Study protocol: type II hybrid effectiveness-implementation study of routine functional status screening in VA...

Area of Science:

• Gerontology
• Health Services Research
• Implementation Science

Background:

• Maintaining functional status is crucial for older adults' independence and quality of life.
• Current tools for measuring functional status in primary care are burdensome, leading to inconsistent adoption.
• Identifying functional impairments is key for optimal clinical care and anticipating population-level service needs.

Purpose of the Study:

• To implement and evaluate a patient-centered, low-burden intervention for functional status screening in older veterans.
• To improve the identification and management of functional impairment within Veterans Health Administration (VHA) primary care settings.

Main Methods:

• A hybrid type 2 implementation-effectiveness cluster-randomized adaptive trial will be conducted at 8 VHA sites.
• The study utilizes the Practical, Robust Implementation and Sustainability Model (PRISM) for guidance.
• Implementation strategies include coalition building, champions, technical assistance, and audit/feedback, with adaptive randomization for low-uptake sites.

Main Results:

• Primary implementation outcome: reach (proportion of eligible patients screened).
• Primary effectiveness outcome: appropriate management of impairment (proportion of patients receiving related referrals).
• The trial is registered at ClinicalTrials.gov (NCT06404970).

Conclusions:

• Routine functional status measurement in primary care can significantly improve identification and management of impairment in older veterans.
• Improved management can increase access to services, reduce acute care utilization, and support veterans living independently.
• Implementation data will inform proactive interventions to prevent functional decline and enhance quality of life.