 2024) to evaluate the association of outer and inner contextual factors on key implementation outcomes – the volume of patients admitted, operational efficiency and levels of adoption. Statistical process control graphs will be used to examine variation in the implementation outcomes over time. Linear regression will be applied to assess associations of outcomes with contextual factors that are continuous variables; logistic regression will be applied to assess the associations of outcomes with binary/descriptive contextual factors. To supplement these, qualitative methods will be applied using a content analysis of monthly meeting minutes and focus groups of the implementation team to understand and explain the outcomes of the observational cohort study.
NA (study protocol)
This study protocol applies implementation frameworks to systematically evaluate the scale-up process and identifying barriers and facilitators towards going to full scale.