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

BackgroundHealthcare 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/designThis 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.DiscussionEvidence 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 registrationClinicalTrials.gov NCT02283723 Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-016-0407-5) contains supplementary material, which is available to authorized users.

Healthcare Quality: A Concept Analysis

“…For example, in a randomized controlled trial conducted by Dolvich et al. (), the primary outcome variable used to measure healthcare quality was a goal attainment scaling score. Additional variables to identify descriptors and measures of healthcare quality were identified in systematic reviews.…”

Comparing Enrolees with Non-Enrolees of Cancer-Patient Navigation at End of Life

“…For people having one of the cancers associated with the longest survival times who die of non-cancer causes, the median interval from last navigation visit to death is about 4 years (breast cancer, 223 weeks; colorectal cancer, 203 weeks; prostate cancer, 195 weeks); for people having one of the cancers associated with the shorter survival times, the interval is less than 1 year (esophageal cancer, 41 weeks; pancreatic cancer, 29 weeks). Navigation by nurses 40 or volunteers 41,42 might provide an ideal means to increase advance care planning for people dying of non-cancer conditions, especially those with advancing non-cancer diseases whose navigation rates are less than 20% (Table ii).…”

Exploration of volunteers as health connectors within a multicomponent primary care‐based program supporting self‐management of diabetes and hypertension

“…Volunteers were integrated into an intervention centred on clients’ prioritised health goals and needs, unique e‐Health technologies, activated interprofessional primary care teams and personalised community resources. This motivational, educational, self‐directed program was based on the Health TAPESTRY approach initially developed and tested with older adults (Dolovich et al, ; Dolovich et al, ; Oliver et al, ).…”