Background Telehealth interventions offer an evidenced-based approach to providing cost-effective care, education, and timely communication at a distance. Yet, despite its widespread use, telehealth has not reached full potential, especially in rural areas, due to the complex process of designing and implementing telehealth programs. The objective of this paper is to explore the use of a theory-based approach, the Model for Developing Complex Interventions in Nursing, to design a pilot telehealth intervention program for a rural population with multiple chronic conditions. Methods In order to develop a robust, evidenced based intervention that suits the needs of the community, stakeholders, and healthcare agencies involved, a design team comprised of state representatives, telehealth experts, and patient advocates was convened. Each design team meeting was guided by major model constructs (i.e., problem identification, defining the target population and objectives, measurement theory selection, building and planning the intervention protocol). Overarching the process was a review of the literature to ensure that the developed intervention was congruent with evidence-based practice and underlying the entire process was scope of practice considerations. Results Ten design team meetings were held over a six-month period. An adaptive pilot intervention targeting home and community-based Medicaid Waiver Program participants in a rural environment with a primary objective of preventing re-institutionalizations was developed and accepted for implementation. To promote intervention effectiveness, asynchronous (i.e., remote patient monitoring) and synchronous (i.e., nursing assessment of pain and mental health and care coordination) telehealth approaches were selected to address the multiple comorbidities of the target population. An economic evaluation plan was developed and included in the pilot program to assess intervention cost efficiency. Conclusions The Model for Developing Complex Interventions in Nursing provided a simple, structured process for designing a multifaceted telehealth intervention to minimize re-institutionalization of participants with multiple chronic conditions. This structured process may promote efficient development of other complex telehealth interventions in time and resource constrained settings. This paper provides detailed examples of how the model was operationalized.

中文翻译：

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使用开发复杂护理干预的模型为农村人口设计多方面的远程医疗干预。

背景 远程医疗干预提供了一种循证的方法来提供具有成本效益的护理、教育和远程及时沟通。然而，尽管远程医疗被广泛使用，但由于设计和实施远程医疗计划的复杂过程，远程医疗尚未充分发挥潜力，尤其是在农村地区。本文的目的是探索使用基于理论的方法，即开发护理中复杂干预的模型，为患有多种慢性病的农村人口设计一个试点远程医疗干预计划。方法 为了开发一个稳健、循证的干预措施，以满足社区、利益相关者和相关医疗机构的需求，召集了一个由州代表、远程医疗专家和患者倡导者组成的设计团队。每次设计团队会议都以主要模型结构为指导（即问题识别、定义目标人群和目标、测量理论选择、建立和规划干预方案）。总体过程是对文献的回顾，以确保制定的干预措施与循证实践一致，并且整个过程的基础是实践考虑的范围。结果在六个月的时间里举行了十次设计团队会议。针对农村环境中的家庭和社区医疗补助豁免计划参与者制定了一项适应性试点干预措施，其主要目标是防止再机构化，并接受实施。为了提高干预效果，异步（即远程患者监测）和同步（即，疼痛和心理健康的护理评估和护理协调）选择远程医疗方法来解决目标人群的多种合并症。制定了一项经济评估计划并将其纳入试点计划，以评估干预成本效率。结论 护理中开发复杂干预的模型为设计多方面远程医疗干预提供了一个简单、结构化的过程，以尽量减少患有多种慢性病的参与者的再机构化。这种结构化的过程可以促进在时间和资源有限的环境中有效开发其他复杂的远程医疗干预措施。本文提供了该模型如何实施的详细示例。