Pamela Mazzocato

Research problem and specific questions: The acute staffing crisis in healthcare calls for the need to redesign care delivery models to meet the needs of patients in efficient ways. Remote patient monitoring (RPM) has been proposed as a new model of care to achieve this. Yet, RPM often fails to be implemented due to difficulties in integrating new or changed tasks into the daily work of an already strained workforce. Task shifting has been recommended as a strategy to make best use of available resources, but the shifting of tasks from healthcare staff to patients, caregivers, and digital health technologies remains largely unexplored. Our specific research questions are:How do healthcare professionals, patients, and informal caregivers experience their work tasks related to RPM?How can task shifting and sharing be made explicit in the context of RPM?How does the shifting and sharing of tasks in the context of RPM influence patient, caregiver, and staff experiences?How does the shifting and sharing of tasks in the context of RPM influence healthcare costs?Data and method: The study context will involve four hospitals in the Stockholm Region that are developing RPM services for various care processes. We will engage with the hospitals using an action research approach involving three phases. In phase 1, we will explore experiences of work tasks related to RPM

in phase 2, we will engage relevant actors in co-designing task shifting strategies

in phase 3, we will evaluate experiences and costs of task shifting. Data will be collected qualitatively (observations, interviews, focus group discussions, co-design workshops, documents) and quantitatively (questionnaires, care utilization, costs).Societal relevance and utilization: This project addresses the societal challenge of ensuring high-quality healthcare in the face of workforce shortages and increasing patient demands. By exploring how task shifting can be supported in the context of RPM, we aim to provide evidence-based solutions that can improve resource utilization in healthcare, and the experiences of healthcare professionals, patients, and informal caregivers.Plan for project realization: Access to the study setting has been established. Data collection and analysis will be carried out longitudinally by experienced researchers with interdisciplinary expertise, as well as co-researchers from the study context. The costs cover mainly personnel, analysis, and dissemination activities.

As the prevalence of chronic illness increases, the demands on healthcare services change. The few hours per year that persons with chronic conditions see healthcare professionals represent a mere fraction of their 24/7 lived experience of coping with their condition. Without patient participation no treatment can be carried out

thus healthcare services are co-produced. This reality requires a shift from professional-oriented care toward patient-oriented supported self-care. Co-care refers to the decisions and activities shared by patients, their informal caregivers, and professionals, aimed at achieving goals valued by the patient. Consequently, in contrast to involve patients in healthcare, healthcare needs to get involved in people’s self-care, to the extent that the patient needs and desires. Making this shift, however, has been challenging for health care practice.Given this implementation gap, the current program is based on five patient-driven co-care innovations and aims to study how new models of self-care and co-care are best implemented in everyday health care practice and patients’ lives, supported by eHealth. This program is collaboration with patients, their informal caregivers and healthcare providers, to ensure that the research meets patients’ needs. The program is conducted in two phases studying: 1) the implementation of the five patient-driven co-care innovations and the development of patient-valued outcome measures and 2) the impact of the co-care innovations on clinical practice, care organization and patient-valued outcomes, the spread and scaling up of the innovations and production of best practice guidelines. Multiple research designs (e.g. comparative case studies, participatory workshops, adaptive intervention design) will be used. The program generates knowledge that enables people with chronic conditions, their informal caregivers and formal healthcare providers to effectively engage in co-care.