A Partnered Evaluation to Improve the Identification and Management of Functional Impairment and Frailty Among Older Veterans in Primary Care Settings

Part of paid clinical trials in Philadelphia, Pennsylvania.

Sponsor
VA Office of Research and Development
Study ID
NCT06404970
Status
Recruiting
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Conditions

  • Frailty
  • Functional Impairment

Eligibility Criteria

Sex
ALL
Age
60 Years - N/A
Healthy Volunteers
Not accepted

Interventions

  • Screening intervention — OTHER
    Intervention to improve identification and management of functional impairment among older Veterans in VA primary care settings. Intervention includes 5 components: (1) routine, standardized functional status measurement; (2) nursing screening followed by follow-up primary care provider assessment; (3) electronic tools and templates to facilitate screening, assessment, and documentation; (4) interprofessional educational session; (5) tailored reports on functional status
  • Standard bundle of implementation strategies — OTHER
    Standard strategies include champions plus system-level audit and feedback
  • Enhanced bundle of implementation strategies — OTHER
    Enhanced strategies include technical assistance plus clinician-level audit and feedback

Study Details

Maintaining functional status, or the ability to perform daily activities, is central to older adults' quality of life, health, and ability to remain independent. Identifying functional impairments 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 patient care has been slow and inconsistent due to the burden posed by current tools. The purpose of the proposed QUERI Partnered Evaluation Initiative is to implement and evaluate a patient-centered, low-burden intervention to improve measurement of functional status in VA primary care settings nationally. The investigators hypothesize that implementing this intervention will increase identification and improve management of functional impairment among older Veterans while providing key data to inform VHA strategic planning related to long-term services and supports.

Key Dates

Start date
Apr 1, 2024
Status verified
Jul 2025
Primary completion
Jun 30, 2026
Completion
Dec 31, 2026

Study Design

Enrollment
10,000 participants (estimated)
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
SCREENING

Arms

  • Active Comparator: Functional status screening initiative plus standard bundle of implementation strategies
    During an initial 3 month run-in period, the investigators will implement the intervention at all sites using the standard implementation strategy bundle (implementation champions, system-level audit and feedback). After run-in, the investigators will identify sites with inadequate Reach, defined as \<80% of eligible Veterans receiving screening and/or assessment. Sites with \>80% Reach at the end of run-in will receive standard implementation for all phases of implementation. For sites with \<80% Reach, the investigators will randomize 1:1 by medical center to 3 additional months of a standard vs. enhanced implementation bundle. The enhanced implementation bundle will include technical assistance plus clinician-level audit and feedback. After 3 months' implementation, the investigators will then perform 3 months of crossover allocation. After crossover allocation, both arms will receive 3 months of standard implementation.
  • Experimental: Functional status screening initiative plus enhanced bundle of implementation strategies
    During an initial 3 month run-in period, the investigators will implement the intervention at all sites using the standard implementation strategy bundle (implementation champions, system-level audit and feedback). After run-in, the investigators will identify sites with inadequate Reach, defined as \<80% of eligible Veterans receiving screening and/or assessment. Sites with \>80% Reach at the end of run-in will receive standard implementation for all phases of implementation. For sites with \<80% Reach, the investigators will randomize 1:1 by medical center to 3 additional months of a standard vs. enhanced implementation bundle. The enhanced implementation bundle will include technical assistance plus clinician-level audit and feedback. After 3 months' implementation, the investigators will then perform 3 months of crossover allocation. After crossover allocation, both arms will receive 3 months of standard implementation.

Primary Outcome Measure

Change in reach [ Time Frame: 9 months, 12 months, 15 months, 18 months, 24 months ]

Central Contacts

Locations (1)

FacilityCityStateZIPSite coordinators
Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PAPhiladelphiaPennsylvania19104-4551
Tonia C Reynolds-Hendricks, BA MA
[email protected]
215-823-5800
Johann Ochoa, MS
[email protected]
(215) 823-5821
Rebecca T. Brown, MD MPH (PRINCIPAL_INVESTIGATOR)

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By research site
Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA· Philadelphia, PA

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