Unlocking Continuous Improvement in Heart Failure Remote Monitoring: A Participatory Approach to Unveil Value Dimensions and Performance Indicators.

Introduction: Heart failure (HF) constitutes a public health concern affecting quality of life, survival, and costs. Remote patient monitoring (RPM) can enhance HF management, involving patients actively and improving follow-up. While current HF RPM assessments emphasise cost-effectiveness analysis, there is a need to consider wider RPM impacts and integrate stakeholders' perspectives into assessments for better comprehensiveness. Methods: We developed a four-stage participatory approach to select value dimensions and indicators for continuous HF RPM assessment: Stage 1 involved building a literature-informed initial list; Stage 2 utilized expert interviews for validation and list expansion; Stage 3 involved a web-Delphi process with Portuguese stakeholders and experts for agreement assessment; and Stage 4 included a conclusive expert interview. Results: A literature review identified fourteen studies on telehealth, RPM, and HF, informing an initial list of four value dimensions (Access, Clinical aspects, Acceptability, and Costs) and 22 indicators. Seven semistructured interviews validated and further adjusted the list to 38 indicators. Subsequently, the web-Delphi process engaged 29 stakeholders, giving their opinions regarding assessment aspects' relevance and proposing additional elements - 1 dimension and 12 indicators. Five value dimensions and 38 indicators (76.0%) reached group agreement for selection, while 12 did not reach an agreement. Upon expert appreciation, 5 dimensions, 43 indicators, and 6 case-mix parameters were considered relevant. Discussion: This comprehensive social approach captured diverse stakeholder perspectives, achieving agreement on pertinent HF RPM monitoring and evaluation indicators. Findings can inform visualization and management tool development, aiding day-to-day RPM evaluation and identification of improvement opportunities.

Towards A Framework for Implementing Remote Patient Monitoring From an Integrated Care Perspective: A Scoping Review.

BACKGROUND: Remote patient monitoring (RPM) has been increasingly adopted over the last decade, with the COVID-19 pandemic fostering its rapid development. As RPM implementation is recognised as complex and highly demanding in terms of resources and processes, there are multiple challenges in providing RPM in an integrated logic. METHODS: To examine the structural elements that are relevant for implementing RPM integrated care, a scoping review was conducted in PubMed, Scopus, and Web of Science, leveraging a search strategy that combines terms relative to (1) conceptual models and reallife initiatives; (2) RPM; and (3) care integration. RESULTS: 28 articles were included, covering nine conceptual models and 19 real-life initiatives. Eighteen structural elements of RPM integrated care implementation were identified among conceptual models, defining a structure for assessing real-life initiatives. 78.9% of those initiatives referred to at least ten structural elements, with patient education and self-monitoring promotion, multidisciplinary core workforce, ICTs (information and communications technologies) and telemonitoring devices, and health indicators measurement being present in all studies, and therefore being core elements to the design of RPM initiatives. CONCLUSION: RPM goes far beyond technology, with underlying processes and involved actors playing a central role in care provision. The structural elements identified can guide RPM implementation and promote maturity in adoption. Future research may focus on assessing design completeness, evaluating impacts, and analysing related financial arrangements.

Telemonitoring in Portugal: where do we stand and which way forward?

Following the pandemic, there is growing pressure in Portugal to adopt new practices that promote more efficient, sustainable, and equitable healthcare. Telemonitoring (TM) has been identified as a valuable solution, particularly for chronically ill, long-term or socially isolated patients. Several initiatives have since emerged. Thus, Portuguese stakeholders recognise the need to reflect upon TM's current state and prospects. This study aims to provide a comprehensive analysis of the TM landscape in Portugal. We begin by analysing the underlying conditions for telehealth development. Then, we describe the governmental strategy and priorities towards TM - the National Strategic Plan for Telehealth development and NHS reimbursement opportunities for TM. To understand TM implementation, adoption, and dissemination in Portugal, we analyse 46 reported initiatives and adoption studies focusing on providers' perspectives. Finally, a structured reflection on current challenges and the way forward is provided, according to the seven domains of the Nonadoption, Abandonment, and challenges to the Scale-up, Spread, and Sustainability (NASSS) framework. The adoption of TM by Portuguese institutions has been growing, leveraged by the telehealth governance model and public reimbursement mechanisms, proving particularly relevant during the pandemic. However, monitored patients are still few. Low digital literacy among patients and providers, lack of care integration and resource scarcity represent barriers hampering pilot TM initiatives' scale-up.

Spatial analysis of cattle movement patterns in Portugal.

The network of animal contact through movement is an important factor in disease spread within and between populations. The objective of this study was to characterise the spatial and temporal distribution of bovine movements in Portugal, identifying 'local' and 'long-distance' networks on the basis of geographical proximity. Data were obtained from cattle movements in 2005, as recorded in the national database for bovine identification and registration. Geographic information systems were used to represent distribution and flow of movements. Results did not detect any significant temporal variation either in the number of movements or animals moved. Holdings showed a higher density in the north where a larger number of movements occurs. On the contrary, larger shipment lots tend to occur in the south-central area. The greatest number of movements occurs inside and between contiguous districts; animal movements mostly follow a south-north pattern. Records analysed revealed that 60% of the animals in circulation are beef cows under the age of 10 months (only 31% of the registered animals are younger than 12 months of age).