Delivering the digital ambition: Exploring how we can design, implement and evaluate digital technologies in healthcare.

数字健康技术(DHT)包括广泛的应用，如远程医疗、可穿戴设备以及智能手机和平板电脑应用程序(APP)。然而，尽管国家和国际政策提出了DHT改革医疗保健的雄心勃勃的计划，但很少有人考虑如何将它们成功地整合到医疗保健系统和流程中。这一点很重要，因为许多报告表明，即使是设计良好的DHT也未能在临床实践中被采用或很快被放弃，这意味着它们改变医疗保健的潜力已经丧失。中风康复为使用DHT改善患者预后提供了一个理想的机会。服务压力意味着工作人员可以直接提供的康复量，特别是手臂的康复量，远远达不到已知的有益效果，导致许多人的结果不佳，生活质量下降。随着中风幸存者的人数在未来15年内翻一番，DHT为工作人员提供了一种有吸引力、创新、实用和吸引人的方式，在目前的服务限制范围内，为中风后的患者开出额外的康复处方，并改善康复。然而，DHT在康复中的应用并不广泛，影响其在临床实践中使用的因素尚不清楚。本项目旨在确定和了解将影响DHT在医疗保健中的使用的因素。它将利用这些知识来设计、实施和评估DHT干预措施，并以中风后康复为例。该项目有3个初始阶段。在第一阶段，将审查考虑DHT是否以及如何在医疗保健中使用的证据，以探索影响它们使用的因素。一项全国性的调查、实践观察、问卷调查和访谈将描述当前的实践，并探索中风后患者、康复人员和服务经理关于使用DHT的行为和信念。这些信息将被用来开发关于在医疗康复中使用DHT的影响因素的理论和框架。在第二阶段，将使用该理论和框架与我们内部创新实验室的康复工作人员、中风幸存者和DHT开发人员共同设计、创建和进行APP和干预的初始测试，以补充中风后手臂的常规康复。在第三阶段，将评估APP和干预措施的初步可行性、可接受性和成本，以补充单一NHS信托基金的中风康复。来自采访、问卷和该应用程序生成的数据将调查它在实践中是如何使用的。这些发现将被用来进一步完善在第一阶段发展的理论和框架，以及在第二阶段发展的APP和干预。在第二阶段(第四阶段)，将对APP和干预进行多地点可行性研究。该项目的成果还将用于指导和评估在中风康复中使用其他形式的分布式哈希表(例如虚拟现实)，并将评估它们在其他医疗保健环境中支持和评估分布式哈希表的可转移性。该项目将通过生成清晰的理论和框架并提供实用工具来详细说明在设计、实施和评估分布式哈希表时必须考虑的因素，从而改变分布式哈希表在医疗保健中的使用方式。它将就患者和医护人员如何共同设计DHT提供指导，并设计一项关于APP和干预有效性的未来试验。它的结果将使技术开发人员和研究人员受益，帮助他们设计和利用分布式哈希表来改善患者的预后，并使医疗保健组织和政策制定者能够考虑实现真正创新和启用分布式哈希表的医疗保健服务的愿景所需的重要流程和资源。

Digital health technologies (DHT) comprise a broad range of applications such as telehealth, wearable devices and smart-phone and tablet applications (apps). However, whilst national and international policies present ambitious plans for DHT to revolutionise healthcare, there has been little consideration of how they can be successfully integrated into healthcare systems and processes. This is important as many reports show that even well designed DHT fail to be adopted or are quickly abandoned in clinical practice, meaning that their potential to transform healthcare is lost.Stroke rehabilitation presents an ideal opportunity to use DHT to improve patient outcomes. Pressures on services mean that the amount of rehabilitation that can be directly delivered by staff, particularly for the arm, falls far short of that known to be beneficial resulting in sub-optimal outcomes for many people and reduced quality of life. With the numbers of people surviving a stroke set to double in the next 15 years, DHT provides an attractive, innovative, practical and engaging way for staff to prescribe additional rehabilitation and improve recovery for people after stroke, within current service constraints. However, DHT are not widely used in rehabilitation and the factors that influence their use in clinical practice are not known. This project seeks to identify and understand the factors that will influence the use of DHT in healthcare. It will employ this knowledge to design, implement and evaluate a DHT intervention, using rehabilitation after stroke as a case example.The project has 3 initial phases. In phase 1, the evidence considering if and how DHT are used in healthcare will be reviewed, to explore the factors influencing their use. A national survey, observations of practice, questionnaires and interviews will describe current practice and explore the behaviours and beliefs of people after stroke, rehabilitation staff and service managers about using DHT. This information will be used to develop a theory about, and framework of, the factors influencing the use of DHT in healthcare rehabilitation.In phase 2, the theory and framework will be used to co-design, create and undertake initial testing of an app and intervention to supplement routine rehabilitation for the arm after stroke with rehabilitation staff, stroke survivors and DHT developers from our in-house innovation lab. In phase 3, the initial feasibility, acceptability and costs of the app and intervention to supplement stroke rehabilitation at a single NHS trust will be evaluated. Data from interviews, questionnaires and generated by the app will investigate how it was used in practice. These findings will be used to further refine the theory and framework developed in Phase 1 and the app and intervention developed in Phase 2. In the second period of the fellowship (Phase 4), a multi-site feasibility study of the app and intervention will be conducted. The project outputs will also be used to guide and assess the use of other forms of DHT (e.g. virtual reality) in stroke rehabilitation and their transferability to support and evaluate DHT in other healthcare settings will be evaluated.This project will transform how DHT can be used in healthcare by generating a clear theory and framework and providing practical tools which detail the factors that must be considered in the design, implementation and evaluation of DHT. It will provide guidance on how patients and healthcare staff can co-design DHT and design a future trial of the effectiveness of the app and intervention. Its results will benefit technology developers and researchers by helping them design and utilise DHT to improve patient outcomes and enable healthcare organisations and policy-makers to consider the vital processes and resources required to realise the vision of a truly innovative and DHT-enabled healthcare service.