The study aims to provide a comprehensive set of quality indicators (QIs) for evaluating the quality of OTN Telehomecare Program for patients with heart failure (HF) or chronic obstructive pulmonary disease (COPD).


  1. To conduct a systematic review to identify a set of QIs for evaluating OTN Telehomecare Program among patient with HF or COPD;
  2. To develop a preliminary list of QIs targeting the following domains: patient/caregiver, clinical, technical, services provided to patients, economical, and organizational and social;
  3. To critically appraise and select the final set of QIs using a Delphi panel.   

Design and Methods

Study 1 (Objectives 1&2): A systematic literature review will be conducted to identify all measures used to assess Telehomecare programs in patients with HF or COPD in the following databases: OVID Medline, EMBASE, Cochrane Library, AMED and CINAHL. In terms of types of studies, we will consider randomized controlled trials (RCT), observational, economic evaluation, and systematic review/meta-analysis studies.

Study selection criteria:

  • Population: Patients with HF or COPD, or chronic diseases (if applicable);
  • Intervention: home-based telehealth interventions using audio, or other information and communication technologies to provide patient remote monitoring and care at home, including health coaching sessions;
  • Comparators: usual care.

Criteria used for data extraction and development of the preliminary list of candidate QIs:

  • Solid scientific evidence derived from:
    • systematic reviews or multiple large RCTs;
    • well conducted observational research studies when evidence from RCTs is not available;
    • if neither RCT nor observational study evidence is available, published papers with expert panel consensus might be acceptable;
  • Process/structure measures have established a linkage with health outcomes;
  • Risk adjustment available for outcome measures.

Study 2 (Objective 3): Critical appraisal and selection of the final indicators using a Delphi panel: For the purpose of this project, we will carry a three-round Delphi procedure to rate and select QIs (separately for HF and COPD QIs). We will purposefully select a heterogeneous group of experts to better reflect the variety of stakeholders involved in the Telehomecare program. Healthcare provider and patient panels will be established (1:1 ratio) to ensure that differing views are represented in the final consensus.

Inclusion criteria for healthcare provider panel:

  • Willingness to participate in the panel;
  • Knowledge of the relevant topic;
  • Absence of conflicts of interest;

Inclusion criteria for the patient panel:

  • Having a diagnosis of HF or COPD;
  • Willingness to participate in the panel;
  • Successfully discharged from the Telehomecare program.

Rating of QIs

Healthcare providers will be asked to rate each candidate indicator against a set of five evaluation criteria, including importance, validity, reliability, feasibility, and overall value for inclusion, using a five-point Likert scale with the anchors form ‘strongly disagree’ to ‘strongly agree’. Patients will be asked to rate the importance of each listed indicator using a five-point Likert scale with the anchors form ‘not at all important’ to ‘extremely important’.

Study Timeline

January 2015 – June 2016


A systematic review and development of the preliminary list of quality indicators for HF have been completed.

Research Team

Valeria Rac, MD, PhD
Lusine Abrahamyan, MD, MPH, PhD
Yelena Petrosyan, MD, MPH, PhD
Yeva Sahakyan, MD, MPH
Austin Nam, BSc, MSc
Nida Shahid, HBSc


Ontario Ministry of Health and Long-Term Care (MOHLTC)