Challenges of chronic care pathway projects based on their prevention level and leading institution

Abstract Problem Work Package (WP) 9 of the Joint Action on Cardiovascular Diseases and Diabetes (JACARDI) - a significant EU initiative - aims to improve patient pathways of these diseases through implementing 29 pilot projects. Two of the many aspects of diversity among the pilots are (a)the focus of the different levels of prevention (primary/secondary or tertiary) and (b)the role of the pilot coordinator institution in the healthcare system. Lessons from differences in barriers and facilitators may aid future implementation efforts. Description Pilots performed a situation analysis based on the Consolidated Framework for Implementation Research (CFIR) between January-June 2024 to overview their design and the contextual influencing factors of the environment in which the innovation is to be implemented. By comparing stakeholder engagement strategies, barriers, facilitators, and possible scale-up ideas, we aimed to identify actionable patterns along the two dimensions of interest. Results 27 of the 29 pilots finished the situation analysis, with 4 facing serious challenges in this phase. Pilots are coordinated by national (12), regional (6) or local/other (11) institutions. 19 focus on tertiary, 8 on mixed levels of prevention. Stakeholder assessments were mainly optimistic, but patient representatives’ engagement was often superficial. Pilots coordinated by national/regional institutions indicated more extensive scale-up plans and a higher level of involvement regarding key decision maker stakeholders. Lessons The situation analyses explicated the pilots’ challenges associated with their focus on various aspects of public health issues as well as their stakeholder engagement. There are differences in project design, strategies and possibilities based on the role of the coordinating institutions Key messages • The assessment and engagement of stakeholders in the pre-implementation phase facilitates implementation. • The lack of patient participation might risk pilots’ success.