Research objectives, outcome measures, and data sources: A quantitative pre-post randomized controlled trial analytic approach (1.0), analysis of quantitative and qualitative data over time (2.0), and analysis of cost effectiveness (3.0) were used.
| OUTCOME MEASURES | DATA SOURCES |
|---|---|
| Evaluate the effect of the APTCare program on QOC provided for CDM | |
| Composite QOC score of disease management for 4 chronic conditions | EMR (patients’ clinical charts), patient survey (baseline demographic and other characteristics for group comparison)* |
| 1.0. Evaluate the efficacy of the APTCare program | |
| 1.1. Intermediate clinical outcomes for chronic conditions (BP, HbA1c) | EMR (baseline and end of study) |
| 1.2. Composite score of preventive care management (QOC) | EMR (baseline and end of study) |
| 1.3. Patient quality of life (SF-36, HRQoL-4) | Patient survey* |
| 1.4. Patient functional status (IADL) | Patient survey* |
| 1.5. Patient health service utilization (use frequency of ED, hospitalization, primary care, and allied health services) | EMR, patient survey,* Ministry of Health and Long-Term Care health care service utilization data (throughout the study) |
| 1.6. Medication appropriateness (MAI) | EMR of intervention patients only, patient interviews† |
| 1.7. Caregiver burden (Zarit Burden Scale) | Caregiver survey questionnaire‡ |
| 2.0. Evaluate the acceptability and implementation process of the APTCare program§ | |
| 2.1. Patient, unpaid caregiver, and provider (NP, telehealth RA) program perception (expectations, satisfaction) | 2.1.1. Intervention group patient and caregiver surveyed 2.1.2. Intervention group patient and caregiver face-to-face in-depth interview (for sample of individuals—key informants, at midpoint) 2.1.3. Home telehealth patient and caregiver satisfaction questionnaire (midpoint and end of study) 2.1.4 Telehealth RA and NP questionnaires (midpoint) |
| 2.2. Multidisciplinary collaboration characteristics (communication) | 2.2.1. EMR electronic messaging system component and patient progress notes (at 7 mo and near end of study) 2.2.2. Case study data collection journal (throughout study period) 2.2.3. Way and Jones Collaboration Care Provider Survey (at 5 mo, 12 mo, and end of study) 2.2.4. Care provider focus groups (at 5 mo and 12 mo) 2.2.5. Care providers process interviews (midway and end of study) 2.2.6. NP and pharmacist daily activity log (throughout) 2.2.7. Study administrator discussion log (throughout) 2.2.8. Project meeting minutes (throughout) |
| 3.0. Evaluate the cost effectiveness of the APTCare program | |
| 3.1. Cost-effectiveness ratio of intervention (average per-patient absolute cost required for a 1% improvement in QOC between arms) | EMR; Ontario Ministry of Health and Long-Term Care service utilization data; CCAC list of services use data (throughout) |
BP—blood pressure, CCAC—community care access centre, CDM—chronic disease management, EMR—electronic medical record, HbA1c—hemoglobin A1c, HRQoL-4—health-related quality of life 4, IADL—instrumental activities of daily living, MAI—Medication Appropriateness Index, NP—nurse practitioner, QOC—quality of care, RA—research assistant, SF-36—Short-Form 36.
↵* Patients were surveyed for demographic (baseline only), quality of life (SF-36, HRQoL-4), functional status (Lawton and Brody’s Instrumental Activities of Daily Living Scale), and health service utilization information at the study baseline (before randomization, in person) and the end of the study (before withdrawing APTCare services, in person). A midpoint survey was performed by telephone to capture health service utilization.
↵† The MAI was completed through review of the medical records and patient face-to-face interviews at baseline, and review of the medical records and telephone interviews, as required, at the end of study.
↵‡ Caregiver questionnaires were either left in the patient’s home or mailed to the caregiver’s address (if different) to be completed by the caregiver and returned in the self-addressed stamped envelope included, at baseline and at the end of the study.
↵§ Questionnaires to evaluate the program acceptability were delivered by telephone at 6 wk and in person at the end of the study to patients assigned to the intervention arm and their caregivers.