Spread and Scale-Up of a Region-Wide Telehealth Navigation Service in a Rural Context: Qualitative Process Evaluation

Area of Science:

• Health Services Research
• Rural Health
• Telehealth Implementation

Background:

• Limited research exists on adapting and scaling interventions from urban to rural settings.
• Understanding implementation processes for frequent presenters in rural emergency departments is scarce.
• Patient Watch, a telehealth case management program, was adapted for a rural context to support frequent presenters.

Purpose of the Study:

• To understand the spread, scale-up, and sustainability of the Patient Watch telehealth program in a rural setting.
• To inform the potential transferability of this model to other rural contexts.
• To identify factors influencing the implementation of telehealth interventions in rural healthcare systems.

Main Methods:

• Qualitative process evaluation using semistructured interviews (n=10) with diverse stakeholders.
• Document review of steering committee minutes (n=17) and planning/operational documents (n=20).
• Observation of steering committee meetings (n=11) and an on-site visit to the Patient Watch team.

Main Results:

• Three key themes emerged: healthcare system complexity, context-driven adaptation, and autonomy.
• Organizational capacity for scale-up was influenced by financial, workforce, and infrastructure challenges.
• Local autonomy facilitated adaptation, but restrictive governance hindered responsiveness to local needs.

Conclusions:

• Rural contextual factors significantly impacted the spread, scale-up, and sustainability of Patient Watch.
• Adapting a metropolitan telehealth model to a rural setting requires acknowledging system complexity and prioritizing ongoing, context-specific innovations.
• Future research should focus on balancing distributed leadership to enhance the sustainability of rural telehealth case management programs.