Exploration and modeling of a longitudinal cross-sector telemedicine and ambulatory wound care intervention in Norway – The CROSTAI model

Chronic wounds pose a growing global health challenge, impacting patients' quality of life and straining health care systems. Grounded in the SEIPS framework, this study presents a longitudinal, whole-system exploration of a novel cross-sectoral intervention combining telemedicine and an ambulatory wound care team for chronic wound management in Norway. Baseline and fieldwork data collected across a regional hospital and six municipalities reveal dualities in organizational readiness and wound care competency, highlighting both barriers and opportunities for improving service delivery. The empirically informed CROSTAI model synthesizes these insights, offering a framework for redesigning health care systems and practices to improve the quality of wound care and patient and system outcomes. The study underscores the need for whole-system approaches to the exploration, planning, and implementation of complex new healthcare interventions, with associated redesign implications. This includes maintaining a continuous balance between negative and positive system outcomes and improving the alignment among organizations, technologies, environments, and actual clinical work, in which co-design, human-centered development, and systems-based evaluation are essential. The CROSTAI model, combined with the systematic research design that supports it, contributes to a broader understanding of human-centered design in complex health care systems and has potential for transferability to explorations in similar contexts.