Seniors With a Community Volunteer Admitted to Hospital 8% Less than Others

Community volunteers reduced healthcare usage by senior citizens, shifting healthcare from hospitals to primary care, according to new research published in the Canadian Medical Association Journal.

Health Tapestry did not improve the primary outcome of goal attainment, but the program showed promise in shifting care from reactive to active preventive care.

The intervention group had more primary care visits over six months (4.93) compared to the control group (3.50). The intervention group also had lower odds of undergoing at least one hospital admission, with the intervention group being admitted about 7% of the time, compared to almost 15%.

“These findings suggest that Health Tapestry has the potential to improve the way primary care is delivered in Canada by shifting care of individuals away from hospitals to the community and to a more proactive and preventative team-based model of care,” said co-author David Price, M.D., chair of the department of family medicine at McMaster University.

The Health Tapestry (Health Teams Advancing Patient Experience: Strengthening Quality) is a project developed by McMaster University in Ontario, Canada, which combines trained volunteers and electronic software with current healthcare system efforts to support optimal aging in adults older than 70.

Volunteers visited patients where they live and learned about what matters most to each participant and their health needs. Volunteers recorded the conversations and sent them to patients’ healthcare teams. The idea: Providers could learn more about a patient’s life, health needs, goals and how they can work together to achieve goals.

Researchers conducted a randomized control trial to measure the effectiveness of the Health Tapestry intervention after six months compared to patients who didn’t receive the intervention.

The research team used electronic health records (EHRs) to identify patients, and then family physicians screened the patients for exclusions.

Patients in the intervention group received visits from the trained volunteers and discussed life and health goals, risks and needs and daily activities and general health using structured surveys and unstructured narratives. Volunteers sent a report summarizing the goals, alerts, key issues and observations to the primary care EHR.

Interprofessional teams reviewed the reports and generated plans of care for how the team, community agencies and volunteers could address patients’ goals and health issues, with iterative follow-up.

Participants in the intervention group increased their weekly walking by 81 minutes, compared to a 120-minute decrease in the control group. The intervention group also reported higher levels of physical activity.

The intervention group included 158 individuals, while the control group had 154.

The program did not achieve its ultimate goal, but it showed potential to changing the point of care.

“One reason may be that, in this study, the control group undertook the goal-setting exercise with researchers at baseline,” wrote Susan M. Smith, M.D., Royal College of Surgeons in Ireland. “This was done to allow collection of outcome data on goal ascertainment, yet the process of engaging in goal-setting itself likely had an effect.”

Smith wrote that the results of the study suggest that the intervention could contribute to improvements in patient care for older, community-dwelling adults.

Study authors suggested further evaluation of the program to help understand the effective components, costs and consequences of the intervention.

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