Domains and Methods Used to Assess Home Telemonitoring Scalability: Systematic Review

Abstract

Background The COVID-19 pandemic catalyzed the adoption of home telemonitoring to cope with social distancing challenges. Recent research on home telemonitoring demonstrated benefits concerning the capacity, patient empowerment, and treatment commitment of health care systems. Moreover, for some diseases, it revealed significant improvement in clinical outcomes. Nevertheless, when policy makers and practitioners decide whether to scale-up a technology-based health intervention from a research study to mainstream care delivery, it is essential to assess other relevant domains, such as its feasibility to be expanded under real-world conditions. Therefore, scalability assessment is critical, and it encompasses multiple domains to ensure population-wide access to the benefits of the growing technological potential for home telemonitoring services in health care. Objective This systematic review aims to identify the domains and methods used in peer-reviewed research studies that assess the scalability of home telemonitoring–based interventions under real-world conditions. Methods The authors followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines and used multiple databases (PubMed, Scopus, Web of Science, and EconLit). An integrative synthesis of the eligible studies was conducted to better explore each intervention and summarize relevant information concerning the target audience, intervention duration and setting, and type of technology. Each study design was classified based on the strength of its evidence. Lastly, the authors conducted narrative and thematic analyses to identify the domains, and qualitative and quantitative methods used to support scalability assessment. Results This review evaluated 13 articles focusing on the potential of scaling up a home telemonitoring intervention. Most of the studies considered the following domains relevant for scalability assessment: problem (13), intervention (12), effectiveness (13), and costs and benefits (10). Although cost-effectiveness was the most common evaluation method, the authors identified seven additional cost analysis methods to evaluate the costs. Other domains were less considered, such as the sociopolitical context (2), workforce (4), and technological infrastructure (3). Researchers used different methodological approaches to assess the effectiveness, costs and benefits, fidelity, and acceptability. Conclusions This systematic review suggests that when assessing scalability, researchers select the domains specifically related to the intervention while ignoring others related to the contextual, technological, and environmental factors, which are also relevant. Additionally, studies report using different methods to evaluate the same domain, which makes comparison difficult. Future work should address research on the minimum required domains to assess the scalability of remote telemonitoring services and suggest methods that allow comparison among studies to provide better support to decision makers during large-scale implementation.

Assessing the Quality and Impact of eHealth Tools: Systematic Literature Review and Narrative Synthesis

“…It maps out the number of records identified, included, and excluded and the reasons for exclusion. This process resulted in the inclusion of 40 articles for the qualitative synthesis [ 15 - 21 , 30 - 62 ]. Multimedia Appendix 4 [ 15 - 21 , 30 - 62 ] presents the sample characteristics of the included studies from research methodology, geographical, and clinical focus perspectives.…”

“…The Intervention Scalability Assessment Tool (ISAT) [ 94 ] was used by Azevedo et al [ 30 ], whereas the National Institute for Health and Care Excellence behavior change guidance (NICE BCG) [ 95 ] was used by McMillan et al [ 48 ], and the Prioritering efter NyttoGrunder (PENG; translated as “Prioritizing based on contribution of benefits”) evaluation tool [ 96 ] was used by Parv et al [ 52 ]. Finally, the Replicating Effective Programs (REP) framework [ 97 ] was used by Camacho et al [ 18 ].…”

“…The checklist is provided in Multimedia Appendix 1 , and it evaluates the following key quality criteria of the included studies: whether there was a clear statement of the aims of the research, whether the methodology was appropriate for the research objectives, whether the research design was appropriate to address the aims, whether the recruitment strategy was appropriate for the aims of the research, whether the data were collected in a way that addressed the research issue, whether the role of the researchers was adequately considered, whether ethical issues were considered, whether the data analysis was sufficiently rigorous, whether there was a clear statement of findings, and whether the researchers discussed the contribution the study made to existing knowledge or understanding (eg, did they consider the findings in relation to current practice or policy or relevant research-based literature). A Microsoft Excel (Microsoft Corp) sheet with the results of the appraisal of the included studies can be accessed in Multimedia Appendix 2 [ 15 - 21 , 30 - 62 ].…”

Scaling-up digital follow-up care services: collaborative development and implementation of Remote Patient Monitoring pilot initiatives to increase access to follow-up care

“…Therefore, patients and healthcare professionals had to be part of the research process so that their needs were not compromised at the expense of scalability (39). Problem definition and context characterization are two important domains usually neglected by researchers in scalability assessment (40). The most Level of participation of each team role per PAR phase per pilot initiative.…”

“…Therefore, patients and healthcare professionals had to be part of the research process so that their needs were not compromised at the expense of scalability ( 39 ). Problem definition and context characterization are two important domains usually neglected by researchers in scalability assessment ( 40 ). The most important features for the patients were the outcomes collection using a mobile application, smartphone camera, and IoT devices, outcome-based automated alerts, and the web-based RPM care management platform.…”