Telehealth implementation for congenital heart disease in pediatrics using i-PARIHS: mixed-methods pilot study

Introduction: The objective of this study was to gather cardiology providers’ perspectives on the role of telehealth (TH) and congenital heart disease (CHD), through survey research based on the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework. Materials and methods: A convergent mixed methods design was used to evaluate responses related to telehealth and congenital heart disease (Tele-CHD). Ten pediatric cardiology providers at Children’s Nebraska completed the study, providing perspectives to improve patient-centered care, barriers, and facilitators to CHD patient care. Characteristics and types of CHD patients who received Tele-CHD or single-ventricle interstage home monitoring (Tele-IHM) were noted through a mixed methods research study (qualitative semi-structured interviews and quantitative surveys). A survey and semi-structured questionnaire were administered based on the i-PARIHS framework constructs within the innovation domains of compatibility, usability, relative advantage, trialability, observability, and cost-effectiveness. A directed content analysis approach was used to analyze the providers’ semi-structured interviews. Results: The dimensions of usability and relative advantage were strongly positive. The questionnaires reiterated the responses recorded by the survey. Telehealth was easy to use while seeing patients and helpful in triaging those physically located elsewhere, in rural and remote areas. Moderate concerns, as well as challenges, were observed in the constructs of trialability and cost-effectiveness. Conclusions: Providers deemed TH user-friendly. Regular surveillance of non-urgent CHD patients was deemed relevant, and Tele-IHM for high-risk populations benefited from TH. Barriers to use included a lack of in-person examination and the unavailability of proper diagnostics before the visit. The i-PARIHS framework instrument, using the mixed methods approach, recorded providers’ perspectives related to Tele-CHD implementation and assessment of the Tele-IHM program, and consistency was found between the survey and questionnaires.