Strengthening rural healthcare outcomes through digital health: qualitative multi-site case study

• Published in: BMC health services research 2024-09, Vol.24 (1), p.1096-11, Article 1096
• Main Authors: Woods, Leanna, Eden, Rebekah, Macklin, Sophie, Krivit, Jenna, Duncan, Rhona, Murray, Helen, Donovan, Raelene, Sullivan, Clair
• Format: Article
• Language: English
• Subjects: Case studies; Communication; Consumers; Digital Health; Digital maturity; Digital transformation; E-health; Electronic health records; Executives; Focus Groups; Health care expenditures; Health disparities; Health services; Humans; Informatics; Information technology; Interoperability; Interviews; Interviews as Topic; Medical records; Medical research; Outcome Assessment, Health Care; Patient outcomes; Population; Qualitative Research; Quality of health care; Queensland; Rural areas; Rural health care; Rural health services; Rural Health Services - organization & administration; Service enhancement; Technology application
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-024-11402-4

Rural populations experience ongoing health inequities with disproportionately high morbidity and mortality rates, but digital health in rural settings is poorly studied. Our research question was: How does digital health influence healthcare outcomes in rural settings? The objective was to identify how digital health capability enables the delivery of outcomes in rural settings according to the quadruple aims of healthcare: population health, patient experience, healthcare costs and provider experience. A multi-site qualitative case study was conducted with interviews and focus groups performed with healthcare staff (n = 93) employed in rural healthcare systems (n = 10) in the state of Queensland, Australia. An evidence-based digital health capability framework and the quadruple aims of healthcare served as classification frameworks for deductive analysis. Theoretical analysis identified the interrelationships among the capability dimensions, and relationships between the capability dimensions and healthcare outcomes. Seven highly interrelated digital health capability dimensions were identified from the interviews: governance and management; information technology capability; people, skills, and behaviours; interoperability; strategy; data analytics; consumer centred care. Outcomes were directly influenced by all dimensions except strategy. The interrelationship analysis demonstrated the influence of strategy on all digital health capability dimensions apart from data analytics, where the outcomes of data analytics shaped ongoing strategic efforts. The study indicates the need to coordinate improvement efforts targeted across the dimensions of digital capability, optimise data analytics in rural settings to further support strategic decision making, and consider how consumer-centred care could influence digital health capability in rural healthcare services. Digital transformation in rural healthcare settings is likely to contribute to the achievement of the quadruple aims of healthcare if transformation efforts are supported by a clear, resourced digital strategy that is fit-for-purpose to the nuances of rural healthcare delivery.