Why did we do the study?
The first study testing the value of Health TAPESTRY found that people who received Health TAPESTRY walked more, had fewer hospitalizations, and saw their primary care team more often than the control group.
This study was done under very controlled research conditions so in this second large trial, we wanted to determine if it was feasible to implement Health TAPESTRY in primary care practices in multiple communities across Ontario, Canada. We also wanted to test the reproducibility of the effects of Health TAPESTRY that were found in the first implementation to see if and how the effects could be maintained when Health TAPESTRY is flexibly rolled out in different contexts. In other words, we aimed to see whether Health TAPESTRY reduced hospitalizations and increased physical activity in clients that were given the program. We also did an economic analysis.
Our findings are mapped onto the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework which is a well known guide for users in developing, implementing and evaluate programs.
What did we find?
- How many people did we reach?
- In total, 512 people (257 intervention, 255 control) were enrolled in Health TAPESTRY, 283 initial study visits and 57 follow-up visits were conducted to clients by volunteers. Many clients were interested in discussing advance care planning and reported limitations for walking and stairs.
- How effective was Health TAPESTRY?
- There were no differences between groups for hospitalizations or physical activity (i.e., we didn’t reproduce the results of the first study in this flexible rollout implementation), however, the intervention group did have more primary care visits that the control group at 6-months so it was useful in connecting users with their primary care team. To understand the differences between the two studies – in a sensitivity analysis we looked specifically at the one site that had been the original setting for the first large trial and had enrolled almost 40% of participants in this trial. In this analysis, we found that hospitalizations, emergency visits, and quality of life were favorably affected by Health TAPESTRY, so it appeared the effect persisted. This will help us understand what is needed in rollout in other contexts to maintain the effects seen in the first study.
- Who adopted or helped implement Health TAPESTRY?
- The six primary care practices that implemented Health TAPESTRY differed in many aspects (e.g., size, co-location at the same clinical site, number and type of interprofessional providers, etc). About 61% of eligible physicians had a patient participate. In total, 217 people were trained to volunteer with Health TAPESTRY. In general, the primary care staff involved in the implementation of the program reported improved adoption of the program over time.
- How was Health TAPESTRY implemented?
- The primary care practices implemented Health TAPESTRY according to plan. The TAP-Huddle most often contacted the client after their summary was reviewed by the health care team, although many health care providers were involved in the client’s follow-up. Through interviews/focus groups, participants reported that there were many facilitators to implementation (e.g., volunteers feeling well trained, opportunity to take the time to work collaboratively with colleagues during the TAP-Huddles), however there were still many barriers (e.g., issues with the surveys, not recruiting clients who would benefit most).
- What was the maintenance or long-term implementation of Health TAPESTRY?
- After one year of implementation, Health TAPESTRY was well integrated into practice for the health care practices. More than half of the providers surveyed would recommend the program to others, and 100% of the clients asked would also recommend it to others. Most of the practices said they would be interested in continuing with the program with volunteer support.
- What was the economic evaluation of Health TAPESTRY?
- The intervention group compared to the control group had $380.00 of additional costs and generated 0.0025 more quality-adjusted-life-years (QALYs). This resulted in an incremental cost per QALY gained of $152,558.
What do our findings mean?
Overall, Health TAPESTRY was successfully implemented in multiple primary care practices in six communities across Ontario. We were not able to reproduce the findings from the first implementation. Regardless, the results show some positive impacts on Health TAPESTRY clients, indicating potential that Health TAPESTRY could improve access to comprehensive care for patients.
Full article can be found here:
Mangin D, Lamarche L, Oliver D, Blackhouse G, Bomze S, Borhan S, Carr T, Clark R, Datta J, Dolovich L, Gaber J, Forsyth P, Howard M, Marentette-Brown S, Risdon C, Talat S, Tarride J, Thabane L, Valaitis R, & Price D. (2023). Health TAPESTRY Ontario: A multi-site randomized controlled trial testing implementation and reproducibility. Annals of Family Medicine, 21 (2), 132-142. https://doi.org/10.1370/afm.2944