Improving Detection and Care of Functional Impairment and Frailty in Veterans Over 60 in VA Primary Care

What this Trial Is About

Maintaining the ability to perform daily activities is crucial for the quality of life, health, and independence of older adults. This research focuses on improving how functional impairments and frailty are identified and managed among older Veterans in primary care settings within the Veterans Health Administration VHA. The study aims to increase the use of standardized, low-burden tools to measure functional status, which has been challenging to implement widely due to the complexity of current methods. The initiative aligns with national VA priorities to support aging Veterans and improve healthcare planning. The study evaluates a patient-centered intervention called the PACT Function Initiative, which includes routine, standardized functional status measurement, nursing screening with primary care follow-up, electronic tools for documentation, educational sessions for staff, and tailored reports on functional status. Initially, all participating sites will use a standard bundle of implementation strategies such as champions and system-level audit and feedback. Sites with lower uptake after three months will be randomized to receive either continued standard implementation or an enhanced bundle that adds technical assistance and clinician-level audit and feedback. The study includes phases of pre-implementation, implementation, crossover allocation, and sustainment. Participants, who are older Veterans seen in VA primary care, will be part of assessments over 24 months. Researchers will measure changes in reach, clinical effectiveness, adoption, fidelity, patient experience, sustainability, and functional status using electronic health records and screening data. The study collects data at multiple time points to evaluate the impact of implementing the intervention. This ongoing monitoring will help inform strategies for better managing functional impairment and frailty in this population.

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