Implementation and Evaluation of a Smartphone-Based Telemonitoring Program for Patients With Heart Failure: Mixed-Methods Study Protocol

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

doi:10.2196/resprot.9911

Implementation and Evaluation of a Smartphone-Based Telemonitoring Program for Patients With Heart Failure: Mixed-Methods Study Protocol

JMIR Res Protoc. 2018 May 3;7(5):e121. doi: 10.2196/resprot.9911.

Authors

Patrick Ware^{1

2}, Heather J Ross^{3

4

5}, Joseph A Cafazzo^{1

2

6}, Audrey Laporte^{1

7}, 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.

Abstract

Background: Meta-analyses of telemonitoring for patients with heart failure conclude that it can lower the utilization of health services and improve health outcomes compared with the standard of care. A smartphone-based telemonitoring program is being implemented as part of the standard of care at a specialty care clinic for patients with heart failure in Toronto, Canada.

Objective: The objectives of this study are to (1) evaluate the impact of the telemonitoring program on health service utilization, patient health outcomes, and their ability to self-care; (2) identify the contextual barriers and facilitators of implementation at the physician, clinic, and institutional level; (3) describe patient usage patterns to determine adherence and other behaviors in the telemonitoring program; and (4) evaluate the costs associated with implementation of the telemonitoring program from the perspective of the health care system (ie, public payer), hospital, and patient.

Methods: The evaluation will use a mixed-methods approach. The quantitative component will include a pragmatic pre- and posttest study design for the impact and cost analyses, which will make use of clinical data and questionnaires administered to at least 108 patients at baseline and 6 months. Furthermore, outcome data will be collected at 1, 12, and 24 months to explore the longitudinal impact of the program. In addition, quantitative data related to implementation outcomes and patient usage patterns of the telemonitoring system will be reported. The qualitative component involves an embedded single case study design to identify the contextual factors that influenced the implementation. The implementation evaluation will be completed using semistructured interviews with clinicians, and other program staff at baseline, 4 months, and 12 months after the program start date. Interviews conducted with patients will be triangulated with usage data to explain usage patterns and adherence to the system.

Results: The telemonitoring program was launched in August 2016 and patient enrollment is ongoing.

Conclusions: The methods described provide an example for conducting comprehensive evaluations of telemonitoring programs. The combination of impact, implementation, and cost evaluations will inform the quality improvement of the existing program and will yield insights into the sustainability of smartphone-based telemonitoring programs for patients with heart failure within a specialty care setting.

Keywords: costs and cost analysis; health services research; heart failure; self-management; telemedicine.

©Patrick Ware, Heather J Ross, Joseph A Cafazzo, Audrey Laporte, Emily Seto. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 03.05.2018.