JMIR Publications

ABSTRACT

Background:

Working with eHealth requires health care organizations to make structural changes in the way they work. The organizational structure and process need to be adjusted to provide a high quality of care. This study is follow-up research of a systematic literature review on optimally organizing hybrid health care (eHealth and face-to-face) using the Donabedian Structure, Process, and Outcome (SPO) framework, in order to translate the findings into a modus operandi for health care organizations.

Objective:

This study aims to develop an SPO-based quality assessment model for organizing hybrid health care, with an accompanying self-assessment questionnaire. Health care organizations can use this model and questionnaire to manage and improve their hybrid health care.

Methods:

Concept mapping was used to enrich and validate the evidence-based knowledge from the literature review with practice-based knowledge from experts. First, brainstorming was conducted. Participants listed all the factors that contribute to the effective organization of hybrid health care and the associated outcomes. Data from the brainstorming phase were combined with the data from the literature study, and duplicates were removed. Next, the participants rated the factors on importance and measurability and grouped these factors into clusters. Finally, with multivariate statistical analysis (multidimensional scaling, hierarchical cluster analysis) and group interpretation, an SPO-based quality management model and an accompanying questionnaire were constructed.

Results:

All participants (n=39) were familiar with eHealth and were health care professionals, managers, researchers, patients or eHealth suppliers. The brainstorming and the literature study resulted in a list of 314 factors. After removing duplicates, 78 factors remained. Using multivariate statistical analyses and group interpretation, a quality management model and questionnaire incorporating 8 clusters and 33 factors were developed. The eight clusters were 1. Vision, strategy and organization; 2. Quality IT infrastructure and systems; 3. Quality eHealth application; 4. Providing support toward care professionals; 5. Skills, knowledge and attitude of health care professionals; 6. Attentiveness to the patient; 7. Patient outcomes and 8. Learning system. The Structure-Process-Outcome categories were positioned as overarching themes to emphasize the interrelations between the clusters. Finally, a proposal was made for using the self-assessment questionnaire in practices, allowing to measure the quality of each factor.

Conclusions:

The quality of hybrid care is determined by organizational, technological, process, and personal factors. In this study, the 33 most important factors were clustered in a quality management model and self-assessment questionnaire called the Hybrid Health Care Quality Assessment (HHQA). The model visualizes the interrelations between the factors. With the questionnaire, each factor can be assessed for how effectively it is organized and developed over time. Health care organizations can use the HHQA to identify improvement opportunities for a solid and sustainable hybrid health care.