Health TAPESTRY Ontario: protocol for a randomized controlled trial to test reproducibility and implementation

Mangin, Dee; Lamarche, Larkin; Oliver, Doug; Bomze, Sivan; Borhan, Sayem; Browne, Tracy; Carr, Tracey; Datta, Julie; Dolovich, Lisa; Howard, Michelle; Marentette-Brown, Sarah; Risdon, Cathy; Talat, Samina; Tarride, Jean‐Éric; Thabane, Lehana; Valaitis, Ruta; Price, David

doi:10.1186/s13063-020-04600-y

Cited by 12 publications

(26 citation statements)

References 58 publications

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“…Health TAPESTRY (Teams Advancing Patient Experience: Strengthening Quality) offers an opportunity to describe the development and evolution of ICT as part of a pragmatic complex intervention rooted in primary care. The program creates connections among trained community volunteers, interprofessional primary health care teams, novel technology, and community engagement and connections through improved system navigation [ 12 , 13 ]. The aim is to help older adults stay healthier for longer in the places where they live.…”

Section: Introductionmentioning

confidence: 99%

Lessons Learned Through Two Phases of Developing and Implementing a Technology Supporting Integrated Care: Case Study

et al. 2022

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Background As health care becomes more fragmented, it is even more important to focus on the provision of integrated, coordinated care between health and social care systems. With the aging population, this coordination is even more vital. Information and communication technology (ICT) can support integrated care if the form of technology follows and supports functional integration. Health TAPESTRY (Teams Advancing Patient Experience: Strengthening Quality) is a program centered on the health of older adults, supported by volunteers, primary care teams, community engagement and connections, and an ICT known as the Health TAPESTRY application (TAP-App), a web-based application that supports volunteers in completing client surveys, volunteer coordinators in managing the volunteer program, and primary care teams in requesting and receiving information. Objective This paper describes the development, evolution, and implementation of the TAP-App ICT to share the lessons learned. Methods A case study was conducted with the TAP-App as the case and the perspectives of end users and stakeholders as the units of analysis. The data consisted of researchers’ perspectives on the TAP-App from their own experiences, as well as feedback from other stakeholders and end user groups. Data were collected through written retrospective reflection with the program manager, a specific interview with the technology lead, key emailed questions to the TAP-App developer, and viewpoints and feedback during paper drafting from other research team members. There were 2 iterations of Health TAPESTRY and the TAP-App and we focused on learnings from the second implementation (2018-2020) which was a pragmatic implementation scale-up trial using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework at 6 primary care sites across Ontario, Canada. Results TAP-App (version 1.0), which was iteratively developed, was introduced as a tool to schedule volunteer and client visits and collect survey data using a tablet computer. TAP-App (version 2.0) was developed based on this initial experience and a desire for a program management tool that focused more on dual flow among users and provided better support for research. The themes of the lessons learned were as follows: iterative feedback is valuable; if ICT will be used for research, develop it with research in mind; prepare for challenges in the integration of ICT into the existing workflow; ask whether interoperability should be a goal; and know that technology cannot do it alone yet—the importance of human touch points. Conclusions Health TAPESTRY is human-centered. The TAP-App does not replace these elements but rather helps enable them. Despite this shift in supporting integrated care, barriers remained to the uptake of the TAP-App that would have allowed a full flow of information between health and social settings in supporting patient care. This indicates the need for an ongoing focus on the human use of ICT in similar programs.

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Section: Introductionmentioning

confidence: 99%

Lessons Learned Through Two Phases of Developing and Implementing a Technology Supporting Integrated Care: Case Study

et al. 2022

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“…Although technology rapidly changes, GENIE’s main functions remain relevant in addressing current challenges in primary care. In addition, the use of volunteers in primary care is a more recent innovation that continues to be tested [ 58 ], and we believe that this study is relevant today. Moreover, the implementation of GENIE occurred in the context of the Health TAPESTRY program.…”

Section: Discussionmentioning

confidence: 99%

A Web-Based Social Network Tool (GENIE) for Supporting Self-management Among High Users of the Health Care System: Feasibility and Usability Study

Valaitis¹,

Cleghorn²,

Vassilev³

et al. 2021

JMIR Form Res

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Background Primary care providers are well positioned to foster self-management through linking patients to community-based health and social services (HSSs). This study evaluated a web-based tool—GENIE (Generating Engagement in Network Involvement)—to support the self-management of adults. GENIE empowers patients to leverage their personal social networks and increase their access to HSSs. GENIE maps patients’ personal social networks, elicits preferences, and filters local HSSs from a community service directory based on patient’s interests. Trained volunteers (an extension of the primary care team) conducted home visits and conducted surveys related to life and health goals in the context of the Health TAPESTRY (Teams Advancing Patient Experience: Strengthening Quality) program, in which the GENIE tool was implemented. GENIE reports were uploaded to an electronic medical record for care planning by the team. Objective This study aims to explore patients’, volunteers’, and clinicians’ perceptions of the feasibility, usability, and perceived outcomes of GENIE—a tool for community-dwelling adults who are high users of the health care system. Methods This study involved 2 primary care clinician focus groups and 1 clinician interview (n=15), 1 volunteer focus group (n=3), patient telephone interviews (n=8), field observations that captured goal-action sequences to complete GENIE, and GENIE utilization statistics. The patients were enrolled in a primary care program—Health TAPESTRY—and Ontario’s Health Links Program, which coordinates care for the highest users of the health care system. NVivo 11 (QSR International) was used to support qualitative data analyses related to feasibility and perceived outcomes, and descriptive statistics were used for quantitative data. Results Most participants reported positive overall perceptions of GENIE. However, feasibility testing showed that participants had a partial understanding of the tool; volunteer facilitation was critical to support the implementation of GENIE; clinicians perceived their navigation ability as superior to that of GENIE supported by volunteers; and tool completion took 39 minutes, which made the home visit too long for some. Usability challenges included difficulties completing some sections of the tool related to medical terminology and unclear instructions, limitations in the quality and quantity of HSSs results, and minor technological challenges. Almost all patients identified a community program or activity of interest. Half of the patients (4/8, 50%) followed up on HSSs and added new members to their network, whereas 1 participant lost a member. Clinicians’ strengthened their understanding of patients’ personal social networks and needs, and patients felt less social isolation. Conclusions This study demonstrated the potential of GENIE, when supported by volunteers, to expand patients’ social networks and link them to relevant HSSs. Volunteers require training to implement GENIE for self-management support, which may help overcome the time limitations faced by primary care clinicians. Refining the filtering capability of GENIE to address adults’ needs may improve primary care providers’ confidence in using such tools.

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“…In Health TAPESTRY, two trained volunteers visit older adult clients in their homes and use structured surveys to ask about clients’ health needs, goals, and social context [ 5 ]. Client responses are entered into a web-based application (the TAP-App) using a tablet computer.…”

Section: Methodsmentioning

confidence: 99%

“…Health TAPESTRY has four key parts that have been identified in previous published work: 1) trained community volunteers who meet with clients in their homes and gather health and social information; 2) the use of technology for collecting and sharing information between clients, volunteers, and the health care team; 3) interprofessional primary health care teams who support clients with their health goals and needs; and 4) community engagement and connections; all of these parts encircle the client [ 5 , 6 , 35 ]. Based on the previous implementation and evaluation of the program, including implementer, participant, and stakeholder consultation, these have been identified as the core intervention components.…”

Section: Methodsmentioning

confidence: 99%

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Understanding how context and culture in six communities can shape implementation of a complex intervention: a comparative case study

Gaber

Datta

Clark

et al. 2022

BMC Health Serv Res

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Background Contextual factors can act as barriers or facilitators to scaling-up health care interventions, but there is limited understanding of how context and local culture can lead to differences in implementation of complex interventions with multiple stakeholder groups. This study aimed to explore and describe the nature of and differences between communities implementing Health TAPESTRY, a complex primary care intervention aiming to keep older adults healthier in their homes for longer, as it was scaled beyond its initial effectiveness trial. Methods We conducted a comparative case study with six communities in Ontario, Canada implementing Health TAPESTRY. We focused on differences between three key elements: interprofessional primary care teams, volunteer program coordination, and the client experience. Sources of data included semi-structured focus groups and interviews. Data were analyzed through the steps of thematic analysis. We then created matrices in NVivo by splitting the qualitative data by community and comparing across the key elements of the Health TAPESTRY intervention. Results Overall 135 people participated (39 clients, 8 clinical managers, 59 health providers, 6 volunteer coordinators, and 23 volunteers). The six communities had differences in size and composition of both their primary care practices and communities, and how the volunteer program and Health TAPESTRY were implemented. Distinctions between communities relating to the work of the interprofessional teams included characteristics of the huddle lead, involvement of physicians and the volunteer coordinator, and clarity of providers’ role with Health TAPESTRY. Key differences between communities relating to volunteer program coordination included the relationship between the volunteers and primary care practices, volunteer coordinator characteristics, volunteer training, and connections with the community. Differences regarding the client experience between communities included differing approaches used in implementation, such as recruitment methods. Conclusions Although all six communities had the same key program elements, implementation differed community-by-community. Key aspects that seemed to lead to differences across categories included the size and spread of communities, size of primary care practices, and linkages between program elements. We suggest future programs engaging stakeholders from the beginning and provide clear roles; target the most appropriate clients; and consider the size of communities and practices in implementation. Trial registration ClinicalTrials.gov: NCT03397836.

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Health TAPESTRY Ontario: protocol for a randomized controlled trial to test reproducibility and implementation

Cited by 12 publications

References 58 publications

Lessons Learned Through Two Phases of Developing and Implementing a Technology Supporting Integrated Care: Case Study

Lessons Learned Through Two Phases of Developing and Implementing a Technology Supporting Integrated Care: Case Study

A Web-Based Social Network Tool (GENIE) for Supporting Self-management Among High Users of the Health Care System: Feasibility and Usability Study

Understanding how context and culture in six communities can shape implementation of a complex intervention: a comparative case study

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