Evaluating Virtual Care Implementation and Financial Sustainability:  Qualitative evaluation of a Virtual Care Centre Using the NASSS-CFIR Unified Evaluation Model

Keywords: Virtual care; Emergency medicine; Triage

 

Background:Virtual care centres (VCCs) have emerged as innovative solutions for healthcare delivery, while optimising resources. The Alexandra Hospital Virtual Care Centre has demonstrated promising early outcomes, with 9% utilization rates and 20% emergency department avoidance since its inception in 2020. However, comprehensive multi-stakeholder evaluation and financial sustainability assessments remain limited. Our study will employ a two-phase qualitative inquiry into the VCC's effectiveness, user experiences, and financial viability through the lens of an Integrated Framework: the NASSS-CFIR Unified Evaluation Model, which combines the Non-adoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework with the Consolidated Framework for Implementation Research (CFIR) to provide holistic implementation insights.

 

Approach: This study will employ a qualitative methodology across two distinct but complementary phases. Phase 1 will focus on service evaluation through semi-structured interviews with 30-45 participants, including healthcare providers (n=15-20) and VCC users (n=15-25). Phase 2 will explore financial sustainability by examining patient willingness to pay among emergency department and urgent care centre attendees (n=20-25). The NASSS-CFIR Unified Evaluation Model will guide data collection and analysis, enabling systematic examination of technological complexity, organizational capacity, adoption patterns, and sustainability factors. Interviews will be audio-recorded and analysed using framework analysis, incorporating multiple coder reliability checks and triangulation across data sources.

 

Results: The integrated NASSS-CFIR framework will systematically examine implementation factors affecting VCC operations. The study will document healthcare providers' and users' experiences with the service, identifying both strengths and limitations in current delivery models. Provider interviews will explore practical challenges in integrating virtual care into existing workflows, including issues related to professional roles and coordination between virtual and in-person services. Patient and caregiver perspectives will capture feedback on service accessibility, convenience, and any concerns regarding the appropriateness of virtual consultations for different health conditions.

 

The financial sustainability component will gather data on patients' payment preferences and perceived value of tele-triage services, recognizing that willingness to pay may vary across different patient populations and clinical scenarios. Analysis will identify specific operational facilitators and barriers, such as technological infrastructure, staffing models, and organizational support structures. The findings will provide a realistic assessment of the VCC model and identify areas which require modification or additional support for sustainable implementation.

 

Implications: This research will provide comprehensive evidence for evidence-based virtual care scaling decisions across the National University Health System (NUHS) and beyond. The NASSS-CFIR Unified Evaluation Model will demonstrate value as a practical tool for assessing complex health technology implementations, offering actionable insights for policymakers and healthcare administrators. The study's integrated approach to service quality assessment and financial sustainability analysis will offer a replicable methodology for other healthcare systems considering virtual care expansion.