Case Study: Improving MPE Management with Digital Health - SAPS Model

This case study examines the implementation of a specialized ambulatory pleural service (SAPS) model, enhanced by digital health technologies, to improve the management of malignant pleural effusion (MPE) in Victoria, Australia. It addresses issues of fragmented care, limited access to expertise, and the invasiveness of traditional treatments. The Northern Health initiative utilizes telehealth, real-time remote pleural ultrasonography, and symptom monitoring to provide specialized care in the community, aiming to reduce hospitalization rates and improve patient outcomes. The study analyzes patient experiences and health-related quality of life, considering clinical, patient, psychological, and technological perspectives in the design of the virtual care model. While acknowledging the limitations of virtual care, such as technological challenges and the inability to conduct physical examinations, the case emphasizes the potential of the SAPS model, supported by the Logical Framework Approach (LFA), to enhance MPE management, improve care delivery, and achieve better healthcare outcomes.

A case study
Introduction
In Victoria, Australia, the specialized ambulatory pleural service (SAPS) style of treatment seeks
to enhance the management of malignant pleural effusion (MPE). The region's health services
now use fragmented care models and different MPE management strategies. By using indwelling
pleural catheters (IPC) as a minimally invasive alternative for fluid evacuation from the pleural
space, the necessity for invasive treatments and hospitalization will be decreased(Fitzgerald et
al., 2022).
However, the use of IPCs is restricted since most health providers lack the necessary resources
and competence. In addition, the COVID-19 pandemic has made it clear that additional methods
of lowering hospitalization rates are required. Through the use of digital health technology, the
SAPS model of care aims to solve these issues by expanding the availability of specialist
ambulatory pleural service. Using telehealth (video chats), real-time remote pleural
ultrasonography (teleultrasound), and symptom monitoring, the digital health initiative at
Northern Health (NH) in Victoria seeks to assess the effects of expanding the SAPS program.
With this strategy, patients may obtain professional assistance and support in their local
community, which eliminates the need for repeated trips to the hospital and clinic(Niti Pall &
MICHAL MATUL, 2021).
Within this style of care, the study will evaluate patient experience and health-related quality of
life. The goal of NH is to increase community MPE management and IPC care access by
utilizing digital health technologies. The project's initial phase, which is slated for 2023–2024,
will concentrate on putting the digital health solution and community nursing assistance into
place. This proof-of-concept feasibility study's ultimate objective is to show how the SAPS
model of care, backed by digital health technology, may improve MPE management, save
expensive and time-consuming hospital treatment, and improve patient outcomes in
Victoria(Kuwabara et al., 2020).
Analysis of patients
Malignant pleural effusion (MPE) patients now experience the following pains:
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 Fragmented Care: Various care models are now in use throughout health systems,
resulting in inconsistencies in treatment and a limited ability to translate research into
clinical practice. This may affect patient outcomes and lead to variations in the standard
of care(Jia et al., 2023).
 Limited Access to Expertise: Many health providers do not have the knowledge or
materials necessary to assist people with MPE, particularly in the community setting.
This might cause delays in getting the right therapy and force patients to have more
invasive and expensive procedures like surgical pleurodesis(Grimshaw et al., 2012).
 Hospitalization and intrusive Procedures: The conventional surgical care of MPE is a
costly, uncomfortable, and intrusive operation with accompanying risks and protracted
hospital stays. The patient's quality of life may be greatly impacted by these issues, which
may also raise healthcare expenses(Tolera et al., 2020).
 Clinical inertia: Due to clinical inertia, alternative treatments like indwelling pleural
catheters (IPC) have not been adopted widely. This inaction may be caused by a dearth of
knowledge, skills, and resources needed to introduce and promote IPC management in
the neighborhood(Verhestraeten et al., 2021).
These problems necessitate a virtual care approach, as the SAPS program suggests. It addresses
so many challenges like patients can obtain specialized treatment remotely by utilizing telehealth
technology like video calls. This lessens the requirement for frequent trips to the hospital or
clinic and increases access to treatment, especially for people who live in distant places or have
restricted mobility. The virtual care approach enables medical staff to offer patients expertise as
needed. Teleultrasound, or real-time remote pleural ultrasonography, enables doctors to evaluate
patients and direct therapy without requiring them to physically attend a hospital. As a result,
delays are decreased, and outcomes are improved by providing timely access to expert treatment.
The virtual care model's use of indwelling pleural catheters (IPC) provides a less invasive
method for treating pleural effusion. In comparison to surgical techniques, IPCs offer excellent
symptom treatment with shorter hospital stays, decreased procedural mortality, and fewer further
invasive procedures(Bokolo Anthony Jnr, 2020). In addition to enhancing patient comfort and
quality of life, this strategy lowers healthcare expenses.
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Different perspective in designing the virtue care approaches
To achieve a thorough and patient-centered approach, the design considerations of the virtual
care model for managing malignant pleural effusion (MPE) should take into account a variety of
viewpoints(Addala et al., 2022). Some of the various viewpoints to take into account are:
1. Clinical perspective: From a clinical perspective, the virtual care model's architecture
should prioritize assuring an accurate and prompt diagnosis, efficient symptom
monitoring, and appropriate therapeutic measures. It ought to make it possible for
medical professionals to give top-notch treatment remotely, including through
teleconsultations, teleultrasound, and remote symptom monitoring. Professionals
participating in patient care should be able to communicate and collaborate with each
other easily thanks to the system(Addala et al., 2022).
2. Patient perspective: A good virtual care model must take the patient's perspective into
account throughout design. It should put the comfort and convenience of the patient first.
Patient engagement and satisfaction may be increased by using user-friendly interfaces
and clear navigation(DePuccio et al., 2022). The virtual care model should be created
with each patient's preferences and wants in mind, taking accessibility, privacy, and
cultural issues into account.
3. Psychological perspective: Patients' psychological well-being may be significantly
impacted by MPE treatment. Patients' psychological wellbeing should be taken into
account throughout design, and resources and assistance should be made available for
these elements of treatment. This may entail including elements in the virtual care
paradigm such patient education materials, counseling services, peer support groups, or
mental health resources(Rodríguez Torres et al., 2020).
4. Technological perspective: Technology concerns should be incorporated into the virtual
care model to guarantee user experience and smooth integration. It should be made to
work with a variety of hardware, software, and operating systems so that patients and
healthcare professionals may access and use the system using their chosen
technology(Haleem et al., 2022). To secure patient data and adhere to applicable rules,
security and privacy measures should also be strong.
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Limitation and restriction of Virtue care model
1. Virtual care models rely largely on technology, and problems with that technology might
cause delays in the delivery of treatment. Among the technological constraints are issues
with cybersecurity, faulty gear and software, and poor internet access(MARK
DEBOFSKY, 2022).
2. Healthcare professionals are unable to physically examine the patient under a virtual care
approach. This may lead to unneeded diagnostic testing or a referral to a specialist, which
can reduce the accuracy of diagnosis and treatment.
3. Virtual care might not always give access to specialized care. A virtual care approach
may not allow for the in-person consultation with a professional that patients with
complicated or uncommon diseases may need.
4. Virtual care models lack the resources to deal with urgent medical situations. Patients
who have serious problems or acute symptoms need prompt medical care, which cannot
be given through a virtual platform.
5. Regulations governing virtual healthcare include prohibitions on the prescription of drugs
without an in-person consultation. These limitations may reduce the range of virtual care
and bar healthcare professionals from remotely delivering some forms of treatment.
Summary of case
The establishment of a specialist ambulatory pleural service (SAPS) model of care to enhance
the management of malignant pleural effusion (MPE) is the focus of the case study scenario.
Health services now use fragmented care models, which leads to variances in care and a limited
amount of research that is translated into clinical practice. The traditional surgical treatment for
MPE is intrusive, fraught with risks, extensive stays in the hospital, and expensive. Due to a lack
of knowledge and resources in most healthcare settings, indwelling pleural catheters (IPC) are
not used as frequently as other minimally invasive options. Northern Health (NH) has started a
digital health initiative to broaden the SAPS program's reach in order to solve these issues. The
project's goal is to assess how well the SAPS model of care supports patients in the community
by employing telehealth (video conversations), real-time remote pleural ultrasonography, and
symptom monitoring(Jacobs et al., 2022). The virtual care paradigm improves patient outcomes,
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decreases the need for invasive treatments and hospitalization, and gives patients access to
experts when they need it.
Framework
The Logical Framework Approach (LFA) framework is the one I used to assess the case study.
To develop, oversee, and assess actions, project managers frequently employ the Logical
Framework Approach (LFA). Even though the case study does not specifically reference LFA,
we may examine how it might be used as a framework in this situation. There are four main parts
to the logical framework approach: the aim, goals, actions, and indicators. Each element
contributes to the creation of a logical and organized framework for the design and assessment of
interventions. (Holtrop et al., 2021). It promotes a more effective and efficient use of the SAPS
model of care by ensuring that the intervention's aims and expected results are in line.
 Goal
 Objectives
 Activities
 Indicator
The SAPS model of care, which aims to improve outcomes and overall impact, is being
implemented with the intention of improving MPE management. The goals, which were
developed using the SMART criteria, are to improve patient satisfaction, expand symptom
management, expand access to IPC treatment, and decrease hospitalization rates. The targeted
results of the intervention have distinct targets thanks to these aims. The activities outline the
precise steps that must be taken to accomplish the goals. They entail setting up telehealth
infrastructure, educating medical staff on telemedicine procedures, enabling remote pleural
ultrasonography, creating symptom monitoring guidelines, and organizing community nursing
assistance. These actions make up the concrete steps needed for the SAPS model of care's
successful implementation.
Conclusion
Although the virtual care model has numerous advantages, it is important to understand its
constraints. For implementation to be effective, there are a number of concerns that must be
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resolved, including technical difficulties, a lack of physical examinations, restricted access to
specialist care, an inability to manage crises, and legislative limitations. LFA framework offers
clarity, coherence, and accountability, ensuring that resources are used efficiently, goals are met,
and patient outcomes are improved. It encourages a methodical and complete approach that
unites stakeholders, promotes effective project management, and makes it possible to make
decisions using the best available data. Overall, the use of the LFA improves the viability and
effectiveness of putting the SAPS model of care for MPE management into practice. It
encourages a concentrated and organized effort to meet the unique requirements and difficulties
of MPE patients, eventually resulting in enhanced patient experiences, improved care delivery,
and improved healthcare outcomes.
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