Improving Care for Older Veterans with Functional Impairment and Frailty
This study aims to improve how functional impairment (difficulty with daily activities) and frailty are identified and managed in older Veterans. Researchers are testing two different approaches: a "Screening intervention" that includes routine functional status measurement and nursing assessments, and two bundles of implementation strategies (Standard and Enhanced) to help clinics adopt these changes. The goal is to see if these interventions help clinics better identify and manage these conditions, ultimately improving the quality of life for older Veterans. You may be eligible if you are a Veteran over 60 years old and receive primary care at a VA facility. The study will look at how widely these interventions are used and how effective they are over 9 to 24 months.
- Study design
- This interventional study plans to enroll 10,000 participants. It is not specified if participants will be randomly assigned to different groups.
- What's involved
- Not specified in the trial record.
- Compensation
- Not stated in the trial record.
- Follow-up
- Participants will be followed for up to 24 months after the intervention begins.
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A Partnered Evaluation to Improve the Identification and Management of Functional Impairment and Frailty Among Older Veterans in Primary Care Settings
At a glance
Conditions
Where it's being run
1 sites across 1 statesStudy leadership
- Rebecca T. Brown, MD MPH · PRINCIPAL_INVESTIGATOR · Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
- Francesca M Nicosia, PhD MA · PRINCIPAL_INVESTIGATOR · San Francisco VA Medical Center, San Francisco, CA
Who to contact
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Do you actually qualify for this trial?
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Inclusion
Exclusion
What this trial measures
- Change in reach9 months, 12 months, 15 months, 18 months, 24 months
Reach is defined as the proportion of eligible Veterans who receive LVN screening and PCP assessment at each center. The investigators will identify eligible Veterans (i.e., 60 years old, seen in primary care after implementation begins) and use Health Factors to identify completed screening, defined as an LVN completing the electronic tool, and assessment, defined as a PCP reviewing screening results and either (a) documenting via checkbox that further referral is not needed or (b) placing a referral to address impairments.
- Change in clinical effectiveness0 months, 9 months, 12 months, 15 months, 18 months, 24 months
The primary outcome is proportion of Veterans with impairments who receive appropriate referrals. Appropriate referrals will be defined as the PCP reviewing the LVN screening results and either (1) documenting via checkbox that further referral is not needed or (2) placing a referral to address identified impairments.
- Change in association of electronic health record frailty indices with functional status0 months, 9 months, 12 months, 15 months, 18 months, 24 months
Frailty will be measured using the validated VA Frailty Index (VA-FI), calculated using the cumulative deficit method. The VA-FI includes up to 31 age-related health deficits based on VA EHR diagnostic and procedure codes. Categories include non-frail (0-0.1), pre-frail (0.11-0.2), and frail (\>0.2). Functional status will be measured from Health Factors. In sensitivity analyses, the investigators will examine other EHR frailty indices (e.g., JEN Index100)