Constructing a Theoretical Hybrid Care Pathway From Stakeholder Perspectives: User-Centered Design Study

Chronic obstructive pulmonary disease (COPD) is characterized by acute exacerbations that frequently result in hospitalization, highlighting the need for improved follow-up care. Hybrid care incorporates digital health strategies such as remote patient monitoring (RPM). This could offer the opportunity to detect early signs of disease worsening by remotely tracking selected health indicators. However, it is unknown how RPM can effectively be integrated into current practice.

This study aims to cocreate a theoretical hybrid COPD care pathway integrating RPM into the existing care trajectory, considering the expertise of participating care pathway stakeholders.

This 2-phase study was conducted between May and August 2025. At first, semistructured interviews were conducted with stakeholders (ie, patients and health care professionals [HCPs]) involved in COPD care to map the existing care pathway in a single tertiary care hospital in Belgium. Patients were approached during hospitalization based on predefined eligibility criteria, whereas HCPs were recruited through convenience sampling. In phase 2, patient representatives and HCPs were recruited through patient-organization networks and professional referral, respectively, using convenience sampling, and participated in separate interactive workshops. These workshops reviewed existing care pathway phases and HCP roles and explored the integration of RPM, including timing, duration, implementation, data monitoring, and follow-up responsibilities, to codevelop a theoretical hybrid care pathway. Interview and workshop data were independently reviewed by 2 researchers to extract information on care pathway elements, stakeholder roles, limitations, and proposed adaptations. Findings were organized according to the relevant care pathway phase, independently summarized and compared, with discrepancies resolved through discussion and consensus. Interview findings informed the development of an initial infographic representing the existing care pathway, which was subsequently adapted based on workshop findings to represent the proposed cocreated theoretical hybrid care pathway.

In total, 10 stakeholders participated in the interviews (5 patients and 5 HCPs), and 6 stakeholders participated in the workshops (3 patient representatives and 3 HCPs). The existing COPD care pathway involves multiple stakeholders whose activities can be organized into 5 functional domains: support, treatment, medical advice, patient education, and monitoring. Stakeholders can be divided into hospital-based, community-based, or cross-setting. The workshop participants identified the need for a stakeholder dedicated to RPM activities in order to integrate RPM strategies into the care pathway. This individual could be responsible for all RPM-related activities (ie, RPM device installation, providing RPM-related education, data review, alert management, and RPM discontinuation) and could serve as the bridge between patients and physicians, ensuring close communication.

This study resulted in a cocreated theoretical hybrid COPD care pathway. Stakeholders highlighted the potential value of a dedicated RPM role to coordinate and deliver RPM activities as part of the COPD care pathway. Further research is needed to assess its feasibility and clinical applicability.