Supporting Goal-Oriented Primary Health Care for Seniors with Complex Care Needs Using Mobile Technology: Evaluation and Implementation of the Health System Performance Research Network, Bridgepoint Electronic Patient Reported Outcome Tool

Background Older adults experiencing multiple chronic illnesses are at high risk of hospitalization and health decline if they are unable to manage the significant challenges posed by their health conditions. Goal-oriented care approaches can provide better care for these complex patients, but clinicians find the process of ascertaining goals “too complex and too-time consuming,” and goals are often not agreed upon between complex patients and their providers. The electronic patient reported outcomes (ePRO) mobile app and portal offers an innovative approach to creating and monitoring goal-oriented patient-care plans to improve patient self-management and shared decision-making between patients and health care providers. The ePRO tool also supports proactive patient monitoring by the patient, caregiver(s), and health care provider. It was developed with and for older adults with complex care needs as a means to improve their quality of life. Objective Our proposed project will evaluate the use, effectiveness, and value for money of the ePRO tool in a 12-month multicenter, randomized controlled trial in Ontario; targeting individuals 65 or over with two or more chronic conditions that require frequent health care visits to manage their health conditions. Methods Intervention groups using the ePRO tool will be compared with control groups on measures of quality of life, patient experience, and cost-effectiveness. We will also evaluate the implementation of the tool. Results The proposed project presented in this paper will be funded through the Canadian Institute for Health Research (CIHR) eHealth Innovation Partnerships Program (eHIPP) program (CIHR–143559). The expected completion date of the study is November, 2019. Conclusions We anticipate our program of work will support improved quality of life and patient self-management, improved patient-centered primary care delivery, and will encourage the adoption of goal-oriented care approaches across primary health care systems. We have partnered with family health teams and quality improvement organizations in Ontario to ensure that our research is practical and that findings are shared widely. We will work with our established international network to develop an implementation framework to support continued adaptation and adoption across Canada and internationally.


Comments
Proposal explicit in addressing evaluation criteria.
A well-developed goal-setting tool, beyond "state of art" intervention to agree and Planned Intervention: monitor progress towards agreed goals with older people with complex needs and their care-givers. Based upon useful user-centred iterative design processes: appendices provide screen-shots of prototype.. Generic outcomes well developed: Quality-of-life, experience of care, attainment of goals, cost-effectiveness: convincing as broad outcomes. Some potential to integrate into primary care services. appropriate approach to confirm design of intervention in real-world eHealth Innovation Evaluation: settings, yet of older people with two or more chronic conditions. highly diverse target population Phased study with 1,2,3 done and 4 under-way, Application for next phase: suggests low risk proposal. Bias acknowledged and well-addressed. Includes a convincing cost-effectiveness component. Documents prepared for data collection, participant information & consent (ethics addressed) : good team with high likelihood of success, includes international partners, led by industry partner, Team : no comment. CAN$91,387 in year 1. Budget Determining how to engage older adults in taking greater responsibility for their health care is a very important goal in today's world where most older adults have been indoctrinated in believing that the health care system knows best.
This approach has great merit for the younger older adults of today and may be of benefit to some of the mid and old older adults.
A paradigm shift toward shared decision making and responsibility taking is essential to future health care therefore this may be a good way to make that transition to goal oriented primary health care.
Good combination of researchers, practitioners and technology. :

Planned Intervention
Building on successful development of an eHealth tool to allow patients with complex needs to create and monitor their own goals for care, this project aims to use the tool to enable monitoring, self management, and shared decision-making. Seniors seldom present with only one health problem and this innovation takes that into account. It will address quality of life issues for seniors with complex care needs. The technology has been developed and is already at TRL of 7. It is build using a tested platform . There is a high probability that the ePRO can improve self-management, patient experience and quality of life. Patients have been involved from the beginnings of development of this tool and have found it effective to assist with goal setting and monitoring. There is a willingness and interest on the part of patient participants to continue their involvement with co-development of this project. Change management has been addressed with a very comprehensive plan that is supported by team members with strong change management skills. It follows Canada Health Infoway's Change Management Framework to support adoption of the ePRO tool. The involvement of international partners indicates a perception of usability and value and will greatly aid with scalability and adoption. :

eHealth Innovation Evaluation
The research questions are clear and reflect the desired outcomes: improved self-management, patient experience and quality of life, and cost effectiveness. These outcomes are very relevant and important to seniors such as myself.
The sample size has been calculated to reflect 80% power derived from a power calculation, with 660 participants in all. The novel approach of utilizing embedded case studies to collect unique differences will strengthen the evaluation through identification of outcomes which may not have been anticipated. Approaches to bias control, cost-effectiveness evaluation and analysis including sex/gender analysis appear well thought out and complete.

Team:
Many of the team have been involved in the development process that preceded this research and as such have already worked together towards a successful product. Patient involvement in the team is evident and essential in this patient-centered application. Skills in innovation, eTechnology, and seniors care are all apparent in the team as is the capacity to complete successful quality evaluation.