title: 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: 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
  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.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT02283723.
authors.affiliation: Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th floor, Hamilton, ON, L8P 1H6, Canada. ldolovic@mcmaster.ca.
authors.forename: Lisa
authors.initials: L
authors.lastname: Dolovich
authors.affiliation: 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.
authors.forename: Doug
authors.initials: D
authors.lastname: Oliver
authors.affiliation: Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th floor, Hamilton, ON, L8P 1H6, Canada.
authors.forename: Larkin
authors.initials: L
authors.lastname: Lamarche
authors.affiliation: 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.
authors.forename: Gina
authors.initials: G
authors.lastname: Agarwal
authors.affiliation: Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th floor, Hamilton, ON, L8P 1H6, Canada.
authors.forename: Tracey
authors.initials: T
authors.lastname: Carr
authors.affiliation: Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th floor, Hamilton, ON, L8P 1H6, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Chan
authors.affiliation: Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th floor, Hamilton, ON, L8P 1H6, Canada.|School of Nursing, McMaster University, Hamilton, Canada.
authors.forename: Laura
authors.initials: L
authors.lastname: Cleghorn
authors.affiliation: Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.
authors.forename: Lauren
authors.initials: L
authors.lastname: Griffith
authors.affiliation: Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th floor, Hamilton, ON, L8P 1H6, Canada.
authors.forename: Dena
authors.initials: D
authors.lastname: Javadi
authors.affiliation: Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
authors.forename: Monika
authors.initials: M
authors.lastname: Kastner
authors.affiliation: Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th floor, Hamilton, ON, L8P 1H6, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Longaphy
authors.affiliation: Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th floor, Hamilton, ON, L8P 1H6, Canada.
authors.forename: Dee
authors.initials: D
authors.lastname: Mangin
authors.affiliation: Department of Medicine, McMaster University, Hamilton, Canada.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Papaioannou
authors.affiliation: School of Nursing, McMaster University, Hamilton, Canada.
authors.forename: Jenny
authors.initials: J
authors.lastname: Ploeg
authors.affiliation: Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.
authors.forename: Parminder
authors.initials: P
authors.lastname: Raina
authors.affiliation: School of Rehabilitation Science, McMaster University, Hamilton, Canada.
authors.forename: Julie
authors.initials: J
authors.lastname: Richardson
authors.affiliation: 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.
authors.forename: Cathy
authors.initials: C
authors.lastname: Risdon
authors.affiliation: Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.
authors.forename: P Lina
authors.initials: PL
authors.lastname: Santaguida
authors.affiliation: Institute of Health Management and Policy, University of Toronto, Toronto, Canada.
authors.forename: Sharon
authors.initials: S
authors.lastname: Straus
authors.affiliation: Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.
authors.forename: Lehana
authors.initials: L
authors.lastname: Thabane
authors.affiliation: School of Nursing, McMaster University, Hamilton, Canada.
authors.forename: Ruta
authors.initials: R
authors.lastname: Valaitis
authors.affiliation: 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.
authors.forename: David
authors.initials: D
authors.lastname: Price
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D055991:Health Records, Personal; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team; D017060:Patient Satisfaction; D011320:Primary Health Care; D012107:Research Design
keywords: Health services research; Healthcare volunteers; Implementation; Integrated care; Interdisciplinary healthcare teams; Older adults; Personal health record; Primary healthcare; Randomized controlled trial