Abstract
Keeping future care good, accessible, and affordable: that is the major challenge the healthcare
sector faces. To achieve this, efforts are needed, among other things, to provide the right care in the
right place and to promote regional collaboration among healthcare institutions.
Deventer Hospital, home care organization Carinova, Huisartsen Coöperatie Deventer en
Omstreken (HCDO), and the healthcare insurer Salland Zorgverzekeringen are collaborating to
improve the care for patients with heart failure. They formulated the following ambition: "To provide
high-quality and cost-effective care in the right place and by the right professionals for heart failure
patients in the Salland region and its surroundings through the use of telemonitoring." This ambition
has been translated into a design for localized and integrated care.
The process began with an analysis based on literature and benchmarking on regional
telemonitoring. In a client panel, experienced individuals provided insight based upon experience on
the desires and needs of patients. Subsequently, the healthcare partners in the Salland region
collectively designed a telemonitoring program for patients with heart failure. Design choices were
made regarding the care process and the necessary data exchange. The design of the transmural
care pathway was implemented in a pilot program. Monitoring of the objectives and their follow-up
was established, and steps are taken to sustain the care pathway.
The transmural care pathway for telemonitoring patients with heart failure was evaluated using the
NASSS framework (Greenhalgh et al., 2017). Barriers and enablers, together with lessons learned
from the project itself, were translated into a general guideline for organizing telemonitoring in
collaboration with regional partners.
Finally, recommendations were made for the sustainability and upscaling of telemonitoring in the
Salland region and these might be applicable in other regions.
sector faces. To achieve this, efforts are needed, among other things, to provide the right care in the
right place and to promote regional collaboration among healthcare institutions.
Deventer Hospital, home care organization Carinova, Huisartsen Coöperatie Deventer en
Omstreken (HCDO), and the healthcare insurer Salland Zorgverzekeringen are collaborating to
improve the care for patients with heart failure. They formulated the following ambition: "To provide
high-quality and cost-effective care in the right place and by the right professionals for heart failure
patients in the Salland region and its surroundings through the use of telemonitoring." This ambition
has been translated into a design for localized and integrated care.
The process began with an analysis based on literature and benchmarking on regional
telemonitoring. In a client panel, experienced individuals provided insight based upon experience on
the desires and needs of patients. Subsequently, the healthcare partners in the Salland region
collectively designed a telemonitoring program for patients with heart failure. Design choices were
made regarding the care process and the necessary data exchange. The design of the transmural
care pathway was implemented in a pilot program. Monitoring of the objectives and their follow-up
was established, and steps are taken to sustain the care pathway.
The transmural care pathway for telemonitoring patients with heart failure was evaluated using the
NASSS framework (Greenhalgh et al., 2017). Barriers and enablers, together with lessons learned
from the project itself, were translated into a general guideline for organizing telemonitoring in
collaboration with regional partners.
Finally, recommendations were made for the sustainability and upscaling of telemonitoring in the
Salland region and these might be applicable in other regions.
| Original language | Dutch |
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| Supervisors/Advisors |
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| Place of Publication | Eindhoven |
| Publisher | |
| Publication status | Published - 21 Sept 2023 |