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      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

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          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

          Electronic supplementary material

          The online version of this article (doi:10.1186/s13012-016-0407-5) contains supplementary material, which is available to authorized users.

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          Most cited references60

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          A Coefficient of Agreement for Nominal Scales

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            Goal setting and task performance: 1969-1980.

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              The Zarit Burden Interview: a new short version and screening version.

              The purpose of the study was to develop a short and a screening version of the Zarit Burden Interview (ZBI) that would be suitable across diagnostic groups of cognitively impaired older adults, and that could be used for cross-sectional, longitudinal, and intervention studies. We used data from 413 caregivers of cognitively impaired older adults referred to a memory clinic. We collected information on caregiver burden with the 22-item ZBI, and information about dependence in activities of daily living (ADLs) and the frequency of problem behaviors among care recipients. We used factor analysis and item-total correlations to reduce the number of items while taking into consideration diagnosis and change scores. We produced a 12-item version (short) and a 4-item version (screening) of the ZBI. Correlations between the short and the full version ranged from 0.92 to 0.97, and from 0.83 to 0.93 for the screening version. Correlations between the three versions and ADL and problem behaviors were similar. We further investigated the behavior of the short version with a two-way analysis of variance and found that it produced identical results to the full version. The short and screening versions of the ZBI produced results comparable to those of the full version. Reducing the number of items did not affect the properties of the ZBI, and it may lead to easier administration of the instrument.
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                Author and article information

                Contributors
                (905) 525-9140 , ldolovic@mcmaster.ca
                Journal
                Implement Sci
                Implement Sci
                Implementation Science : IS
                BioMed Central (London )
                1748-5908
                5 April 2016
                5 April 2016
                2015
                : 11
                : 49
                Affiliations
                [ ]Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th floor, Hamilton, ON L8P 1H6 Canada
                [ ]McMaster Family Health Team, Hamilton, Canada
                [ ]School of Nursing, McMaster University, Hamilton, Canada
                [ ]Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
                [ ]Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
                [ ]Department of Medicine, McMaster University, Hamilton, Canada
                [ ]School of Rehabilitation Science, McMaster University, Hamilton, Canada
                [ ]Institute of Health Management and Policy, University of Toronto, Toronto, Canada
                Article
                407
                10.1186/s13012-016-0407-5
                4820854
                27044360
                96131e8d-7ab8-43df-8acc-db0ef091983b
                © Dolovich et al. 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 26 January 2016
                : 12 March 2016
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100000008, Health Canada;
                Award ID: 6817-06-2013/5570001
                Award Recipient :
                Funded by: Government of Ontario
                Award ID: 06547
                Award Recipient :
                Funded by: Labarge Optimal Aging Initiative
                Funded by: McMaster Family Health Organization
                Funded by: Department of Family Medicine at McMaster University
                Categories
                Study Protocol
                Custom metadata
                © The Author(s) 2016

                Medicine
                primary healthcare,older adults,randomized controlled trial,integrated care,healthcare volunteers,interdisciplinary healthcare teams,implementation,health services research,personal health record

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