Navigating the Complexities of Scaling Remote Patient Management: A Scoping Review (Preprint)

Abstract

Large-scale implementation of Remote Patient Management (RPM) promises to improve the overall quality of healthcare. However, innovation often remains on a small and local scale due to complex, multi-faceted challenges during the scaling process of RPM. Overcoming these challenges requires a thorough understanding of the scaling process. The current literature is heterogeneous, and, to our knowledge, there is no comprehensive overview of the multilevel complexity of the scaling process.

This scoping review examines how the current literature describes the scaling process of RPM, what theoretical frameworks are used and what factors hinder or enable this process.

Following PRISMA-ScR guidelines, a literature search was conducted in the Pubmed and Embase databases. This resulted in the inclusion of 12 studies. Data extraction focused on the characteristics of included studies, terminology of the scaling process, frameworks applied, and factors influencing scaling RPM.

The included studies exhibited considerable heterogeneity in methodology, focus, and approach to scaling RPM. The terminology used to describe scaling processes varied, reflecting a continuum across the RPM innovation lifecycle. 7 theoretical frameworks were identified that provided mainly descriptive and evaluative insights into the levels of scaling RPM. A total of 568 factors (barriers and enablers) were identified and categorised into 12 thematic clusters.

Three sources of complexity in scaling RPM were identified: the process continuum in the terminology used to describe the scaling process; the management of scaling as a multi-levelled process; and the multitude of interconnected categories of factors related to the transition from pilot to scaling. Recommendations for researchers and practitioners are proposed to navigate through these complexities, including clear terminology distinction, development of multi-level process frameworks, holistic assessment of factors, and the creation of integrated overarching scaling strategies. Scaling RPM within healthcare systems presents diverse challenges stemming from the complex nature of the process. Addressing these challenges requires more than “just” implementing in multiple contexts, it requires a strategic approach informed by robust frameworks and actionable recommendations. Future research directions should focus on leveraging knowledge from innovation management to develop effective strategies for scaling RPM in healthcare.