A Randomized Controlled Trial Using the Health TAPESTRY Approach to Care for Older Adults

The participant will identify up to 5 areas of health that will serve as the basis for Goal Attainment Scale(GAS) measurement and will assign subjective weights using a scale of 1 to 9 (higher scores indicating greater importance). An indicator for each goal is selected and used to indicate progress in meeting the goal. The expected outcomes for each problem area will be identified. These outcomes will be standardized and as descriptive, objective and observable as possible. The indicators will be applied to the intervention group and control group in the same manner. Participants will be followed up at the end of 6 months by an independent and blinded assessor for the purpose of study comparison to evaluate the patient's level of goal attainment for each priority problem area that has a goal attainment scale constructed for it although participants in the intervention group may have follow occur more frequently as the information about goals is transmitted to the health care team

1)The EuroQol-5 Demensop-5 Level (EQ-5D-5L) is comprised of six questions investigating patients' present health status. The last question requires patients to rate one's own current health status on a scale from 0-100, 0 being worst and 100 being the best; and 2)Veterans Rand-12 (VR-12) It's a 9 item survey that focuses mainly on physical and emotional health. The survey was developed at RAND Corporation with the support of US Department of Veterans Affairs. Both of these tools are under consideration by the Canadian Institute of Health Research (CIHR) led community based primary healthcare indicators group and the proposed TAPESTRY study offers the opportunity to compare the two tools.

The scale measures the ability and confidence of patient to self-manage their own health. The scale comprises of 6 items and each item is responded on a 10-point Likert scale with 0 indicates not at all confident and 10 denotes totally confident.

Single question, "In terms of your own healthy aging, would you say it is excellent, very good, good, fair, or poor?" Ratings become a 5-point scale ranging from 1 to 5. A similar question has been used in the Canadian Longitudinal Study on Aging.

This validated scale is comprised of 11 questions. The first seven questions measure satisfaction with social support and the latter five questions assess social networking. Satisfaction score range from 6-18 whereas networking scores ranges from 4-12. The scale facilitates understanding patients' relationships with friends/family and whoever supports them. Those individuals who score less than 10 on the satisfaction scale are considered at risk.

Perceived clinic comprehensives regarding patient healthcare needs will be assessed via CIHR common indicator (comprehensiveness domain). Participants respond to 4 questions using a 4-point scale ("not at all" to "definitely"), with an additional option of "I haven't needed such support.

The extent to which participants feel in control with regard to healthcare is measure via CIHR common indicator (patient empowerment domain). Participants respond to 5 questions using a 4-point scale ("not at all" to "definitely").

The extent to which participants feel their healthcare team addresses what matters to them will be assessed via CIHR common indicator (Patient-Centredness domain). Participants respond to 6 questions using a 4-point scale ("not at all" to "completely").

Patient access to services will be assessed via CIHR common indicators project: Access subdomain.

This is a one item scale that about satisfaction with primary care received. Participants are asked to rate their level of satisfaction from 1 ("not at all satisfied") to 10 ("completely satisfied").

An indirect measure of access to primary care is seen for example, in increased for diagnoses that can be effectively managed outside hospital (ambulatory care sensitive conditions; ACSCs). ACSCs such as chronic obstructive pulmonary diseases, asthma, diabetes, hypertension, angina and others), have rates of 387 per 100,000 for those aged 75 to 84 years compared to 2240 per 100,000 for those 85 years or older. Hospitalizations for Adverse Events will also be calculated.

For those participant who answer "yes" to being a caregiver, the 4-item Zarit screen will be administered in addition to a description of the context of their caregiving will be given. For this screen, participants answer 4 questions using a 5-point scale from "never" to "always".

Program costs: Will be measured using micro costing techniques where a healthcare cost and Resource utilization form has been pilot tested to record resources used during the implementation of the TAPESTRY program. This resource use information will be combined with unit prices for each resource and summed across all resources to estimate the total cost of the program. Maintaining and updating infrastructure costs will be included. Healthcare resource use and cost: Will be obtained from the patient questionnaire that will assess cost and resources involved in providing healthcare for older adults.

Patients will be asked to rate their level of satisfaction with volunteer visits.

An adapted version of the Organizational Readiness for Change Assessment (ORCA) will be used to measure team functioning. This questionnaire includes 18 questions to assess evidence, context, and facilitation and to give a general sense of healthcare professionals' perceptions of the clinic's organizational readiness for change as it relates to the uptake of TAPESTRY

Volunteers will be asked to rate their confidence in performing 3 tasks related to a volunteer visit for each visit they complete.