Sustainability and scalability of a volunteer-based primary care intervention (Health TAPESTRY): a mixed-methods analysis

• Published in: BMC health services research 2017-08, Vol.17 (1), p.514-514, Article 514
• Main Authors: Kastner, Monika, Sayal, Radha, Oliver, Doug, Straus, Sharon E, Dolovich, Lisa
• Format: Article
• Language: English
• Subjects: Aged; Canada; Chronic Disease - therapy; Chronic illnesses; Data Collection - methods; Health services; Health Services Research; House Calls; Humans; Innovations; Interviews as Topic; Methods; Mixed methods research; National Health Programs; Observations; Older people; Patient Care Team; Personal health; Primary care; Primary Health Care; Qualitative Research; Qualitative study; Scalability; Survey; Surveys and Questionnaires; Sustainability; Telemedicine; Translational Medical Research; Volunteers - education
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-017-2468-9

Chronic diseases are a significant public health concern, particularly in older adults. To address the delivery of health care services to optimally meet the needs of older adults with multiple chronic diseases, Health TAPESTRY (Teams Advancing Patient Experience: Strengthening Quality) uses a novel approach that involves patient home visits by trained volunteers to collect and transmit relevant health information using e-health technology to inform appropriate care from an inter-professional healthcare team. Health TAPESTRY was implemented, pilot tested, and evaluated in a randomized controlled trial (analysis underway). Knowledge translation (KT) interventions such as Health TAPESTRY should involve an investigation of their sustainability and scalability determinants to inform further implementation. However, this is seldom considered in research or considered early enough, so the objectives of this study were to assess the sustainability and scalability potential of Health TAPESTRY from the perspective of the team who developed and pilot-tested it. Our objectives were addressed using a sequential mixed-methods approach involving the administration of a validated, sustainability survey developed by the National Health Service (NHS) to all members of the Health TAPESTRY team who were actively involved in the development, implementation and pilot evaluation of the intervention (Phase 1: n = 38). Mean sustainability scores were calculated to identify the best potential for improvement across sustainability factors. Phase 2 was a qualitative study of interviews with purposively selected Health TAPESTRY team members to gain a more in-depth understanding of the factors that influence the sustainability and scalability Health TAPESTRY. Two independent reviewers coded transcribed interviews and completed a multi-step thematic analysis. Outcomes were participant perceptions of the determinants influencing the sustainability and scalability of Health TAPESTRY. Twenty Health TAPESTRY team members (53% response rate) completed the NHS sustainability survey. The overall mean sustainability score was 64.6 (range 22.8-96.8). Important opportunities for improving sustainability were better staff involvement and training, clinical leadership engagement, and infrastructure for sustainability. Interviews with 25 participants (response rate 60%) showed that factors influencing the sustainability and scalability of Health TAPESTRY emerged across two dimensions: I) Health TAP