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Principal Investigator: Rebecca Tyler Brown
Organization: PHILADELPHIA VA MEDICAL CENTER
Fiscal Year: 2024
Funding agency: Veterans Affairs
PROJECT SUMMARY/ABSTRACT
Background: Maintaining functional status, or 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 purpose of the
proposed QUERI Partnered Evaluation Initiative is to implement and evaluate the Patient-Aligned Care Team
(PACT) Functional Status Screening Initiative (hereafter “PACT Function Initiative”), a patient-centered, low-
burden intervention to improve measurement of functional status in VA primary care settings nationally.
Significance/Impact: 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, reducing potentially preventable acute care utilization,
and allowing Veterans to live in the least restrictive setting for as long as possible. The proposed QUERI
Partnered Evaluation Initiative is directly aligned with national VA strategic priorities including VA’s Aging in
Place and Aging and Frail Veterans initiatives (Objective 2.2) and developing Data as a Strategic Asset
(Objective 4.2) to inform evidence-based decisions.
Innovation: The PACT Function Initiative is novel because it addresses prior barriers to functional status
measurement. It incorporates Veteran and caregiver preferences while minimizing burden for primary care
teams and maximizing clinical effectiveness. Implementing this intervention will provide functional status data
that is directly actionable for patient care while creating a repository of data to inform VA strategic planning.
Specific Aims: (1) Measure clinician- and organization-level reach, adoption, implementation, and
sustainment of the PACT Function Initiative; (2) Compare the effectiveness of a standard versus enhanced
implementation bundle to improve adoption; (3) Measure patient-level clinical effectiveness of the intervention;
and (4) To inform future GEC initiatives, test the effectiveness of EHR-based frailty screening for identifying
Veterans at risk for functional impairment. We hypothesize that implementing the PACT Function Initiative will
result in increased identification and improved management of functional impairment among older Veterans
while providing key data to inform VHA strategic planning related to long-term services and supports.
Methodology: In partnership with GEC and Primary Care, we will implement and evaluate the PACT Function
Initiative using a hybrid type 2 implementation-effectiveness cluster-randomized adaptive trial design with three
phases: pre-implementation, implementation, and sustainment. We will use the Practical, Robust
Implementation and Sustainability Model (PRISM) to guide implementation and evaluation. During pre-
implementation, we will engage stakeholders and develop local adaptations to maximize intervention-setting fit.
During implementation, we will launch a standard bundle of implementation strategies (champions, system-
level audit and feedback), identify sites with low uptake, and randomize those sites to receive continued
standard vs. enhanced strategies (technical assistance, clinician-level audit and feedback).
Next Steps/Implementation: Establishing routine, standardized measurement of functional status and frailty
among older Veterans will provide data to inform the delivery of proactive interventions to prevent and delay
the development of functional impairment and improve quality of life, health, and independence.
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