BACKGROUND
Communication within the circle of care is central to coordinated, safe, and effective care; yet patients, caregivers, and healthcare providers often experience poor communication and fragmented care [1,2]. Through a sequential program of research, the Loop Research Collaborative developed a web-based clinical communication system for team-based care. Loop assembles the circle of care centred on a patient, in private networking spaces called Patient Loops. The patient, and/or their caregiver, is part of the Patient Loop. The communication is threaded; it can be filtered and sorted in multiple ways; it is securely stored and can be exported for upload to a medical record.
OBJECTIVE
The objective of this study was to implement and evaluate Loop. The study reporting adheres to the Standards for Reporting Implementation Research.
METHODS
The study was a Hybrid Type II mixed methods design to simultaneously evaluate Loop’s clinical and implementation effectiveness, and implementation barriers and facilitators in six healthcare sites. Data included monthly user check-in interviews and bi-monthly surveys to capture patient or caregiver experience of continuity of care, in-depth interviews to explore barriers and facilitators based on the Consolidated Framework of Implementation Research (CFIR) and Loop usage extracted directly from the Loop system.
RESULTS
We recruited 25 initiating healthcare professionals (iHCPs) across six sites who then identified patients and/or caregivers for recruitment. Of 147 patient or caregiver participants who were assessed and met screening criteria, 57 consented and 52 were enrolled on Loop, creating 52 Patient Loops. Across all Patient Loops, 96 additional health care providers (HCPs) consented to join the Loop teams. Loop usage was followed for up to 8 months. The median number of messages exchanged per team was 1 with a range of 0-28. The monthly check-in and CFIR interviews showed that although participants acknowledged that Loop could potentially fill a gap, existing modes of communication, workflows, incentives, and the lack of integration with the hospital EMRs and patient portals were barriers to its adoption. While participants acknowledged Loop’s potential value for engaging the patient and caregiver, and for improving communication within the patient’s circle of care, Loop’s relative advantage was not realized during the study and there was insufficient tension for change. Missing data limited the analysis of continuity of care.
CONCLUSIONS
Fundamental structural and implementation challenges persist toward realizing Loop’s potential as a shared system of asynchronous communication. Barriers include health information system integration; system, organizational, and individual tension for change; and a fee structure for healthcare provider compensation for asynchronous communication.
Exploring barriers and facilitators to integrated hypertension-HIV management in Ugandan HIV clinics using the Consolidated Framework for Implementation Research (CFIR)
