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

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.


Intervention
Description of the proposed programme or intervention to address the problem. [18] Strategic/politic al context Description of the strategic, political, or environmental contextual factors that potentially influence any intervention to be scaled up. [18]

Evidence of Effectiveness
Level of evidence available to support the scale-up of the proposed intervention, such as scientific literature and other known evaluations of the intervention. [18]

Intervention Costs & Benefits
Consideration of the known costs of the intervention delivery and any quantifiable benefits. This includes the results of any types of economic evaluation studies. [18]

Fidelity & Adaptation
Description of the proposed changes to the intervention required for scale-up. [18]

Reach & Acceptability
Description of the possible reach and acceptability of the intervention for the target population. [18]

Delivery Setting & Workforce
Define the setting within which the intervention is delivered as well as the delivery workforce. [18] Implementation Infrastructure Implementation infrastructure is required for scaleup. [18]

Sustainability
Longer-term outcomes of the scale-up and how once scaled up, the intervention could be sustainable over the medium to longer term. [18]

Clinical Outcomes Assessment
Clinical outcomes assessment refers to the evaluation of efficacy endpoints when developing a therapy for a disease or condition. The patient assessment used in an endpoint, is the measuring instrument that provides a rating or score (categorical or continuous) that is intended to represent some aspect of the patient's health status. [45] Humanistic Outcomes Assessment Humanistic outcomes assessment refers to the evaluation of outcomes of interest to patients, which are clinically meaningful with practical implications for disease recognition and management and that are based on a patient's unique perspective, e.g., patient-reported scales that indicate pain level, degree of functioning, etc. This category of outcomes involves measures of health-related quality of life (HRQoL) and patient-reported outcomes measurements, which include measures of HRQoL. [46]

Utilization Outcomes Assessment
Utilization outcomes measurement refers to the evaluation of measures of health resource utilization, such as number of inpatient or outpatient visits, total days of hospitalization in a given year, or number of days treated with antibiotics. These outcomes are often used as proxies for measuring cost. [46] Satisfaction Assessment Assessment of patient' and healthcare professionals' satisfaction with the health intervention. -

Economic Evaluation
Economic evaluation involves a comparison between alternative strategies, considering both their costs and their benefits. [47]

Fidelity Assessment
Fidelity assessment refers to the confirmation that the manipulation of the independent variable occurred as planned to ensure that fair, powerful, and valid comparisons of replicable treatments can be made. [48] Feasibility Assessment Feasibility assessment consists of determining whether an intervention should be adjusted to be relevant and sustainable through the identification of aspects requiring modification. [49] Adaptability Assessment Proposed changes to the intervention required for scale-up. [18] Acceptability Assessment Acceptability assessment refers to the evaluation of the level of satisfaction, suitability or attractiveness perceived by the programme delivers or recipients. [49] Adoption Assessment Assessment of the number of adopters of the proposed programme or intervention. [30] Compliance Assessment Compliance assessment refers to the evaluation of the extent to which the patient follows the prescribed and dispensed regimen as intended by the prescriber and dispenser. [50]

Penetration Assessment
Assessment of the level of integration of the programme or intervention within the existing services. [30] This is a Multimedia Appendix to a full manuscript published in the J Med Internet Res. For full copyright and citation information see http://dx.doi.org/10.2196/jmir.29381