Development of an integrated model of care for allogeneic stem cell transplantation facilitated by eHealth—the SMILe study

Abstract

Purpose Allogeneic stem cell transplantation would benefit from re-engineering care towards an integrated eHealth-facilitated care model. With this paper we aim to: (1) describe the development of an integrated care model (ICM) in allogeneic SteM-cell-transplantatIon faciLitated by eHealth (SMILe) by combining implementation, behavioral, and computer science methods (e.g., contextual analysis, Behavior Change Wheel, and user-centered design combined with agile software development); and (2) describe that model’s characteristics and its application in clinical practice. Methods The SMILe intervention’s development consisted of four steps, with implementation science methods informing each: (1) planning its set-up within a theoretical foundation; (2) using behavioral science methods to develop the content; (3) choosing and developing its delivery method (human/technology) using behavioral and computer science methods; and (4) describing its characteristics and application in clinical practice. Results The SMILe intervention is embedded within the eHealth enhanced Chronic Care Model, entailing four self-management intervention modules, targeting monitoring and follow-up of important medical and symptom-related parameters, infection prevention, medication adherence, and physical activity. Interventions are delivered partly face-to-face by a care coordinator embedded within the transplant team, and partly via the SMILeApp that connects patients to the transplant team, who can monitor and rapidly respond to any relevant changes within 1 year post-transplant. Conclusion This paper provides stepwise guidance on how implementation, behavioral, and computer science methods can be used to develop interventions aiming to improve care for stem cell transplant patients in real-world clinical settings. This new care model is currently being tested in a hybrid I effectiveness-implementation trial.

The SMILe integrated care model in allogeneic SteM cell TransplantatIon faciLitated by eHealth: a protocol for a hybrid effectiveness-implementation randomised controlled trial

“…The SMILe-ICM was initially developed for the German setting [ 62 ], then further developed and adapted to the Swiss setting using information gathered by the contextual analysis [ 63 ]. The Swiss adaptations to the SMILe-ICM consisted mainly of technology-based changes to guarantee the SMILe technology’s interoperability with the USB’s information systems and care processes regarding alloSCT patients.…”

“…Phase A consisted of contextual and technology acceptance analyses. These informed the development of the SMILe-ICM and its implementation strategies for the first participating centre (University Hospital Freiburg, Germany), where implementation was successful yet no effectiveness data are available at the current time [58][59][60][61][62]. Phase A also guided the care model's development and adaption for the second participating centre (University Hospital Basel (USB), Switzerland) [63], (Valenta et al Contextspecific adaptation of an eHealth-facilitated, integrated care model and tailoring its implementation strategies -a mixed-methods study as a part of the SMILe implementation science project, Submitted).…”

“…The development and further adaption of the SMILe-ICM, which was based on a combination of behavioural, computer and implementation science methods, has been reported previously [60][61][62]. It is a complex, theorybased intervention, the eHealth components of which have been developed and further adapted by applying agile software development processes and a user-centred design approach [59,62].…”

“…This data transfer allows the APNs to monitor, identify and act upon critical values, symptom-related issues or trends based on pre-established cut-offs and risk-adjusted care protocols. Care protocols also specify when other members of the alloSCT team (e.g., responsible physicians, nurses) will be involved [ 62 ]. Patients can also view the progress of their entered values in the SMILeApp and read up on important symptoms in the SMILeApp lexicon.…”

Rehabilitation after Allogeneic Haematopoietic Stem Cell Transplantation: A Special Challenge

“…New in the last few years is a web or smartphone-based information system, whereby the patient can inform her/his caregivers every day about any clinical changes like diarrhoea, fever, vomiting, weight loss, and so on. The SMILE ® program [ 49 , 50 ] has been implemented in Freiburg with an excellent response, and high patient satisfaction. In cases of genuine emergencies, even at night-time, the patient must be able to be examined in an emergency department.…”