Developing a Core Outcome Set for the Evaluation of Remote Patient Monitoring Interventions Using the Sextuple Aim: Modified Delphi Study.

Background: The rapid expansion of remote patient monitoring (RPM) interventions highlights the need for their comparison and evaluation. Current evaluation frameworks often fail to capture a multistakeholder perspective. Traditional health technology assessment approaches emphasize health and economic outcomes, providing an incomplete picture of RPM's broader impact. The Sextuple Aim, encompassing health outcomes, costs, patient and provider experience, equity, and sustainability, offers a more comprehensive approach. Yet, the specific aspects that are important for capturing each domain for diverse stakeholders, and that could form a core outcome set (COS) for RPM evaluation, remain undefined. Objective: This study aimed to identify the most important value aspects for evaluating RPM interventions from the Sextuple Aim domains. Methods: Value aspects relevant to evaluating RPM interventions within the Sextuple Aim framework were identified in a review of the literature, and this initial set was refined through stakeholder meetings. Subsequently, 6 stakeholder groups completed 3 Delphi rounds. Patients and informal caregivers (25-30 respondents per group) were recruited via a patient federation. Health care providers (20-30 experts), managers, insurers, and researchers (10-20 experts per group) were recruited. In each round, participants rated the importance of aspects on a 5-point Likert scale. In round 2, participants ranked aspects within each domain to determine their relative importance; in round 3, they ranked aspects across domains. A multicriteria consensus rule was used to select aspects for the preliminary COS. The COS was finalized during a multistakeholder expert meeting with 7 experts. Results: Of the 171 respondents, 137 (80%) completed all Delphi rounds. The input set, formed through a literature search and meetings, contained 43 value aspects. The total set contained 47 aspects after the first round. After all 3 rating rounds, 33 of 47 (70%) value aspects met the predefined importance threshold. Ranking results from rounds 2 and 3 identified aspects prioritized within and across domains. In total, 26 (55%) aspects met the multicriteria consensus rule and formed the preliminary COS. During the final multistakeholder expert meeting involving subgroup exercises and moderated discussions, value aspects with conceptual overlap were merged, removed, or relocated. The final COS included 17 value aspects, with 1 additional emergent aspect identified during the expert meeting and included as a recommended item, which also resulted in full Sextuple Aim domain coverage. Conclusions: An RPM Sextuple Aim COS comprising 17 value aspects and 1 recommended aspect was developed, providing a multidimensional and multistakeholder evaluation set. This COS provides a standardized, comprehensive basis for evaluating RPM interventions and can be used to support the validation and refinement of existing RPM evaluation tools. Future research may consider operationalizing the COS and its recommended aspect into measurable items and assessing its feasibility and uptake in practice.