Study protocol: type II hybrid effectiveness-implementation study of routine functional status screening in VA primary care
Abstract Background Maintaining functional status, defined as the ability to perform daily activities such as bathing, dressing, and preparing meals, is central to older adults’ quality of life, health, and ability to remain independent. Identifying functional impairments – defined as having difficu...
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2025-01-01
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| Online Access: | https://doi.org/10.1186/s43058-025-00698-w |
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| author | Francesca M. Nicosia Kara Zamora LauraEllen Ashcraft Gregory Krautner Marybeth Groot Bruce Kinosian Cathy C. Schubert Sumedha Chhatre Helene Moriarty Orna Intrator Andrea Wershof Schwartz Ariela R. Orkaby Jason Prigge Rebecca T. Brown |
| author_facet | Francesca M. Nicosia Kara Zamora LauraEllen Ashcraft Gregory Krautner Marybeth Groot Bruce Kinosian Cathy C. Schubert Sumedha Chhatre Helene Moriarty Orna Intrator Andrea Wershof Schwartz Ariela R. Orkaby Jason Prigge Rebecca T. Brown |
| author_sort | Francesca M. Nicosia |
| collection | DOAJ |
| description | Abstract Background Maintaining functional status, defined as the ability to perform daily activities such as bathing, dressing, and preparing meals, is central to older adults’ quality of life, health, and ability to remain independent. Identifying functional impairments – defined as having difficulty or needing help performing these activities – is essential for clinicians to provide optimal care to older adults, and on a population level, understanding function can help anticipate service needs. Yet uptake of standardized measurement of functional status into routine patient care has been slow and inconsistent due to the burden posed by current tools. The goal of the Patient-Aligned Care Team (PACT) Functional Status Screening Initiative is to implement and evaluate a patient-centered, low-burden intervention to improve identification and management of functional impairment among older veterans in Veterans Health Administration (VHA) primary care settings. Methods We will conduct a hybrid type 2 implementation-effectiveness cluster-randomized adaptive trial at 8 VHA sites using the Practical, Robust Implementation and Sustainability Model (PRISM) to guide implementation and evaluation. During a Pre-Implementation phase, we will engage clinical partners and develop local adaptations to maximize intervention-setting fit. During an Implementation phase, we will launch a standard bundle of implementation strategies (coalition building, champions, technical assistance) and system-level audit and feedback, identify sites with low uptake, and randomize those sites to receive continued standard vs. enhanced strategies (standard strategies plus clinician-level audit and feedback). The primary implementation outcome is reach (proportion of eligible patients at each site who receive screening/assessment) and the primary effectiveness outcome is appropriate management of impairment (proportion of patients with identified impairments who receive related referrals). Discussion Implementing routine measurement of functional status in primary care has the potential to improve identification and management of functional impairment for older veterans. Improved management includes increasing access to services and supports for veterans and family caregivers, reducing potentially preventable acute care utilization, and allowing veterans to live in the least restrictive setting for as long as possible. Implementation will also provide data to inform the delivery of proactive interventions to prevent and delay development of functional impairment and improve quality of life, health, and independence. Trial registration Registered at ClinicalTrials.gov on May 7, 2024, at NCT06404970 ( https://clinicaltrials.gov/ ). Reporting guidelines Standards for Reporting Implementation Studies (Additional file 1). |
| format | Article |
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| institution | Kabale University |
| issn | 2662-2211 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
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| series | Implementation Science Communications |
| spelling | doaj-art-6e69be04939c4e9da4d77313e3eaa5362025-02-02T12:26:58ZengBMCImplementation Science Communications2662-22112025-01-016111410.1186/s43058-025-00698-wStudy protocol: type II hybrid effectiveness-implementation study of routine functional status screening in VA primary careFrancesca M. Nicosia0Kara Zamora1LauraEllen Ashcraft2Gregory Krautner3Marybeth Groot4Bruce Kinosian5Cathy C. Schubert6Sumedha Chhatre7Helene Moriarty8Orna Intrator9Andrea Wershof Schwartz10Ariela R. Orkaby11Jason Prigge12Rebecca T. Brown13Center for Data to Discovery to Delivery Innovation (3DI), San Francisco Veterans Affairs (VA) Healthcare SystemSan Francisco VA Healthcare SystemCenter for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical CenterCentral Office of Geriatrics and Extended Care, District of ColumbiaCenter for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical CenterCenter for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical CenterCommunity, Home, and Geriatrics Service, Richard L. Roudebush VA Medical CenterCenter for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical CenterCenter for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical CenterGeriatrics & Extended Care Data & Analyses Center (GECDAC)New England Geriatric Research Education and Clinical Center (GRECC), VA Boston Healthcare SystemNew England Geriatric Research Education and Clinical Center (GRECC), VA Boston Healthcare SystemCenter for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical CenterCenter for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical CenterAbstract Background Maintaining functional status, defined as the ability to perform daily activities such as bathing, dressing, and preparing meals, is central to older adults’ quality of life, health, and ability to remain independent. Identifying functional impairments – defined as having difficulty or needing help performing these activities – is essential for clinicians to provide optimal care to older adults, and on a population level, understanding function can help anticipate service needs. Yet uptake of standardized measurement of functional status into routine patient care has been slow and inconsistent due to the burden posed by current tools. The goal of the Patient-Aligned Care Team (PACT) Functional Status Screening Initiative is to implement and evaluate a patient-centered, low-burden intervention to improve identification and management of functional impairment among older veterans in Veterans Health Administration (VHA) primary care settings. Methods We will conduct a hybrid type 2 implementation-effectiveness cluster-randomized adaptive trial at 8 VHA sites using the Practical, Robust Implementation and Sustainability Model (PRISM) to guide implementation and evaluation. During a Pre-Implementation phase, we will engage clinical partners and develop local adaptations to maximize intervention-setting fit. During an Implementation phase, we will launch a standard bundle of implementation strategies (coalition building, champions, technical assistance) and system-level audit and feedback, identify sites with low uptake, and randomize those sites to receive continued standard vs. enhanced strategies (standard strategies plus clinician-level audit and feedback). The primary implementation outcome is reach (proportion of eligible patients at each site who receive screening/assessment) and the primary effectiveness outcome is appropriate management of impairment (proportion of patients with identified impairments who receive related referrals). Discussion Implementing routine measurement of functional status in primary care has the potential to improve identification and management of functional impairment for older veterans. Improved management includes increasing access to services and supports for veterans and family caregivers, reducing potentially preventable acute care utilization, and allowing veterans to live in the least restrictive setting for as long as possible. Implementation will also provide data to inform the delivery of proactive interventions to prevent and delay development of functional impairment and improve quality of life, health, and independence. Trial registration Registered at ClinicalTrials.gov on May 7, 2024, at NCT06404970 ( https://clinicaltrials.gov/ ). Reporting guidelines Standards for Reporting Implementation Studies (Additional file 1).https://doi.org/10.1186/s43058-025-00698-wFunctional statusFrailtyPrimary CareGeriatricsImplementation ScienceVeterans |
| spellingShingle | Francesca M. Nicosia Kara Zamora LauraEllen Ashcraft Gregory Krautner Marybeth Groot Bruce Kinosian Cathy C. Schubert Sumedha Chhatre Helene Moriarty Orna Intrator Andrea Wershof Schwartz Ariela R. Orkaby Jason Prigge Rebecca T. Brown Study protocol: type II hybrid effectiveness-implementation study of routine functional status screening in VA primary care Implementation Science Communications Functional status Frailty Primary Care Geriatrics Implementation Science Veterans |
| title | Study protocol: type II hybrid effectiveness-implementation study of routine functional status screening in VA primary care |
| title_full | Study protocol: type II hybrid effectiveness-implementation study of routine functional status screening in VA primary care |
| title_fullStr | Study protocol: type II hybrid effectiveness-implementation study of routine functional status screening in VA primary care |
| title_full_unstemmed | Study protocol: type II hybrid effectiveness-implementation study of routine functional status screening in VA primary care |
| title_short | Study protocol: type II hybrid effectiveness-implementation study of routine functional status screening in VA primary care |
| title_sort | study protocol type ii hybrid effectiveness implementation study of routine functional status screening in va primary care |
| topic | Functional status Frailty Primary Care Geriatrics Implementation Science Veterans |
| url | https://doi.org/10.1186/s43058-025-00698-w |
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