Evaluating the Effectiveness and Implementation of an Organizational Model Promoting Interprofessional Collaboration in Home Care (RIAP): Protocol for a Multi-Method Study Using the RE-AIM Framework

This paper outlines the protocol for a multi-method, Type-2 hybrid effectiveness-implementation study utilizing the RE-AIM framework to evaluate the clinical, organizational, and implementation outcomes of the RIAP interprofessional home care model in Geneva compared to usual care.

The Gist

Imagine your home is a busy, complex construction site. You are the homeowner, and you need a roof fixed, plumbing repaired, and the garden tended. In the old way of doing things (the "Usual Care" model), you might hire a plumber who shows up on Tuesday, a gardener on Thursday, and a roofer who only comes when you call. They all have their own tools, their own schedules, and they rarely talk to each other. Sometimes, the roofer doesn't know the plumber just moved a pipe, leading to a leak. You, the homeowner, are left running between them, trying to make sure everyone is on the same page.

This is exactly the problem facing elderly or sick people receiving home care in Geneva, Switzerland. They often have many different doctors, nurses, and social workers, but these professionals don't always coordinate well. It's chaotic, and care can slip through the cracks.

Enter the RIAP Model: The "Super-Team" Approach

To fix this, the Geneva Home Care Institution (IMAD) created a new way of working called RIAP. Think of RIAP not as a single doctor visiting your house, but as a dedicated "Squad" assigned to your home.

In this new model:

• Shared Blueprints: Instead of the nurse and the doctor having separate notebooks, they share a single, digital "master blueprint" (a shared patient portfolio).
• The Huddle: They meet regularly to talk about your specific needs, rather than just treating their specific part of the problem.
• The Goal: They work together to prevent emergencies before they happen, ensuring you stay safe and healthy at home for as long as possible.

The "EFFI-RIAP" Project: The Test Drive

Now, the researchers (led by Catherine Busnel and her team) want to know: Does this "Super-Team" approach actually work better than the old way?

They are running a massive study called EFFI-RIAP. You can think of this study as a scientific test drive of a new car model. They aren't just checking if the car looks cool; they are checking if it gets better gas mileage, if the brakes work, and if the drivers actually like it.

Here is how they are testing it, using a famous checklist called RE-AIM (which stands for Reach, Effectiveness, Adoption, Implementation, Maintenance):

1. Reach (Who is getting the new car?): Are they giving this new "Super-Team" care to the right people? Are they reaching the most vulnerable patients, or just the easy ones?
2. Effectiveness (Does the car run better?): They will compare patients in the RIAP "Super-Team" against patients in the old "hired-by-the-hour" model.
   • The Test: Do RIAP patients go to the hospital less? Do they feel safer? Do they feel like their care is more connected?
   • The Tools: They will use surveys (like asking the driver how smooth the ride was) and check medical records (like checking the engine logs for breakdowns).
3. Adoption (Do the drivers like it?): Do the nurses and doctors actually want to work this way? Or is it too much paperwork? They are asking the professionals if they feel empowered and if they like collaborating.
4. Implementation (Is the car built right?): Is the team actually following the rules? Are they really meeting and sharing the "blueprints"? They are also checking the cost: Is this new way too expensive, or does it actually save money by preventing hospital visits?
5. Maintenance (Will they keep driving it?): If they try this for a year, will they still be doing it in five years? Or will they go back to the old, chaotic way?

Why This Matters

The researchers are using a mix of hard numbers (like hospital visit counts and costs) and human stories (interviews with patients and nurses) to get the full picture.

• The Good News: If this works, it means fewer people ending up in the hospital, less stress for families, and happier healthcare workers who feel supported by their team.
• The Goal: They want to prove that when healthcare professionals stop working in silos (separate rooms) and start working as a unified squad, everyone wins.

In a Nutshell

This paper is a recipe and a tasting menu for a new way of caring for people at home. The chefs (researchers) are cooking up a new method (RIAP) where the kitchen staff (doctors and nurses) talk to each other constantly. They are currently serving this meal to a group of people in Geneva to see if it tastes better, is cheaper, and keeps the customers (patients) healthier than the old menu. If the review is good, they plan to serve this meal to the whole city, and maybe even the whole country.

Technical Summary

Based on the provided preprint, here is a detailed technical summary of the EFFI-RIAP protocol paper.

1. Problem Statement

The paper addresses critical challenges in home care delivery driven by an aging population, rising comorbidities, and fragmented care systems.

• Context: In Switzerland (specifically the Canton of Geneva), home care institutions face increasing demand for complex, coordinated care. Current models often suffer from "siloed" delivery, where Case Manager Nurses (CMNs) must coordinate with numerous Primary Care Physicians (PCPs) and other professionals without a structured framework.
• The Gap: This fragmentation hinders effective interprofessional collaboration, continuity of care, and proactive care planning. While interprofessional collaboration is known to improve quality, its implementation in real-world home care settings remains difficult due to geographical distances, organizational barriers, and lack of shared patient portfolios.
• The Intervention: To address this, the Institution genevoise de maintien à domicile (IMAD) developed the RIAP model (Réseau Interprofessionnel Ambulatoire de Proximité or Local Interprofessional Outpatient Network). This model shifts from a traditional nurse-referent approach to a shared patient portfolio system where CMNs and PCPs work as a dyad to collectively manage patient care.

2. Methodology

The study employs a Type-2 Hybrid Effectiveness-Implementation Design guided by the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance). It is a multi-method study combining quantitative and qualitative approaches.

• Study Design:

  • Quasi-experimental: Compares the RIAP model against "usual care" (traditional organizational model).
  • Real-world setting: Utilizes naturally deployed teams across the Canton of Geneva rather than a controlled clinical trial.
  • Data Sources:
    • Routine Institutional Data: Extracted from IMAD records (clinical, financial, and operational data) for ~7,000 patients (including ~300 RIAP patients).
    • Project-Specific Questionnaires: Administered to patients, CMNs, and PCPs to measure perceptions, satisfaction, and collaboration.
    • Qualitative Data: Open-ended questions in surveys and follow-up semi-structured interviews to explore barriers, facilitators, and implementation fidelity.

• Participants:

  • Intervention Group: ~300 adult patients under the RIAP model; ~20 CMNs and ~10 PCPs working in RIAP dyads.
  • Control/Comparison Group: ~7,000 adult patients receiving usual care; non-RIAP staff.

• Key Measures & Instruments:

  • Effectiveness (RQ1): Patient Experienced Continuity of Care Questionnaire (PECQ), Interprofessional Collaboration Scale (ICS), interRAI-HC (health status/frailty), COMID (care complexity), and economic indicators (hospitalizations, costs).
  • Implementation (RQ2): Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM), and cost analysis (travel time, coordination meetings).
  • Adoption (RQ4): Participation rates and a custom questionnaire based on a nursing competency framework for complex needs.
  • Maintenance (RQ5): Long-term adherence, staff turnover, and barriers/facilitators via an Implementation Research Logic Model (IRLM).

• Statistical Analysis:

  • Descriptive statistics for all groups.
  • Comparative analyses (chi-square, t-tests, regression) between RIAP and usual care.
  • Potential use of Difference-in-Differences (DiD) and multivariable regression to adjust for confounders and temporal trends.
  • Inductive thematic analysis for qualitative data.

3. Key Contributions

• Protocol Development: This paper provides a comprehensive protocol for evaluating a novel organizational model (RIAP) specifically designed to bridge the gap between home care nurses and primary care physicians.
• Framework Application: It demonstrates the application of the RE-AIM framework to a home care context, ensuring a holistic evaluation that goes beyond clinical outcomes to include implementation fidelity, cost, and sustainability.
• Methodological Rigor: The study integrates routine administrative data with specific psychometric instruments (PECQ, ICS, interRAI-HC) and qualitative insights, offering a robust "real-world evidence" approach.
• Focus on Complexity: By utilizing the COMID tool and interRAI-HC, the study specifically targets the evaluation of care for multimorbid and complex patients, a population often under-represented in interprofessional collaboration studies.

4. Results

• Status: As this is a protocol paper, no empirical results (outcomes of the intervention) are presented yet.
• Current Progress:
  • The project began in October 2025.
  • Ethical approval (waiver) was granted in January 2026.
  • Data extraction and preparation of the institutional dataset are ongoing.
  • Project-specific questionnaires and qualitative data collection are scheduled for September 2026.
  • The total project duration is 22 months.

5. Significance

• Policy and Practice: The findings will provide evidence to policymakers and home care institutions on whether the RIAP model improves continuity of care, reduces hospitalizations, and is cost-effective. This is crucial for scaling the model to other regions.
• Implementation Science: By identifying specific barriers and facilitators to implementing interprofessional dyads (CMN-PCP), the study will offer actionable strategies for overcoming organizational silos in healthcare.
• Patient Outcomes: If successful, the model could lead to better health outcomes for frail, elderly, and multimorbid patients through more coordinated, person-centered care.
• Sustainability: The study explicitly evaluates the maintenance of the model, addressing a common failure point in healthcare innovations where new models are adopted but not sustained over time.

Limitations Noted: The study is observational (not randomized), which limits causal inference. Additionally, being confined to a single canton (Geneva) may limit the generalizability of findings to healthcare systems with different organizational structures.