Table 2 Cross-site comparison – contexts and implementation
Site A: large city, South East England | Site B: major city, Northern Ireland | Site C: major city, East Midlands | Site D: rural, South West England | Site E: major city, North West England | Site F: urban area, South East England | Site G: major town, South England | |
|---|---|---|---|---|---|---|---|
Existing service prior to SUPPORT-HF2 trial | Consultant-led clinics and inpatient management Standard primary care diagnosis and ongoing management | ||||||
Hospital HFSN team, community HFSN teams serving HFrEF only | Hospital and community HFSN teams | Hospital and community HFSN teams | Hospital and community HFSN teams | Community HFSN team in one part of CCG only | Hospital and community HFSN teams | No community HFSN team | |
Staff involved in SUPPORT-HF2 trial | Chief investigator, secondary care HF nurses, SUPPORT HF trial team | Local PI, 2 research nurses | Local PI, secondary care-based lead HFSN and 2 communities | Local PI, secondary care HFSNs, 2 research practitioners | Local PI, research administrator | Local PI, secondary care-based HFSN | Local PI |
Setting for recruitment | Study lead nurse recruited from wards or clinics, community HF nurses in the early phase only | Research nurse recruited from CCU and other wards or by letters sent out post-discharge | Recruited by lead HFSN then later by research nurse and community HFSNs from the clinic | 2 research practitioners, secondary care HFSNs and local PI recruited from wards and hospital clinics | By local PI in hospital clinic | By secondary care nurse in hospital clinic | By local PI in hospital clinic |
Clinical profile of participants in this site | As per protocol, no specific distinction described. | As per protocol, no specific distinction described. | Patients were recruited only when ready for discharge from the hospital clinic or HFSN service. | As per protocol, no specific distinction described. | Patients were targeted if they were particularly unwell and deemed in need of monitoring between 6 monthly clinic visits. | In time, with appreciation of RCT design, staff avoided recruitment of any patients deemed too unstable for the control arm. | As per protocol, no specific distinction described. |
How technology use by patients was supported during the trial | By CCM team | By local research nurse, supported by the CCM team | By local research nurse, supported by the CCM team | By local research nurse, supported by the CCM team | By CCM team | By CCM team | By CCM team |
Extent to which the model was integrated into clinical pathways | Initially integrated, later separated due to role overlap | Limited: resistance from both hospital and community HFSNs and GPs | Partial: intention was for participants to be looked after by the CCM team, but sometimes, the hospital HFSN accessed patient data. | Partial: integrated with secondary care only as community HFSN service was resistant | Not integrated: following recruitment, participants were looked after by the CCM team. | Not integrated: following recruitment, participants were looked after by the CCM team. | Not integrated: following recruitment, participants were looked after by the CCM team. |