Abstract
Background: In Quebec, fragmentation of the health system and health data can hinder service delivery and compromise patient outcomes, especially in remote areas of Quebec. To address these challenges, Quebec has integrated innovative digital technologies - virtual care coordination and telemonitoring - into chronic pain management pathways. The digital pathway was co-designed with providers, decision-makers, and patients, using the principles of learning health systems to improve access, integration, continuity, coordination, and communication. The technology developed and woven into service delivery includes 1) interdisciplinary asynchronous and synchronous primary care consultation; 2) remote patient monitoring using real-time personalized self-management strategies and clinical advice; 3) self-directed self-management; 4) real-time clinical information during different points of care; and 5) coordination of care. The digitally-enabled care pathway aims to improve accessibility, enhance patient engagement, facilitate care coordination, and ensure continuity of care. Using the Pan-Canadian Digital Health Evaluation Framework, we explore the opportunities/challenges of implementing digital health solutions and demonstrate their impact.
Approach: As part of a multi-phased mixed-methods study, participatory design workshops were conducted with key stakeholders during the planning phase to identify needs, conceptualize a prototype, and validate its functionalities. In the current implementation phase, semi-structured interviews are being conducted with decision-makers, healthcare providers, and patients to understand barriers and facilitators, including governance and partnerships, at micro, meso, and macro levels. Surveys were distributed to end users to evaluate appropriateness, acceptability, feasibility, effectiveness, value proposition, and outcomes related to the Quintuple Aim. The Framework Method will guide thematic analysis, while quantitative data will be analyzed using descriptive statistics.
Results: A co-design approach, coupled with evidence-based implementation strategies (e.g., education, network engagement, rapid-cycle evaluation and adaptation), facilitated the integration of technology into complex care pathways. Preliminary data indicate that seamlessly coupling technology with clinical/administrative processes and people improves access to equitable care, coordination/continuity of care, and experience. An agile governance strategy facilitates successful technology implementation by enabling collaboration and engagement of key actors in addressing key domains including policy, funding, security, interoperability, infrastructure, and analytics. Further, emphasizing flexibility, communication, and defined roles in governance allows teams to iteratively adapt to operational needs while focusing on strategic goals. At a patient level, key facilitators include patient agency, informed consent, and enhancing digital literacy. Building a network of relationships among political, regulatory, and community partners is vital for resource sharing and shared learning in technology implementation.
Implications: User-centered co-design and evidence-based strategies can be used to effectively guide the development and implementation of a digital approach to chronic pain management, optimizing processes to build capacity and strengthen patient-centered care, when and where they need it. The agile governance framework can be adopted to facilitate seamless collaboration and alignment with strategic objectives in deploying a digitally-enabled care trajectory. By integrating cross-functional teams and promoting an iterative approach, stakeholders are empowered to make timely decisions to address ongoing challenges and fostering innovation and continuous improvement. Having an adaptive approach to technology implementation may support scaling of digital health interventions for integrated care across organizations.