Full Evaluation, Scale and Spread: Pragmatic Trial of the HSPRN-Bridgepoint Electronic Patient Reported Outcome (ePRO) Mobile Application to Support the Needs of Persons With Complex Chronic Disease and Disability

The pragmatic trial will take place at 6 Family Health Teams (FHTs) to a maximum of 16 FHTs in Ontario utilizing a stepped-wedge randomized method with an embedded case study of implementation at four sites. The research team will observe provider-patient goal-setting visits at the time of onboarding onto the intervention. Additional consent will be obtained from the patient and provider prior to initiating the observational visit. In addition, the research team will attend FHT rounds at the identified case study sites (when appropriate) to observe and document how providers discuss and set goals in an interdisciplinary team environment. Using a stepped-wedge design, each FHT will receive the ePRO tool (intervention) but will be randomized on when in the stepped-wedge design they will receive the intervention. The stepped-wedge randomization will assign (through number generator or coin flip) each of the FHTs to either a: 1) 3 month control period and a 12 month intervention period, or 2) 6 month control period and a 9 month intervention period; and their respective participants will be assigned accordingly.

Providers and patients recruited at all sites will receive training on how to use the ePRO tool prior to the start of the trial. During the intervention period, patients will receive one-on-one training with a research assistant; and provider training will occur in a group setting. Training will be led by a member of the research team and will take between 30-60 minutes. Patients and providers will also be provided with a manual and training video on how to use the tool and portal, and the patients will be offered refresher sessions (individual or group) every 3 months over the duration of the study.

Following consent, all patients will complete pre and post surveys every 3 months (through control and intervention periods). Patients will also complete an additional survey at study closeout to capture tool usability feedback. We anticipate survey completion to take 20-35 minutes.

Additionally, patients are requested to attend a minimum of two schedule appointments with their provider during the study. The first (on-boarding) visit will have the patient and provider collaboratively discuss and set monitoring protocols for tracking. The second (off-boarding) visit, following the monitoring period, will allow patients and providers to privately discuss their experience with the ePRO tool, before participating in their respective focus group or interview. As was the case in our usability pilot and exploratory trial, we anticipate that patients will have additional appointments with their providers during the study at which point they can use the tool to discuss patient progress towards goals. All patients are requested to attend 4-5 scheduled appointments with their provider during the study. In accordance to earlier study phases on-boarding and off-boarding visits typically take 30 minutes. Other scheduled visits take between 10-30 minutes depending on the type of visit and provider they are seeing.

Embedded within the pragmatic trial will be case studies of 4 intervention sites. Provider and patient participants at case sites will participate in mid and post-intervention period semi-structured interviews to capture implementation enables and barriers. To adequately capture organizational level barriers and enablers we will additionally conduct semi-structured interviews with organizational leaders (executive directors and/or clinical leads). We will also collect relevant documents from all sites (i.e. organizational policies regarding the use of mobile applications or provider trainings and manuals in using technology as part of usual care).