A Clinical Communication Tool (Loop) for Team-Based Care in Pediatric and Adult Care Settings: Hybrid Mixed Methods Implementation Study

Abstract

Background Communication within the circle of care is central to coordinated, safe, and effective care; yet patients, caregivers, and health care providers often experience poor communication and fragmented care. Through a sequential program of research, the Loop Research Collaborative developed a web-based, asynchronous clinical communication system for team-based care. Loop assembles the circle of care centered on a patient, in private networking spaces called Patient Loops. The patient, their caregiver, or both are part of the Patient Loop. The communication is threaded, it can be filtered and sorted in multiple ways, it is securely stored, and can be exported for upload to a medical record. Objective The objective of this study was to implement and evaluate Loop. The study reporting adheres to the Standards for Reporting Implementation Research. Methods The study was a hybrid type II mixed methods design to simultaneously evaluate Loop’s clinical and implementation effectiveness, and implementation barriers and facilitators in 6 health care sites. Data included monthly user check-in interviews and bimonthly surveys to capture patient or caregiver experience of continuity of care, in-depth interviews to explore barriers and facilitators based on the Consolidated Framework for Implementation Research (CFIR), and Loop usage extracted directly from the Loop system. Results We recruited 25 initiating health care providers across 6 sites who then identified patients or caregivers for recruitment. Of 147 patient or caregiver participants who were assessed and met screening criteria, 57 consented and 52 were enrolled on Loop, creating 52 Patient Loops. Across all Patient Loops, 96 additional health care providers consented to join the Loop teams. Loop usage was followed for up to 8 months. The median number of messages exchanged per team was 1 (range 0-28). The monthly check-in and CFIR interviews showed that although participants acknowledged that Loop could potentially fill a gap, existing modes of communication, workflows, incentives, and the lack of integration with the hospital electronic medical records and patient portals were barriers to its adoption. While participants acknowledged Loop’s potential value for engaging the patient and caregiver, and for improving communication within the patient’s circle of care, Loop’s relative advantage was not realized during the study and there was insufficient tension for change. Missing data limited the analysis of continuity of care. Conclusions Fundamental structural and implementation challenges persist toward realizing Loop’s potential as a shared system of asynchronous communication. Barriers include health information system integration; system, organizational, and individual tension for change; and a fee structure for health care provider compensation for asynchronous communication.

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Scoping review protocol to map the use of text-based two-way communication between patients and healthcare professionals after hospital discharge and identify facilitators and barriers to implementation

“…Some studies focus on patients' and healthcare professionals' perceptions and preferences [24][25][26][27][28] and others on organisational factors that affect acceptance and diffusion of text-based communication. 22 23 Husain et al 22 implemented and evaluated a web-based clinical communication system for team-based care with patients with a focus on facilitators and barriers, but found that even though the system could fill a gap of communication, existing modes of communication, workflows, incentives and lack of integration with electronic medical records were barriers to adoption. Even factors such as individual tension for change among healthcare professionals to use text-based communication with patients made implementation difficult.…”

“…Even factors such as individual tension for change among healthcare professionals to use text-based communication with patients made implementation difficult. 22 Another recent study investigated parents’ usage and experiences of communicating with professionals in hospital-to-home transitions after their child’s preterm birth or surgery related to this, using an eHealth device with embedded online chat, where they could communicate with nurses at the hospital. Even though the parents felt that the eHealth device supported their self-treatment by providing communication with healthcare professionals, the authors described barriers related to the technical infrastructure and to the adoption by healthcare professionals.…”

“…This suggests that there may be barriers to use, as known from other eHealth services 20 21. In a preliminary search of PubMed, we have found studies investigating the use of text-based communication to increase access to healthcare and facilitate two-way dialogue in the period post hospital discharge 14 16 22–24. The identified studies cover diverse patient populations with different focus, study designs and evaluation methods.…”