gms | German Medical Science

Background: Integrating new technologies into standard workflows poses many challenges for healthcare organisations. In addition to considering complex implementation determinants, change processes require the continuous engagement of stakeholders. The digitisation of the German healthcare system is an example of the need for a systematic approach to implementation. eHealth interventions such as telemedicine, health apps and e-prescription have barely made it into everyday healthcare. Effective implementation strategies for integrating eHealth interventions into existing workflows are often not adapted to the local context or are completely lacking. Therefore, feasible approaches that closely match the specific requirements of implementation practice are needed to provide effective implementation support.

Objective: The aim of this project is to develop an action guide based on a concept mapping approach (CMA), which will enable implementers in the German healthcare system to tailor the implementation to their context-specific determinants. Further, the effectiveness of the action guide will be evaluated.

Methods: The project is organised in two parts. The first part aims to adapt the CMA to the implementation of eHealth interventions, to the conceptual requirements of tailored implementation and to the stakeholders involved. Work packages:

1.

analysis of claims data on adoption of eHealth interventions;

2.

scoping review with intervention component analysis to identify key elements of participatory approaches for tailored implementation; and

3.

qualitative interviews on the perceptions of stakeholders involved in implementation initiatives.

The work packages will be carried out in parallel. A convergent mixed methods design including joint interpretation will be used to develop a first adapted version of the CMA. Potential end-users of the adapted CMA will then be invited to provide recommendations for changes and to assess the appropriateness, acceptability and feasibility of the adapted version in a consensus workshop.

In the second part, the adapted CMA will be investigated in a two-arm cluster randomised controlled implementation trial (cRCT). In the cRCT, the CMA will be applied to the use case „Implementation of the e-prescription process at the interface between the general practitioner, the specialist and the nursing home". Participating general and specialist practices (cluster level, 80 physicians in up to 60 practices) will be randomly assigned to the (1) CMA group or the (2) control group. The implementation behaviour of the physicians (use of e-prescribing services) will be observed over 12 months (6 months initial CMA use, 6 months follow-up with demand-oriented use of CMA). The cRCT will be accompanied by a mixed methods process evaluation. Further, a socio-economic impact assessment will be conducted to evaluate economic aspects of the implementation process from the perspective of various stakeholders.

Implication for research and/or (healthcare) practice: Literature shows that implementation strategies that are based on implementation determinants and that can be flexibly adapted to the respective context are a crucial factor for implementation success. This project evaluates a single method of tailoring implementation. If effective, further research would be needed to test external validity (e.g. in other settings, in other interventions).

Funding: Innovationsfonds/Versorgungsforschung; Project name: eHealth-COMPATH; Grant number: 01VSF23029