DISSEMINATION, IMPLEMENTATION, AND IMPACT

• Published in: Health Services Research
• Main Authors: Breton, M., Ann Smithman, M., Lamoureux‐Lamarche, C., Dumas Pilon, M., Keely, E., Farrell, G., Singer, A., Woods, P., Bibeau, C., Nabelsi, V., Gaboury, I., Gagnon, M.‐P., Steele Gray, C., Shaw, J., Hudon, C., Aubrey‐Bassler, K., Bush, P., Côté‐Boileau, É., Gagnon, J., Visca, R., Liddy, C.
• Format: Article in Journal/Newspaper
• Language: English
• Published: Wiley 2020
• Subjects: Canada; Newfoundland
• Online Access: http://dx.doi.org/10.1111/1475-6773.13409; https://onlinelibrary.wiley.com/doi/pdf/10.1111/1475-6773.13409; https://onlinelibrary.wiley.com/doi/full-xml/10.1111/1475-6773.13409

Research Objective Effective health innovations are rarely scaled‐up—missing countless opportunities to improve health systems. Yet, little evidence exists on strategies to support large scale implementation of proven innovations. eConsult is an asynchronous online platform connecting primary care providers to specialists to discuss patients’ care, that improves access, patient experience, provider satisfaction, and reduces costs. eConsult services have been implemented in 16 countries, most widely in the United States and Canada. In Canada, each province has a single payer health system with universal coverage and efforts to scale‐up eConsult are underway in several provinces, with over 75 000 eConsult cases completed across the country thus far. This provides a unique opportunity to understand the strategies used to support scale‐up of this type of innovation across a range of contexts. Our objective is to present the strategies used to scale‐up eConsult in multiple jurisdictions. Study Design We conducted a multiple case study, where the cases were four Canadian provinces at varying stages of scaling‐up eConsult (Ontario, Quebec, Newfoundland and Labrador and Manitoba). Our data sources include document review (e.g., meeting minutes, reports, websites, presentations), meeting observations where provincial scale‐up of eConsult is discussed ( n = 26), semi‐structured interviews ( n = 25) and focus groups ( n = 2). We conducted deductive and inductive thematic analysis using Milat et al.’s scaling‐up conceptual framework (2016) to identify strategies and emerging themes. Population Studied Our study was conducted with key stakeholders (e.g., patients, family physicians, specialists, policy makers, decision makers) involved in the scaling‐up of eConsult in four Canadian provinces. Principal Findings We identified 6 common strategies used to support scaling‐up of eConsult in Canada : (a) Linking eConsult to research has helped develop and improve the innovation (e.g., technological infrastructure), establishing ...