A protocol for a pragmatic randomized controlled trial using the Health Teams Advancing Patient Experience: Strengthening Quality (Health TAPESTRY) platform approach to promote person-focused primary healthcare for older adults

Abstract

Background: Healthcare systems are not well designed to help people maintain or improve their health. They are generally not person-focused or well-coordinated. The objective of this study is to evaluate the effectiveness of the Health Teams Advancing Patient Experience: Strengthening Quality (Health TAPESTRY) approach in older adults. The overarching hypothesis is that using the Health TAPESTRY approach to achieve better integration of the health and social care systems into a person's life that centers on meeting a person's health goals and needs will result in optimal aging.

Methods/design: This is a 12-month delayed intervention pragmatic randomized controlled trial. The study will be performed in Hamilton, Ontario, Canada in the two-site McMaster Family Health Team. Participants will include 316 patients who are 70 years of age or older. Participants will be randomized to the Health TAPESTRY approach or control group. The Health TAPESTRY approach includes intentional, proactive conversations about a person's life and health goals and health risks and then initiation of congruent tailored interventions that support achievement of those goals and addressing of risks through (1) trained volunteers visiting clients in their homes to serve as a link between the primary care team and the client; (2) the use of novel technology including a personal health record from the home to link directly with the primary healthcare team; and (3) improved processes for connections, system navigation, and care delivery among interprofessional primary care teams, community service providers, and informal caregivers. The primary outcome will be the goal attainment scaling score. Secondary outcomes include self-efficacy for managing chronic disease, quality of life, the participant perspective on their own aging, social support, access to health services, comprehensiveness of care, patient empowerment, patient-centeredness, caregiver strain, satisfaction with care, healthcare resource utilization, and cost-effectiveness. Implementation processes will also be evaluated. The main comparative analysis will take place at 6 months.

Discussion: Evidence of the individual elements of the Health TAPESTRY platform has been shown in isolation in the previous research. However, this study will better understand how to best integrate them to maximize the system's transformation of person-focused, primary care for older adults.

Trial registration: ClinicalTrials.gov NCT02283723.

Keywords: Health services research; Healthcare volunteers; Implementation; Integrated care; Interdisciplinary healthcare teams; Older adults; Personal health record; Primary healthcare; Randomized controlled trial.

Fig. 1

Study design. R randomization, T ₀ baseline, T ₆ 6-month time point, T ₁₂ 12-month time point

Fig. 2

Health TAPESTRY process. Volunteers visit clients in their home and use the Health TAP-App to collect information. This information is summarized on a Health TAPESTRY report and is uploaded into the person’s electronic medical record to be shared with the intake team at the clinic. Reports are viewed and an action plan is developed which can include community organizations and resources, volunteer follow-up visit, and follow-up in any nature by healthcare team members and the client using their personal health record. The Health TAPESTRY process continues in an iterative fashion until the participant is discharged from the program