{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T11:50:43Z","timestamp":1782301843288,"version":"3.54.5"},"update-to":[{"DOI":"10.3310\/nihropenres.14008.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T00:00:00Z","timestamp":1780531200000}}],"reference-count":45,"publisher":"National Institute for Health and Care Research","license":[{"start":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T00:00:00Z","timestamp":1780531200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.nationalarchives.gov.uk\/doc\/open-government-licence\/version\/3\/"}],"funder":[{"name":"National Institute for Health and Social Care Research","award":["154231"],"award-info":[{"award-number":["154231"]}]}],"content-domain":{"domain":["openresearch.nihr.ac.uk"],"crossmark-restriction":false},"short-container-title":["NIHR Open Res"],"abstract":"<ns5:p>Background High blood pressure (BP) is a leading cause of morbidity and mortality. Blood pressure home monitoring improves blood pressure control, but there is limited evidence about the implementation of specifically \u2018technology-enabled\u2019 remote monitoring of blood pressure (TERM BP) at home. This evaluation aims to improve the evidence base on what constitutes TERM BP services, how they work, and what influences their implementation, impacts, spread, and scale. Methods A multi-method, rapid qualitative evaluation involved four sites that implemented TERM BP. Across sites, we conducted interviews with staff (n\u00a0=\u00a035) and patients (n\u00a0=\u00a015) and analyzed key service documents. Three workshops with site staff, patients, and regional and national stakeholders helped refine the learning process. Thematic analysis and synthesis, and triangulation against existing literature, helped inform recommendations and was guided by the Non-adoption, Abandonment, and challenges to Scale-up, Spread and Sustainability of the technology framework. Patient and public voices informed the evaluation design and conduct. Results TERM BP implementation varies in governance, patient eligibility, technology, workforce, and workflow. Perceived impacts include improved blood pressure control, case-finding, and a more efficient workload distribution. The parallel running of technology-enabled and paper-based pathways mitigates access inequalities, but involves a high administrative workload. Sociotechnical influences on implementation relate to technology user-friendliness and adaptability, health system relationships and resources, practice capabilities and learning cultures, and patient acceptability and enablement. Flexibility within a planned, gradual approach that embeds skills in teams and systems and impacts evidence generation support scale and spread. Conclusions Technology and social forces co-evolve to shape TERM BP pathways and manage co-existing tensions, including planning, emergence, demand, and capacity. Decision makers should establish implementation guidance and commissioning criteria, address regulatory issues, and enable evidence generation and shared learning. Further research is needed on the impact of TERM BP, especially in integrated care and related to inequalities.<\/ns5:p>","DOI":"10.3310\/nihropenres.14008.2","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T11:24:08Z","timestamp":1782300248000},"page":"81","update-policy":"https:\/\/doi.org\/10.3310\/nihropenres.crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Enabling scale and spread of technology-enabled remote monitoring of blood pressure at home: findings from a rapid qualitative evaluation"],"prefix":"10.3310","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9951-6626","authenticated-orcid":false,"given":"Frances","family":"Wu","sequence":"first","affiliation":[{"name":"Cambridge England CB2 8BF RAND Europe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saoirse","family":"Moriarty","sequence":"additional","affiliation":[{"name":"Cambridge England CB2 8BF RAND Europe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7245-1759","authenticated-orcid":false,"given":"Hampton","family":"Toole","sequence":"additional","affiliation":[{"name":"Cambridge England CB2 8BF RAND Europe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7701-4783","authenticated-orcid":false,"given":"Joseph","family":"Wherton","sequence":"additional","affiliation":[{"name":"Oxford England OX2 6GG University of Oxford Nuffield Department of Primary Care Health Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9567-7193","authenticated-orcid":false,"given":"Damon","family":"Mohebbi","sequence":"additional","affiliation":[{"name":"Oxford England OX2 6GG University of Oxford Nuffield Department of Primary Care Health Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James P","family":"Sheppard","sequence":"additional","affiliation":[{"name":"Oxford England OX2 6GG University of Oxford Nuffield Department of Primary Care Health Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7014-4793","authenticated-orcid":false,"given":"Sara E","family":"Shaw","sequence":"additional","affiliation":[{"name":"Oxford England OX2 6GG University of Oxford Nuffield Department of Primary Care Health Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6956-2007","authenticated-orcid":false,"given":"Sonja","family":"Marjanovic","sequence":"additional","affiliation":[{"name":"Cambridge England CB2 8BF RAND Europe"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"6221","published-online":{"date-parts":[[2026,6,4]]},"reference":[{"key":"ref2","doi-asserted-by":"publisher","first-page":"419-26","DOI":"10.1007\/5584_2016_99","article-title":"Hypertension is a risk factor for several types of heart disease: review of prospective studies.","volume":"956","author":"Y Kokubo","year":"2017","journal-title":"Adv Exp Med Biol."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"957-967","DOI":"10.1016\/S0140-6736(15)01225-8","article-title":"Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis.","volume":"387","author":"D Ettehad","year":"2016","journal-title":"Lancet."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"285-292","DOI":"10.1161\/HYPERTENSIONAHA.119.14240","article-title":"High blood pressure and cardiovascular disease.","volume":"75","author":"F Fuchs","year":"2020","journal-title":"Hypertension."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"28-36","DOI":"10.1001\/jamainternmed.2017.6015","article-title":"Association of blood pressure lowering with mortality and cardiovascular disease across blood pressure levels: a systematic review and meta-analysis.","volume":"178","author":"M Brunstr\u00f6m","year":"2018","journal-title":"JAMA Intern Med."},{"key":"ref7","doi-asserted-by":"publisher","first-page":"262-269","DOI":"10.1016\/j.ijcard.2021.01.070","article-title":"Current challenges for hypertension management: from better hypertension diagnosis to improved patients' adherence and blood pressure control.","volume":"331","author":"G Parati","year":"2021","journal-title":"Int J Cardiol."},{"key":"ref8","doi-asserted-by":"publisher","first-page":"e001461","DOI":"10.1136\/openhrt-2020-001461","article-title":"Prevalence and determinants of hypertension control among almost 100 000 treated adults in the UK.","volume":"8","author":"N Tapela","year":"2021","journal-title":"Open Heart."},{"key":"ref10","article-title":"Evaluation of the BP@Home initiative across south east and south west London.","year":"2023"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"m4858","DOI":"10.1136\/bmj.m4858","article-title":"Home and Online Management and Evaluation of Blood Pressure (HOME BP) using a digital intervention in poorly controlled hypertension: Randomised Controlled Trial.","volume":"372","author":"R McManus","year":"2021","journal-title":"BMJ."},{"key":"ref12","article-title":"Blood pressure optimisation programme: impact report.","year":"2023","journal-title":"The AHSN Network."},{"key":"ref13","doi-asserted-by":"publisher","first-page":"e1002389","DOI":"10.1371\/journal.pmed.1002389","article-title":"Self-monitoring of blood pressure in hypertension: a systematic review and individual patient data meta-analysis.","volume":"14","author":"K Tucker","year":"2017","journal-title":"PLoS Med."},{"key":"ref14","article-title":"CVD prevent: data & improvement tool.","year":"2024","journal-title":"NHS England."},{"key":"ref16","article-title":"Independent investigation of the National Health Service in England.","year":"2024"},{"key":"ref18","article-title":"Scale-up BP final evaluation.","author":"H Alexander","year":"2022","journal-title":"TEC."},{"key":"ref19","article-title":"Connect me for clinicians.","year":"2024"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.17605\/OSF.IO\/G8A6M","article-title":"Potential for scale and spread of technology-enabled remote monitoring of blood pressure at home.","author":"F Wu","year":"2025","journal-title":"Open Sci."},{"key":"ref22","article-title":"The public's experience of monitoring their blood pressure at home.","year":"2022"},{"key":"ref23","article-title":"Benefits, research and evaluation team delivery hub blood pressure monitoring @Home Trailblazer sites evaluation.","author":"G Solomons","year":"2022"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"949-959","DOI":"10.1016\/S0140-6736(18)30309-X","article-title":"Efficacy of self-monitored blood pressure, with or without telemonitoring, for titration of antihypertensive medication (TASMINH4): an unmasked Randomised Controlled Trial.","volume":"391","author":"R McManus","year":"2018","journal-title":"Lancet."},{"key":"ref25","doi-asserted-by":"publisher","first-page":"163-172","DOI":"10.1016\/S0140-6736(10)60964-6","article-title":"Telemonitoring and self-management in the control of hypertension (TASMINH2): a Randomised Controlled Trial.","volume":"376","author":"R McManus","year":"2010","journal-title":"Lancet."},{"key":"ref26","doi-asserted-by":"publisher","first-page":"799-808","DOI":"10.1001\/jama.2014.10057","article-title":"Effect of self-monitoring and medication self-titration on systolic blood pressure in hypertensive patients at high risk of cardiovascular disease: the TASMIN-SR randomized clinical trial.","volume":"312","author":"R McManus","year":"2014","journal-title":"JAMA."},{"key":"ref27","doi-asserted-by":"publisher","first-page":"356-364","DOI":"10.1161\/HYPERTENSIONAHA.119.13926","article-title":"Impact of changes to national hypertension guidelines on hypertension management and outcomes in the United Kingdom.","volume":"75","author":"S Lay-Flurrie","year":"2020","journal-title":"Hypertension."},{"key":"ref28","doi-asserted-by":"publisher","first-page":"f3030","DOI":"10.1136\/bmj.f3030","article-title":"Telemonitoring based service redesign for the management of uncontrolled hypertension: multicentre Randomised Controlled Trial.","volume":"346","author":"B McKinstry","year":"2013","journal-title":"BMJ."},{"key":"ref29","doi-asserted-by":"publisher","first-page":"e1003124","DOI":"10.1371\/journal.pmed.1003124","article-title":"Telemonitoring at scale for hypertension in primary care: an implementation study.","volume":"17","author":"V Hammersley","year":"2020","journal-title":"PLoS Med."},{"key":"ref30","doi-asserted-by":"publisher","first-page":"1517-1530","DOI":"10.1177\/2047487313501886","article-title":"Telemonitoring and self-management in the control of hypertension (TASMINH2): a cost-effectiveness analysis.","volume":"21","author":"B Kaambwa","year":"2014","journal-title":"Eur J Prev Cardiol."},{"key":"ref31","doi-asserted-by":"publisher","first-page":"1231-1239","DOI":"10.1161\/HYPERTENSIONAHA.118.12415","article-title":"Cost-effectiveness of telemonitoring and self-monitoring of blood pressure for antihypertensive titration in primary care (TASMINH4).","volume":"73","author":"M Monahan","year":"2019","journal-title":"Hypertension."},{"key":"ref32","doi-asserted-by":"publisher","first-page":"e002681","DOI":"10.1136\/bmjopen-2013-002681","article-title":"Telemonitoring-based service redesign for the management of uncontrolled hypertension (HITS): cost and cost-effectiveness analysis of a Randomised Controlled Trial.","volume":"3","author":"A Stoddart","year":"2013","journal-title":"BMJ Open."},{"key":"ref33","doi-asserted-by":"publisher","first-page":"e0298898","DOI":"10.1371\/journal.pone.0298898","article-title":"Investigating barriers & facilitators for the successful implementation of the BP@home initiative in London: primary care perspectives.","volume":"19","author":"E Riboli-Sasco","year":"2024","journal-title":"PLoS One."},{"key":"ref34","doi-asserted-by":"publisher","DOI":"10.1017\/9781009326049","article-title":"Approaches to spread, scale-up, and sustainability.","author":"C Papoutsi","year":"2024","journal-title":"Elements of Improving Quality and Safety in Healthcare."},{"key":"ref35","doi-asserted-by":"publisher","first-page":"581-629","DOI":"10.1111\/j.0887-378X.2004.00325.x","article-title":"Diffusion of innovations in service organizations: systematic review and recommendations.","volume":"82","author":"T Greenhalgh","year":"2004","journal-title":"Milbank Q."},{"key":"ref36","doi-asserted-by":"publisher","first-page":"e16861","DOI":"10.2196\/16861","article-title":"The NASSS-CAT tools for understanding, guiding, monitoring, and researching technology implementation projects in health and social care: protocol for an evaluation study in real-world settings.","volume":"9","author":"T Greenhalgh","year":"2020","journal-title":"JMIR Res Protoc."},{"key":"ref37","doi-asserted-by":"publisher","first-page":"e23775","DOI":"10.2196\/23775","article-title":"Spread, scale-up, and sustainability of video consulting in health care: systematic review and synthesis guided by the NASSS framework.","volume":"23","author":"H James","year":"2021","journal-title":"J Med Internet Res."},{"key":"ref38","article-title":"Rapid assessment process: an introduction.","author":"J Beebe","year":"2001","journal-title":"Rowman Altamira."},{"key":"ref39","doi-asserted-by":"publisher","first-page":"1-47","DOI":"10.3310\/BTNU5673","article-title":"Rapid evaluation of service innovations in health and social care: key considerations.","volume":"11","author":"J Smith","year":"2023","journal-title":"Health Soc Care Deliv Res."},{"key":"ref40","doi-asserted-by":"publisher","first-page":"510-540","DOI":"10.2307\/258786","article-title":"Explaining development and change in organizations.","volume":"20","author":"A Ven","year":"1995","journal-title":"Acad Manage Rev."},{"key":"ref41","doi-asserted-by":"publisher","first-page":"72-88","DOI":"10.2307\/2392227","article-title":"Interorganizational dialectics.","volume":"25","author":"G Zeitz","year":"1980","journal-title":"Adm Sci Q."},{"key":"ref42","doi-asserted-by":"publisher","first-page":"56-69","DOI":"10.1287\/orsc.1030.0037","article-title":"On the dialectics of strategic alliances.","volume":"15","author":"M Rond","year":"2004","journal-title":"Organization Science."},{"key":"ref43","doi-asserted-by":"publisher","first-page":"24-40","DOI":"10.1016\/j.eist.2011.02.002","article-title":"The multi-level perspective on sustainability transitions: responses to seven criticisms.","volume":"1","author":"F Geels","year":"2011","journal-title":"Environ Innov Soc Transitions."},{"key":"ref44","doi-asserted-by":"publisher","first-page":"897-920","DOI":"10.1016\/j.respol.2004.01.015","article-title":"From sectoral systems of innovation to socio-technical systems: insights about dynamics and change from sociology and institutional theory.","volume":"33","author":"F Geels","year":"2004","journal-title":"Res Policy."},{"key":"ref45","doi-asserted-by":"publisher","first-page":"48-75","DOI":"10.4337\/9781845423421.00013","volume":"44","author":"F Berkhout","year":"2004","journal-title":"System Innovation and The Transition to Sustainability: Theory, Evidence and Policy."},{"key":"ref46","doi-asserted-by":"publisher","first-page":"772-791","DOI":"10.1016\/j.respol.2013.10.010","article-title":"The structuration of socio-technical regimes\u2014Conceptual foundations from institutional theory.","volume":"43","author":"L Fuenfschilling","year":"2014","journal-title":"Research Policy."},{"key":"ref47","doi-asserted-by":"publisher","first-page":"28","DOI":"10.3310\/nihropenres.13842.1","article-title":"Digitally Enabled Care in Diverse Environments (DECIDE): protocol for a programme of rapid evaluation of technology-enabled remote monitoring in health and social care [version 1; peer review: 1 approved, 1 approved with reservations].","volume":"5","author":"S Shaw","year":"2025","journal-title":"NIHR Open Res."},{"key":"ref48","article-title":"Working together to provide the care that\u2019s right for you.","year":"2025"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"e612-e620","DOI":"10.3399\/bjgp19X704585","article-title":"Using mHealth for the management of hypertension in UK primary care: an embedded qualitative study of the TASMINH4 Randomised Controlled Trial.","volume":"69","author":"S Grant","year":"2019","journal-title":"Br J Gen Pract."},{"key":"ref57","doi-asserted-by":"publisher","first-page":"399-417","DOI":"10.1016\/j.respol.2007.01.003","article-title":"Typology of sociotechnical transition pathways.","volume":"36","author":"F Geels","year":"2007","journal-title":"Res Policy."},{"key":"ref59","doi-asserted-by":"publisher","first-page":"283-297","DOI":"10.1093\/scipol\/scaa005","article-title":"Innovating for improved healthcare: sociotechnical and innovation systems perspectives and lessons from the NHS.","volume":"47","author":"S Marjanovic","year":"2020","journal-title":"Sci Public Policy."}],"container-title":["NIHR Open 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status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.3310\/nihropenres.15231.r37523, Eduard Shantsila, University of Liverpool, Liverpool, England, 25 Oct 2025, version 1, 1 approved, 1 approved with reservations","URL":"https:\/\/openresearch.nihr.ac.uk\/articles\/5-81\/v1#referee-response-37523","order":0,"name":"referee-response-37523","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Frances Wu<\/b>; \n<i>Posted: 04 Jun 2026<\/i>; \n<b>Article 14008: Enabling scale and spread of technology-enabled remote monitoring of blood pressure at home: findings from a rapid qualitative evaluation<\/b>  We thank the reviewer for their constructive and thoughtful comments and suggestions. We are pleased that the richness, relevance and usefulness of the paper is reflected in the feedback.  We are delighted to enclose a revised manuscript address reviewers\u2019 points. We append to this letter a table detailing our responses and the changes we have made to the paper.  We look forward to hearing from you again in due course.  Kind regards    \n<b>Reviewer 1 Comments and Response to Comments<\/b>   \n<b>Comment:<\/b> Page. 4. 'Based on 18 papers from peer-reviewed literature and 12 papers from grey literature, we found that all BP remote monitoring, also known as 'home BP monitoring' or 'self-monitoring,' relies on some form of technology, such as upper arm blood pressure machines.' BP measurements require BP machines by definition. Please revise the statement. \n<b>Response: <\/b>We have now edited and clarified the statement while remaining aligned to the way we conceptualise technology-enabled remote monitoring. It now reads: \u201cBlood pressure monitoring always requires a blood pressure measurement device, such as an upper arm blood pressure machine. Remote monitoring, also known as \u2018home BP monitoring\u2019 or \u2018self-monitoring\u2019 therefore always relies on some form of technology, but the level of technology-enablement can vary.\u201d  \n<b>Comment:&nbsp;<\/b>'Compared to usual care, both paper based and TERM BP approaches were found to control BP effectively.' TERM BP provides BP measurements rather than achieving BP control itself. Please revise. \n<b>Response:&nbsp;<\/b>We consider TERM BP as a service and not just technological process but agree with the reviewer\u2019s comment. We have now revised this to say: \u201cCompared to usual care, both paper-based and TERM BP approaches were found to be helpful in efforts to effectively control BP.\u201d  \n<b>Comment:&nbsp;<\/b>The study acknowledges the diversity of TERM BP designs. While it would be challenging to provide information for all aspects of every design, it would be helpful to consistently consider the usability of technologies for hypertension diagnosis and hypertension management. \n<b>Response:&nbsp;<\/b>Thank you for the comment. We have now more explicitly reflected on technology usability in the influences section with as much information as we have collected in the study, as well as now provided a summary table of pathway stages and designs.  \n<b>Comment:&nbsp;<\/b>The team undertook a focused document review of TERM BP service planning or operational documents (2\u20133 per site). This is a small sample, and the findings may change significantly if more records, practices and country regions were explored. The discussion can benefit from consideration of reports of the BP@home programme. \n<b>Response:&nbsp;<\/b>We have clarified this. The focused document review section in methods refers to study site documentation and which has been triangulated against the wider literature on the topic (including information related to BP@home). We have explained this in the methods section of the paper, under the Analysis subsection. When making final inferences from our evaluation, this information was triangulated with insights from other case study information sources and the wider literature). It is also worth noting that the paper provides reference to the full literature review in the Open Science Framework data repository: https:\/\/osf.io\/g8a6m\/files\/osfstorage\/68550a1ce0d018106bd16536  \n<b>Comment:&nbsp;<\/b>Consideration should be given to how the COVID-19 pandemic's exit influenced the practice of TERM BP. \n<b>Response:&nbsp;<\/b>Thank you for the comment. We have provided information on the impact of COVID-19, to the extent we can based on the evidence gathered, and especially in the section on the motivations for TERM BP. While the key insights we gained have to do with the growing use of TERM BP was catalysed by the COVID-19 pandemic which led to a growing recourse to remote care, we have also clarified that post pandemic, the practice of remote monitoring has also been attuned to wider policy initiatives to support health system transformation including the growing focus on more digitally-enabled care and growing patient acceptance of digital care.  \n<b>Comment:&nbsp;<\/b>The included practices did not use the popular approach of the onboarding done by 'health coaches'. Please consider the implications of the approach, and the consideration of value for education as part of TERM BP, particularly in relation to the statement 'A few staff members at South Coast PCN noted that not all were motivated by such potential benefits.' \n<b>Response:&nbsp;<\/b>Thank you. This was not prominent in the literature covered in the scope of the work on TERM BP and in the findings from primary data collection, but we have now acknowledged this as an area where further research is needed. Specifically, in the conclusion section, we now comment on the need for further research into into the role that other interventions (e.g. such as health coaches for promoting behavioural and lifestyle change) in combination with remote blood pressure monitoring can have in optimising implementation of remote monitoring (e.g. adherence) and impacts (e.g. blood pressure control).  \n<b>Comment:&nbsp;<\/b>The study identified the limited consideration for inequalities. It would be helpful to consider the impact of specific inequities, to identify those that need to be addressed explicitly in the future as part of service design, research and developing new technologies. \n<b>Response:&nbsp;<\/b>The section on inequalities and our findings related to this topic do not include insights on the impact of specific inequities as it was outside the scope of the work conducted. The findings also point to the importance of considering the combination of inequalities. We have now however strengthened the reflection on this issue in the conclusion section and note that future research would also benefit from insights stemming from more diverse patient populations, such as exploring the uptake or abandonment of TERM BP for patients with multiple markers of disadvantage, and digging deeper into the ways through which diverse inequalities in access can be mitigated or managed - be they related to digital exclusion, socioeconomic, cognitive and physical or cultural traits.  \n<b>Comment:&nbsp;<\/b>BP device maintenance for TERM BP is not well regulated; it would be beneficial to incorporate related practices in the included GP surgeries, if available. \n<b>Response:&nbsp;<\/b>Unfortunately we do not have information on this available but it would be interesting to know, perhaps in future research.","URL":"https:\/\/openresearch.nihr.ac.uk\/articles\/5-81\/v2#referee-comment-3593","order":1,"name":"referee-comment-3593","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.3310\/nihropenres.15638.r40688, Musab S. Hommos, Mayo Clinic, Scottsdale, 24 Jun 2026, version 2, indexed","URL":"https:\/\/openresearch.nihr.ac.uk\/articles\/5-81\/v2#referee-response-40688","order":2,"name":"referee-response-40688","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"This project is funded by the National Institute for Health and Social Care Research under its grant no.154231. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":3,"name":"grant-information","label":"Grant Information"},{"value":"This open access work is licensed under the Open Government Licence v3.0.","order":0,"name":"copyright-info","label":"Copyright"}]}}