KEY TAKEAWAYS
- The Swiss SMILe project was developed at the University Hospital Freiburg to support allogeneic stem cell transplant patients.
- The study demonstrated that involving stakeholders and implementing a robust methodology yields exceptional outcomes in the eHealth solutions realm.
Patients undergoing allogeneic stem cell transplant (alloSCT) might see improved health outcomes with an integrated eHealth care model (eICM). Researchers designed such a model, named SMILe, at the University Hospital Freiburg, Germany. This model merged technological tools like the SMILe-App with human support from an Advanced Practice Nurse team. For its introduction in Switzerland, modifications were needed. The goal was to detail the customization of the SMILe-ICM for Switzerland, and the ongoing evaluation of its effectiveness at the University Hospital Basel (USB, Switzerland).
A comprehensive study, approved by the ethics committee of Northwest and Central Switzerland, was conducted between 04/2019–06/2020. Data was gathered from surveys, individual patient interviews, and clinician focus groups. Assistance from stakeholders, user tests, and theoretical frameworks facilitated the Swiss adaptation.
Since April 2021, the SMILe-ICM has been evaluated through a hybrid effectiveness-implementation RCT approved by the responsible ethics committee (EKNZ: 2021-00202). The study has targeted 80 adult alloSCT patients who have been transplanted at USB with basic German proficiency, elementary computer literacy, internet access, and have provided written informed consent. The study aimed to evaluate the SMILe–ICM’s effectiveness in terms of re-hospitalization rate, GvHD, and survival, as well as implementation outcomes such as acceptability and feasibility. To achieve this, multi-method assessments such as questionnaires and interviews were used.
In the current clinical practice, acute care is mostly prioritized. Patients understood the importance of new tools to track their health habits, symptoms, and health data. They rated the need for these tools as 9 out of 10. All interviewed clinicians were open to using tech and valued eICMs as a great way to give better and faster care. To effectively implement the SMILe-ICM, some adaptations were required at the organizational level. Implementation strategies, such as visiting the first center and creating new clinical teams, were modified to fit the Swiss setting.
Recruitment concluded in June 2022, much ahead of schedule. 98% of the intervention group engage with the SMILe-App daily and report high satisfaction. Initial feedback highlighted increased security and a sharper perception of health shifts. Effectiveness and implementation outcomes will be shared by 09/2023.
Based on the combination of methodologies supported, context-specific adaptation and tailoring of implementation strategies was possible. The dual focus on implementation and effectiveness informed the optimization of the SMILe-ICM. It provided valuable insights regarding implementation pathways. If successful, SMILe has the potential to serve as a blueprint for future interventions in various settings and populations.
Source: https://ebmt2023.abstractserver.com/program/#/details/presentations/467
Clinical Trial: https://classic.clinicaltrials.gov/ct2/show/NCT04789863
Valenta, S., Ribaut, J., Leppla, L., Teynor, A., Gerull, S., Mielke, J., Koehly, K., Grossmann, F., Simon, M., Bartakova, J., Kaier, K., Eckstein, J., Geest, S.D. NG14-02 CONTEXT-SPECIFIC ADAPTATION, IMPLEMENTATION AND EVALUATION OF AN EHEALTH-FACILITATED INTEGRATED CARE MODEL WITH CONTINUOUS STAKEHOLDER INVOLVEMENT IN ALLOGENEIC STEM CELL TRANSPLANTATION – THE SWISS SMILE PROJECT.
