A Combined Telemedicine and Ambulatory Wound Care Team Intervention for Improving Cross-Sector Outpatient Chronic Wound Management: Protocol for the Mixed Methods TELE-AMBUS Research Project

• Published in: JMIR research protocols 2024-11, Vol.13, p.e55502
• Main Authors: Høyland, Sindre Aske, Holte, Kari Anne, Øygarden, Olaug, Islam, Kamrul, Kjerstad, Egil, Gjerstad-Sørensen, Ragnhild, Høyland, Synnøve Aske, Wærnes, Hanne Rusten, Carayon, Pascale, Fallon, Maureen, Bradbury, Sarah, Gürgen, Marcus, Husebø, Sissel Eikeland, Rødseth, Eirin
• Format: Article
• Language: English
• Subjects: Ambulatory Care; Chronic Disease - therapy; Chronic illnesses; Cost reduction; Health care delivery; Hospitals; Humans; Interdisciplinary aspects; Intervention; Medical diagnosis; Medical personnel; Nurses; Outpatient care facilities; Outpatients; Patient Care Team - organization & administration; Patients; Primary care; Professionals; Protocol; Quality Improvement; Quality of life; Telemedicine; Wound healing; Wounds and Injuries - therapy
• ISSN: 1929-0748; 1929-0748
• DOI: 10.2196/55502

There is a growing prevalence of nonhealing wounds and chronic diseases in society, and there is an associated need for wound management solutions that include the use of telemedicine. A broad spectrum of factors influences the planning and execution of interventions within telemedicine in chronic wound management, spanning organizations, technologies, and individuals, including professionals and patients. The Telemedicine and Ambulatory Wound Care Team (TELE-AMBUS) project applies a whole-system research approach to account for this spectrum of factors. The primary objective of this study was to explore and analyze the implementation and consequences of an outpatient wound management model, comprising 2 interconnected quality improvement interventions (ie, telemedicine and ambulatory wound care team) aimed at older and vulnerable patients with chronic wounds, across the specialist and primary health care sectors. Embedded in this objective is the aim to improve the competence levels of health care providers and, consequently, the service quality of outpatient wound management across specialist and primary health care services. This project examines the implementation and consequences of an outpatient wound management model through a combined process and economic evaluation research strategy. A sociotechnical system theory approach and multiple work package design support the examination. The project uses observations, conversations, interviews, and economic assessments to gather rich, in-depth insights and understanding on why and how the new wound management model contributes to a change or not compared with the traditional treatment model. The project has been funded from 2021 to 2025. Baseline interviews have been conducted since April 2022 and concluded in January 2024. Fieldwork, including nonparticipant observations, semistructured interviews, and informal conversations, has been conducted since November 2022 and is expected to conclude in March 2025. In parallel and as part of the cost-effectiveness analyses, time usage data on the outpatient and regular clinical models are being gathered during the fieldwork. We applied a whole-system approach in multiple ways, that is, to design or inform our fieldwork and to explore, evaluate, and translate project findings into practice across services. To our knowledge, this approach has not been undertaken in telemedicine in chronic wound management literature and associated human factors and ergonomics resea