Building a Digital Bridge to Support Patient-Centered Care Transitions From Hospital to Home for Older Adults With Complex Care Needs: Protocol for a Co-Design, Implementation, and Evaluation Study

Carolyn Steele Gray   ^{1, 2} , MA, PhD ;   Terence Tang   ^{3, 4} , MD, PhD ;   Alana Armas   ¹ , MSc ;   Mira Backo-Shannon   ⁵ , MD ;   Sarah Harvey   ⁶ , PhD ;   Kerry Kuluski   ^{2, 3} , MSW, PhD ;   Mayura Loganathan   ^{4, 7} , MD ;   Jason X Nie   ³ , MSc ;   John Petrie   ³ , BSc, MBA ;   Tim Ramsay   ^{8, 9} , PhD ;   Robert Reid   ³ , MPH, MD, PhD ;   Kednapa Thavorn   ^{8, 9} , PhD ;   Ross Upshur   ^{1, 4} , BA, MA, MSc, MD, FRCPC ;   Walter P Wodchis   ^{2, 3} , BMath, MAE, MA, PhD ;   Michelle Nelson   ^{1, 2, 10} , PhD

¹ Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada

² Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

³ Institute for Better Health, Trillium Health Partners, Toronto, ON, Canada

⁴ Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada

⁵ Clinical, Health System Strategy, Integration and Planning, Ontario Health (Central Region), Mississauga Halton Local Health Integration Network, Toronto, ON, Canada

⁶ QoC Health Inc, Toronto, ON, Canada

⁷ Mount Sinai Academic Family Health Team, Toronto, ON, Canada

⁸ Ottawa Methods Centre, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada

⁹ School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa, Ottawa, ON, Canada

¹⁰ March of Dimes Canada, Toronto, ON, Canada