Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.
Queensland Digital Health Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia.
BMC Health Serv Res. 2024 Sep 19;24(1):1096. doi: 10.1186/s12913-024-11402-4.
Rural populations experience ongoing health inequities with disproportionately high morbidity and mortality rates, but digital health in rural settings is poorly studied. Our research question was: How does digital health influence healthcare outcomes in rural settings? The objective was to identify how digital health capability enables the delivery of outcomes in rural settings according to the quadruple aims of healthcare: population health, patient experience, healthcare costs and provider experience.
A multi-site qualitative case study was conducted with interviews and focus groups performed with healthcare staff (n = 93) employed in rural healthcare systems (n = 10) in the state of Queensland, Australia. An evidence-based digital health capability framework and the quadruple aims of healthcare served as classification frameworks for deductive analysis. Theoretical analysis identified the interrelationships among the capability dimensions, and relationships between the capability dimensions and healthcare outcomes.
Seven highly interrelated digital health capability dimensions were identified from the interviews: governance and management; information technology capability; people, skills, and behaviours; interoperability; strategy; data analytics; consumer centred care. Outcomes were directly influenced by all dimensions except strategy. The interrelationship analysis demonstrated the influence of strategy on all digital health capability dimensions apart from data analytics, where the outcomes of data analytics shaped ongoing strategic efforts.
The study indicates the need to coordinate improvement efforts targeted across the dimensions of digital capability, optimise data analytics in rural settings to further support strategic decision making, and consider how consumer-centred care could influence digital health capability in rural healthcare services. Digital transformation in rural healthcare settings is likely to contribute to the achievement of the quadruple aims of healthcare if transformation efforts are supported by a clear, resourced digital strategy that is fit-for-purpose to the nuances of rural healthcare delivery.
农村人口持续面临健康不平等问题，发病率和死亡率高得不成比例，但农村地区的数字健康服务研究甚少。我们的研究问题是：数字健康如何影响农村地区的医疗保健结果？目的是根据医疗保健的四重目标（即人群健康、患者体验、医疗成本和提供者体验）确定数字健康能力如何使农村地区的结果得以实现。
在澳大利亚昆士兰州的农村医疗系统中，对 93 名医疗保健人员（10 个系统）进行了多地点定性案例研究，包括访谈和焦点小组。一个基于证据的数字健康能力框架和医疗保健四重目标作为分类框架进行演绎分析。理论分析确定了能力维度之间的相互关系，以及能力维度与医疗保健结果之间的关系。
从访谈中确定了七个高度相关的数字健康能力维度：治理和管理；信息技术能力；人员、技能和行为；互操作性；战略；数据分析；以患者为中心的护理。除了战略，所有维度都直接影响结果。相互关系分析表明，战略对所有数字健康能力维度都有影响，除了数据分析，数据分析的结果影响着持续的战略努力。
研究表明，需要协调针对数字能力各个维度的改进工作，优化农村地区的数据分析，以进一步支持战略决策，并考虑以患者为中心的护理如何影响农村医疗保健服务中的数字健康能力。如果农村医疗保健环境中的数字化转型得到明确、有资源支持的数字战略的支持，该战略适合农村医疗服务提供的细微差别，那么这种转型可能有助于实现医疗保健的四重目标。
