Exploring and redesigning a cross-sector outpatient wound management model comprising telemedicine and ambulatory wound care interventions

The TELE-AMBUS project explores implementation of a new cross-sectoral model for chronic wound management at the Wound Diagnostic Center/Department of Dermatology, Stavanger University Hospital. In the wound model, comprising telemedicine and an outpatient wound team, the wound team receives a referral from a GP, travels to the patient in the municipality, evaluates the patient's wounds, transfers images to the Dermatology Department via telemedicine, and performs the first wound treatment procedure. In parallel, nursing staff are taught "on site" about the wound procedure and the use of the telemedicine app. After the visit, a multidisciplinary medical team decides on a wound diagnosis and makes a treatment plan based on the wound nurses' findings. The wound nurses and nursing staff in the municipalities communicate, via telemedicine, questions and challenges related to the patient’s wound treatment. The project and model aim to improve service quality across the primary and secondary health care sectors through more direct communication and learning including telemedicine, to strengthen patients' quality of life through early intervention, and to contribute to a more holistic approach to chronic wound management across sectors and services. The project applies observations, conversations, interviews, and economic assessments to gather rich in-depth insight and the basis for understanding why and how the new wound model contributes to a change or not. More specifically, we want to examine from a larger system perspective various factors and outcomes related to the model’s implementation across sectors, including both managers' and employees' strategies for dealing with barriers. The project responds to regional and national strategies towards stronger interconnection of health services and proximity to patients. The project's unique system approach aims to strengthen current knowledge within and outside the wound field nationally and internationally.

Aimed at improving quality and holistic integration of wound diagnosis and treatment across primary and specialist health care services, the TELE-AMBUS research project explores and analyses cross-sector implementation and consequences of an outpatient chronic wound management model comprising two closely intertwined interventions; ICT-based telemedicine (TM) and ambulatory wound care team. The project’s tandem exploration of two quality improving interventions within the research field of TM in chronic wound management has to our knowledge not been undertaken in a Norwegian context and thus represents an ambitious and novel national approach. Adding to novelty, we apply the socio-technical system framework SEIPS in multiple and creative ways, i.e., to design/inform our field work and to explore and redesign an outpatient model and work systems across sectors, with SEIPS becoming a pedagogic tool to transform project findings into strategies and practices across services. This theoretical and methodological approach has to our knowledge not been undertaken in HF/E literature more broadly as well as TM in chronic wound management literature. Specifically, addressing current knowledge needs, we assess the cost-effectiveness of quality improvement interventions in rapidly expanding clinical applications (as in, the outpatient model bringing services closer to the patient), and we analyse in-depth why and how an intervention was effective/contributed to change or not, i.e., to understand from a broad (cross-sector work system and redesign) approach the outcomes and the mechanisms of change involved including employee and management strategies for dealing with barriers. The TELE-AMBUS project is a collaboration between NORCE, Norwegian Centre for E-health Research (NSE), and regional primary and specialist partners including a national Wound Diagnostic Centre, accompanied by leading international research partners in wound management and innovation, and system modelling.