Design, implementation and evaluation of a nurse-led telehealth triage protocol for chronic disease management

Thesis Abstract

The study addresses the growing demand for timely, accessible, and cost-effective chronic disease management by investigating a nurse-led telehealth triage protocol designed to optimize patient outcomes and resource utilization in primary care. Despite increases in telehealth adoption, there is limited high-quality evidence on structured triage protocols led by nurses that integrate chronic disease guidelines, patient self-management support, and real-time clinical decision-making. The aim is to design, implement, and evaluate a nurse-led telehealth triage protocol for chronic disease management, with specific objectives (1) to develop a standardized triage protocol anchored in the Chronic Care Model and the 5A framework (Ask, Advise, Assess, Assist, Arrange) adapted for telehealth; (2) to assess feasibility, fidelity, and acceptability among patients and clinicians; (3) to determine the protocol’s effectiveness on clinical outcomes (blood pressure, HbA1c, lipid profiles), service utilization (emergency visits, hospital admissions), and patient-reported outcomes (self-efficacy, quality of life); (4) to identify barriers and facilitators to implementation; and (5) to generate a scalable implementation framework for broader rollout. A mixed-methods, sequential explanatory design will be employed. In the quantitative phase, a quasi-experimental design will compare intervention and control groups across 12 months, enrolling 420 adults with hypertension, diabetes, and/or hyperlipidemia from four urban primary care clinics. Data collection will include clinical markers (BP, HbA1c, LDL-C), healthcare utilization, and patient-reported outcomes (Self-Efficacy for Chronic Disease Management Scale, EQ-5D-5L). Analyses will use multilevel linear and logistic regression to adjust for clustering at the clinic level and potential confounders. Time-series analyses will examine trends in emergency visits and hospitalizations. In the qualitative phase, purposive sampling will recruit 30 patients and 20 clinicians to participate in semi-structured interviews and 6 focus groups to explore perceived usefulness, acceptability, and fidelity. Thematic analysis will be guided by the Consolidated Framework for Implementation Research (CFIR) to elucidate contextual determinants of adoption. Integration of quantitative and qualitative findings will occur through joint display techniques to interpret how fidelity and context influence outcomes. Ethical approval will be secured from the university’s ethics committee, with informed consent obtained from all participants. Data integrity will be maintained via secure, encrypted data storage and de-identified datasets for analysis. Validity and reliability will be ensured through pilot testing of the triage protocol, inter-rater reliability checks for nurse assessments, and triangulation across data sources. Expected findings anticipate that the nurse-led telehealth triage protocol will improve blood pressure control, glycemic management, and lipid levels, reduce unscheduled healthcare utilization, and enhance patient self-management and quality of life compared with standard care. It is hypothesized that higher fidelity to the protocol and greater clinician support will correlate with better outcomes, moderated by patient health literacy and access to technology. The study contributes to knowledge by providing rigorous, context-rich evidence on a scalable, nurse-driven telehealth model that integrates guideline-based triage, person-centered care, and continuous monitoring. It will articulate a detailed implementation framework, including training requirements, workflow redesign, information technology needs, patient engagement strategies, and metrics for ongoing evaluation. The primary conclusion is that a structured nurse-led telehealth triage protocol is an effective and feasible approach to chronic disease management in primary care when integrated with supportive organizational processes and patient-centered communication. Recommendations include adopting the protocol within diverse primary care settings, investing in nurse training and telehealth infrastructure, and tailoring implementation to local contexts. Directions for future research include long-term sustainability studies, cost-effectiveness analyses, and exploration of protocol adaptation for other chronic conditions and populations.