Process evaluation of the implementation of a personalized digital care pathway tool using the RE-AIM framework

This study evaluated the implementation of a Personalized Digital Care Pathway (PDCP) tool in the context of three different patient groups (i.e. scar clinic, cleft care and gender-affirming care). We assessed the reach of patient users, information provision perceived by patients (effectiveness), adoption by healthcare professionals, implementation in practice including perceived satisfaction, and sustainable implementation of the PDCP-tool.

A process evaluation was conducted according to the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework using mixed methods. Data collection included patient questionnaires administered before (n = 139) and after (n = 68) implementation, tool user statistics, and in-depth interviews (n = 16) and focus groups (n = 4) with patients and healthcare professionals, supplemented by researcher field notes.

Most patients using the tool were digitally literate and had previously used other hospital applications. Patients felt well-informed after using the PDCP-tool, but some expressed little added value. For adoption by healthcare professionals, their involvement during development and perceived added value of the tool were essential. For implementation, it was important to have a user-friendly tool, that is integrated with existing systems and meets the information needs of patients. Ongoing financial and technical support by the healthcare organization is needed for sustainable implementation.

The PDCP-tool was found to be of value in providing appropriate information, particularly to digital and language proficient, information-hungry patient groups. This process evaluation showed many promising elements for implementation of a digital tool in a large healthcare organization. However, achieving and sustaining the value of the tool required considerable efforts during development and implementation, as it necessitated continuous commitment to keep it in the focus of patients, healthcare professionals and the organization. Future studies should explore the effectiveness of integrating such a tool into widely used hospital information systems, ensuring it becomes an integral part of the healthcare workflow, rather than a stand-alone solution.