A Combined Telemedicine and Ambulatory Wound Care Team Intervention for Improving Cross-Sector Outpatient Chronic Wound Management: The TELE-AMBUS Research Project Protocol (Preprint)

BACKGROUND There is a growing prevalence of non-healing wounds and chronic diseases in societies, and an associated need for wound management solutions that include the use of telemedicine. There is also a broad spectrum of factors influencing the planning and execution of interventions within telemedicine in chronic wound management, spanning organization, technology, and individuals including the professional and the patient. The TELE-AMBUS project applies a whole system research approach to account for this spectrum of factors. OBJECTIVE The primary objective is to explore and analyse implementation and consequences of an outpatient wound management model comprised of two interconnected quality improvement interventions – telemedicine and ambulatory wound care team – aimed at elderly and vulnerable chronic wound patients across the specialist and primary healthcare sectors. Embedded in this objective is the aim to improve competence levels of healthcare providers and consequently service quality of outpatient wound management across specialist and primary healthcare services. METHODS By means of a combined process and economic evaluation research strategy, this project examines implementation and consequences of an outpatient wound management model. A sociotechnical system theory approach and multiple work package design support the examination. The project employs observations, conversations, interviews, and economic assessments to gather rich in-depth insight and the basis for understanding why and how the new wound management model contributes to a change or not, compared to the traditional treatment model. RESULTS The project was funded from 2021 to 2025. A systematic review and synthesis of knowledge on telemedicine interventions in chronic wound management was published in the International Wound Journal in July 2022. Baseline interviews have been conducted since April 2022 and are expected to conclude in early 2024. Field work including non-participant observations, semi-structured interviews, and informal conversations have been conducted since November 2022 and are expected to conclude in March 2025. Initial empirical results from the baseline interviews were presented at the Organizational Design and Management Conference 2023 conference. CONCLUSIONS We apply a socio-technical system framework in multiple and creative ways, i.e., to design/inform our field work and to explore and redesign an outpatient model and work systems across sectors, with SEIPS becoming a pedagogic tool to translate and implement project findings into practice across services. This approach has to our knowledge not been undertaken in human factors and ergonomics literature more broadly as well as telemedicine in chronic wound management literature. Thus, our approach can produce both original and novel research and theoretical results internationally. CLINICALTRIAL The TELE-AMBUS research project was accepted by the ethical committee REC West in Norway (application id. 375986) and approved by NSD Norwegian Centre for Research Data (reference no. 236558). The project has also been agreed by the internal data protection representative at Stavanger University Hospital (SUH) (protocol no. 2847-2847).