Implementation of an eHealth-facilitated Integrated Care Model in Allogeneic Stem Cell Transplantation: The SMILe-ICM...

Allogeneic hematopoietic stem cell transplantation (AlloHSCT) survivors have complex needs and can benefit from eHealth-facilitated integrated care models (ICM), such as the SMILe-ICM (SteM cell transplantation faciLitated by eHealth) which combines eHealth monitoring and support from an advanced practice nurse (APN). Originally developed in a Swiss/German context, it showed promising outcomes regarding mortality, rehospitalization and cost-effectiveness. Implementing the SMILe-ICM into a new setting with an existing electronic patient health record and APN support requires adaptations and selection of appropriate implementation strategies to fit the local practice. We aimed to perform a context analysis to identify barriers and facilitators to implementation and inform the effective transition of the SMILe-ICM to a different setting.

We performed a context analysis using the Basel Approach for coNtextual ANAlysis (BANANA). Based on implementation science principles, we took a mixed-methods multi-stakeholder approach to understand our local practice patterns, stakeholder expectations and needs regarding eHealth-based and nurse-led integrated post-alloHSCT care.

The majority of alloHSCT patients were open to eHealth technologies and remote data-collection but patients struggled with issues related to shared-decision making, coping with daily life issues, self-management and health literacy. Healthcare providers emphasized the importance of providing appropriate training to both patients and healthcare staff regarding the SMILe-ICM, leveraging existing eHealth infrastructure, and ensuring cost-effective, sustainable implementation. The supplemental burden of eHealth data for both HCPs and patients was a key concern.

Our rigorous context-based approach proposes a blueprint highlighting key context insights to facilitate the implementation of eHealth ICMs in alloHSCT care.