The project eHealth@Hospital-2-Home at the University of Stavanger will develop new knowledge on remote, digital follow-up and how it can affect self-efficacy for self-management, treatment burden, quality of life and readmissions among patients with heart failure and patients surgically treated for colorectal cancer, following hospital discharge. We will test a digital follow-up eHealth service that can strengthen the patient's health-promoting competence and coping skills. The project will also test collaborative means where nurses actively use digital aids to make work easier, treatment better and, above all, avoid unnecessary readmissions. The service will be tested in a care pathway where the patients can meet the hospital digitally, at home, in the critical phase after hospital discharge.
In the project's first work package, we have developed content and functionality of the digital follow-up service, in close collaboration with patient representatives, the healthcare service (i.e. hospitals, GPs), technical staff, and national and international research partners. In addition, the project's PhD student has collected interview data from 30 participants (i.e. GPs, nurses, patients) with the intention of informing the service's content and function. The content consists of information about heart failure and colorectal cancer surgery, and checklists for recording of symptoms. Among the service’s functions is the monitoring of vital measures such as blood pressure, weight, and temperature. We have published a knowledge summary on digital home follow-up for patients with heart failure (https://www.jmir.org/2022/2/e32946) and an article based on the interview study is about to be published (https://preprints.jmir.org/preprint/39391).
During December 2021-November 2022, the service's content and function was tested in a feasibility study, as part of the project's work package 2 (https://bmjopen.bmj.com/content/13/8/e069599.abstract). The study included 30 patients and colorectal cancer. Patients were trained to use MyDignio (the patient's interface) and were at discharge provided with an IPad, a scale, and blood pressure device or temp gauge. They performed measurements and answered symptom questions daily for 30 days after hospital discharge. The nurse navigators continuously responded to the patient's measurements via the digital platform DignioPrevent (nurses' interface), and communicated the response either via telephone, online chat or video call. After the trial, patients and follow-up nurses were interviewed about their experiences with the service. The results will inform a randomized, controlled study starting in the first quarter of 2023.
In work package 3, the results from the feasibility study were used to develop a randomized controlled trial (RCT) which started recruiting patients in May 2023. A total of 240 patients will be recruited from the same diagnosis groups as in the feasibility study. In the RCT, the patients are followed digitally for 6 weeks after discharge from hospital, with the same measuring instrument and symptom reports, assisted by the nurse navigators. As of 1 December, 55 patients have been included in the study. The first evaluation interviews indicate that the patients are very satisfied with being followed up digitally, the follow-up reassures them and helps them with self-care related to illness and treatment.
The project's results are disseminated at national and international conferences and webinars, and published in international journals. In November 2023, the project was a co-organizer of the Health Services Research Conference 2023, where the project team together with international partners organized a symposium on the development and implementation of new healthcare services. The project results are also made available on the project's website https://www.uis.no/nb/digitalselvhjelp and on LinkedIn under the username @eHealth H2H.
The overall aim is to develop a nurse assisted eHealth Service to reduce BoT and increase HRQoL in HF and CRC patients, post-hospital discharge. We use a modified version of the framework of complex interventions proposed by the UK Medical Research Council. The project includes three phases and corresponding work packages; a) developing a nurse assisted eHealth service, b) assessing its feasibility and piloting the service and c) carrying out a RCT. The eHealth intervention will be tested by three assessment points (baseline, within 30 and 90 days) to evaluate effects of the service. Our nurse assisted eHealth service is personalized and will optimize patient BoT and HRQoL, link to a digitalized BoT-software (My Dignio). It supports self-monitoring by letting the patients register their own health-related data, and allow for electronic communication with Nurse Navigator. Its content will aim to meet BoT challenges (e.g. symptom monitoring, nutrition advice, motivational and emotional support, health literacy needs) identified in two pilot studies, from current BoT literature and input by user advisory board. This e-Health service allows the patient to communicate BoT challenges, conduct measurements, respond to clinical questions, and receive self-management support. The project aligns with the priority list of Norwegian Health Authorities on factors that impede and promote integrated, coherent patient and user pathways between hospital and home for NCD patiens with HF and CRC, eliminate unjustified variation in post-hospital health service and avoid adverse and costly re-hospitalizations, and relates to the Regular General Practitioner Scheme when patients are outside hospital.The proposal builds on the expertise within health promotion and long-term illness at University of Stavanger, Stavanger and St. Olavs University Hospitals, including international researchers from the Netherlands, Sweden, UK and USA. Users will be engaged in all steps of the project.