Spread of a heart failure remote patient management program from speciality to community care settings: multiple case study implementation.

backgroundThe Medly remote management program, which has demonstrated effectiveness in a speciality care setting, enables comprehensive management of patients with heart failure by integrating the Medly digital therapeutic with defined clinical roles. One-time funding from Ontario Health was awarded to 3 community-based organizations to implement Medly for the first time outside a speciality care setting. The objectives of this project were to evaluate implementation success and identify the facilitators and barriers to implementing this intervention in 3 community-based settings.

methodsA multiple case study approach was used to determine implementation success using the Proctor implementation outcomes and barriers and facilitators based on constructs of the Consolidated Framework for Implementation Research (CFIR). Qualitative insights were collected through semi-structured interviews (n = 20) with implementation team members 3 months after enrollment of the first patient. Quantitative data for the implementation outcomes were obtained from a secondary analysis of project status reports analyzed 6-months after go-live.

resultsAlthough there was evidence of intervention fidelity and perceptions of acceptability and appropriateness toward the Medly program at all 3 sites, implementation of the Medly program was found to be successful at only one site based on the key Proctor outcomes of feasibility and adoption. The interviews revealed common implementation facilitators across sites related to characteristics of the intervention, including relative advantage and intervention design quality. Between-site differences related to the CFIR constructs of the inner and outer setting highlight unique features that resulted in differing levels of implementation success. Specifically, facilitators included access to a predefined patient pool, maturity of the organization and communication channels and staffing resources while barriers included lack of time to execute the implementation plan as intended.

conclusionThis work demonstrates that remote management programs, like Medly, can be translated from a speciality care setting and implemented with fidelity in community settings. However, certain contextual conditions are important to enhance the likelihood of success of the implementation, particularly when time constraints are imposed.