Telehealth Clinical Trial
Official title:
Regional Implementation of Collaborative Lung Function Testing
Background/Aims There is evidence indicating that deployment of forced spirometry (FS)
testing in a collaborative scenario, encompassing respiratory specialists and community
professionals, generates healthcare efficiencies. The study describes the roadmap for
regional implementation of the FS program in Catalonia (ES), from January to December 2016.
Methods/Design Firstly, the FS program will be deployed in three healthcare sectors (514 k
inhabitants), following Plan-Do-Study-Act iterative cycles, using the Model for Assessment of
Telemedicine for evaluation purposes. Thereafter, regional deployment of the FS program (7.5M
inhabitants) will be conducted. The third step considers: evaluation of transferability,
preparation for data analytics and recommendations for long-term assessment of outcomes. Main
components of the FS program are: i) Automatic quality testing; ii) Standardized data
transfer to a shared electronic health record; iii) Elaboration of individual FS reports
including historical results; and, iv) Clinical decision support systems providing access to
the FS report, and to remote support upon request.
Discussion/Conclusions The project constitutes the first attempt to scale-up a collaborative
scenario for FS testing that will open new avenues for longitudinal lung function assessment.
Moreover, the setting shows high potential for transferability to different sites and to
other diagnostic procedures.
The Forced Spirometry program emerges from a series of studies reporting on technological
solutions for each of the main components indicating the potential of their articulated
application aiming at covering unmet needs for collaborative FS testing. The studies were
initiated within the EU project NEXES22;23 and specific parts of the overall setting have
already been successfully evaluated in the Basque Country.
The setting & Study design The current protocol has been designed as part of the regional
deployment of integrated care services in Catalonia. It consists of the two lines of activity
ultimately aiming at: i) regional adoption of the FS program; and, ii) generalization of the
approach to other areas, as well as to other testing procedures. The research was submitted
and apoved by the Ethical Committee of the Hospital Clínic i Provincial de Barcelona.
Program deployment The initial 6 months will include three healthcare sectors: Lleida (168k
inhabitants and 21 Primary Care centers), Vic (49k inhabitants and 11 PCC), and Atenció
Integral en Salut Barcelona Esquerra (AISBE) (540k inhabitants and 19 PCC) following a
Plan-Do-Study-Act (PDSA) methodology24. The first PDSA cycle (January - March 2016) including
a total of three primary care centers, one in each healthcare sector, has as main purpose to
ensure full functionality of the setting. Immediately thereafter, the FS program will be
progressively deployed to all Primary Care centers in the three sectors in a second 3-months
PDSA cycle that will be completed by mid-2016. Forced spirometry testing will be prescribed
by the attending general practitioner following standard criteria and it will be carried out
by primary care nurses.
The deployment of the program in the entire region (7.5M inhabitants and 369 Primary Care
centers) will be completed with no discontinuation within 2016. It will follow identical PDSA
methodology. The outcomes of the assessment carried out during each PDSA cycle will modulate
the long-term assessment strategy of the FS program described below.
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