Health TAPESTRY Ontario: A Multi-Site Randomized Controlled Trial Testing Implementation and Reproducibility

Abstract

PURPOSE Health Teams Advancing Patient Experience: Strengthening Quality (Health TAP-ESTRY) is a complex primary care program aimed at assisting older adults to stay healthier for longer. This study evaluated the feasibility of implementation across multiple sites, and the reproducibility of the effects found in the previous randomized controlled trial.METHODS This was a pragmatic, unblinded, 6-month parallel group randomized controlled trial. Participants were randomized (intervention or control) using a computer-generated system. Eligible patients, aged 70 years and older, were rostered to 1 of 6 participating interprofessional primary care practices (urban and rural). In total, 599 (301 intervention, 298 control) patients were recruited from March 2018 through August 2019. Intervention participants received a home visit from volunteers to collect information on physical and mental health, and social context. An interprofessional care team created and implemented a plan of care. The primary outcomes were physical activity and number of hospitalizations. RESULTSBased on the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework, Health TAPESTRY had widespread reach and adoption. In the intention-totreat analysis (257 intervention, 255 control), there were no statistically significant betweengroup differences for hospitalizations (incidence rate ratio = 0.79; 95% CI, 0.48-1.30; P = .35) or total physical activity (mean difference = −0.26; 95% CI, −1.18 to 0.67; P = .58). There were 37 non-study related serious adverse events (19 intervention, 18 control).CONCLUSIONS We found Health TAPESTRY was successfully implemented for patients in diverse primary care practices; however, implementation did not reproduce the effect on hospitalizations and physical activity found in the initial randomized controlled trial.

Cost-effectiveness analysis of health tapestry, a complex primary care program for older adults: a post-hoc analysis

“…Briefly, Health TAPESTRY consists of four main parts: 1) trained volunteers to connect with clients in their home to gather health and social information from clients (i.e., patients enrolled in Health TAPESTRY); 2) interprofessional primary health care teams providing health care services to clients and working with them on meeting their health goals; 3) technology to collect and share information; and 4) community engagement and connections to create links between clients and resources in their communities [ 3 ]. While results showed that Health TAPESTRY was successfully implemented in the six sites, the benefits of the intervention on hospitalizations and physical activity observed in the original trial were not replicated [ 4 ]. With intervention costs of $562 per patient, a trial-based economic evaluation of Health TAPESTRY indicated that the incremental cost-effectiveness of Health TAPESTRY compared to usual care was approximately $150,000 per quality adjusted life years (QALYs) gained [ 4 ].…”

“…While results showed that Health TAPESTRY was successfully implemented in the six sites, the benefits of the intervention on hospitalizations and physical activity observed in the original trial were not replicated [ 4 ]. With intervention costs of $562 per patient, a trial-based economic evaluation of Health TAPESTRY indicated that the incremental cost-effectiveness of Health TAPESTRY compared to usual care was approximately $150,000 per quality adjusted life years (QALYs) gained [ 4 ].…”

“…However, post-hoc analyses [ 4 ] indicated that when compared to usual care, Health TAPESTRY had a beneficial impact on hospitalizations, emergency room visits and health-related quality of life (HRQoL) at the McMaster FHT, the main trial site with approximately 40% of the trial participants. Several factors may explain these differences.…”

Understanding collaborative implementation between community and academic partners in a complex intervention: a qualitative descriptive study

“…We evaluated this implementation scale-up of Health TAPESTRY using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework which included a multi-site randomized controlled trial (RCT) that aimed to assess the reproducibility of the results from the first implementation, and the feasibility of scaling up the program in six sites across Ontario, Canada [ 10 , 11 ]. The results of the full evaluation using the RE-AIM framework are reported in full elsewhere [ 12 ]. In this paper, we discuss the CAP as part of the implementation scale-up of Health TAPESTRY.…”

“…Collaborating between nine partners while implementing a multi-site RCT was a large undertaking. While we used the RE-AIM framework [ 13 ] combined with Normalization Process Theory (NPT) [ 14 ] to understand the overall implementation of Health TAPESTRY and the associated RCT [ 12 ], these frameworks have both broader and different foci than would be needed to understand how the differing groups collaborated to implement Health TAPESTRY. Currently, little is known about what CAP partners’ focus on and discuss during implementation and how that relates to the overall implementation and perception of a program’s success.…”