6th UK and Ireland Implementation Science Research Conference 2023
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PRESENter
Judith Fynn
presenter biography
Dr Judith Fynn is Principal Advisor for real-world evaluation at Eastern Academic Health Science Network (AHSN). Her work focuses on the design and delivery of rapid, robust evaluation to generate relevant evidence and insights from interventions including new products, pathways, and ways of working. Judith’s research interests include exploring approaches to evaluation and knowledge exchange to support implementation of evidence-based interventions. The work being presented was an evaluation of remote monitoring health care pathways, conducted as a collaboration between research staff from East of England Applied Research Collaboration (ARC) especially Jennifer Lynch at the University of Hertfordshire and Adam Wagner and Lisa Miners at the University of East Anglia with Eastern AHSN. The work was funded by the NHS National Insights Prioritisation Programme (NIPP) as part of the Accelerated Access Collaborative in NHS England with support from the National Institute for Health and Care Research (NIHR).
background
Remote monitoring (RM) enables observation and reporting of physiology and behaviour with the intention of supporting patients to self-manage their conditions. In England, RM is central to the National Health Service (NHS) recovery from the COVID-19 pandemic and the government’s plan to drive efficiency, free up hospital beds, clinician time and reduce the COVID backlog (1). Improving understanding of RM implementation and its impacts on patients, staff, carers and health and care systems is critical to enable system resilience post pandemic.
We evaluated the implementation of technology-enabled RM pathways at four sites within different Integrated Care Systems (ICS), each varying in health condition/patient cohort and delivery model.
MEthod
The four mixed method evaluations were designed and conducted with patient and public involvement (PPI). The evaluations had distinct overlapping phases: (1) pathway mapping and logic modelling; (2) quantitative analysis to understand patient characteristics, resources and costs and qualitative staff interviews to understand delivery and impacts; (3) knowledge mobilisation.
results
We used the NASSS framework (2) to identify key factors affecting the implementation of RM pathways in ICS. Cross-cutting themes included: potential for access inequities; system-level challenges and enablers; importance of reporting, sharing and use of data. Variability in data recorded and informatics processes within health systems affects the ability to fully understand patient characteristics, including excluded patients, and wider impacts of RM pathways on staff, patients and carers. Clinical champions were key to driving the development and delivery of RM pathways. Differing staffing and delivery models influenced acceptability and potential for scale-up, spread and sustainability.
Conclusion
Understanding impacts of different implementation models, including staffing integrated working and co-production, is critical to enabling health systems to deliver RM at scale. Improved data sharing and recognition of system level resource requirements is critical to sustaining delivery of novel pathways in the new ICS infrastructure and improving patient experience.