Optimizing Function and Independence QUERI

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Background: The overall goal of the Optimizing Function and Independence QUERI (“Function QUERI”) is to implement and evaluate evidence-based clinical programs focused on maximizing function and independence in vulnerable Veterans. Functional status (e.g., individual’s ability to perform normal daily activities, fulfill usual roles, and maintain health and well-being) is an essential determinant of quality of life. Health-related functional impairments often lead to disability, which is a significant driver of health care utilization and costs. Veterans at risk for functional decline constitute a large group of vulnerable Veterans with unique needs, and therefore a VA Blueprint for Excellence (BPE) national priority group for VA. Methods: Function QUERI will conduct three distinct but related projects aimed at implementing evidence-based programs across the continuum of care for Veterans at risk for functional decline and loss of independence. Implementation Project 1 focuses on prevention of disability related to immobility during hospitalization through a supervised inpatient walking program (STRIDE). Local Quality Improvement Project 2 focuses on improving function in patients with symptomatic knee osteoarthritis through expanded access to Physical Therapy in group-based care delivery (Group PT for Knee OA). Implementation Project 3 focuses on promoting functional ability and avoiding nursing home placement through caregiver training at the time of patient referral for home care services (HI-FIVES). These clinical programs address three high priority gaps in clinical care identified by our national partners in the National Offices of Geriatrics and Extended Care, Physical Medicine and Rehabilitation Services, and the Caregiver Support Program. A major reason for clinical care gaps in this population is poor communication and coordination among the many interdisciplinary providers involved in their care. Adopting new programs requires buy-in and cooperation among many different service lines, and a one-size fits all approach is rarely effective. Function QUERI will utilize implementation strategies focused on promoting flexibility of clinical programs to fit local environments (Replicating Effective Programs) and enhancing the performance of provider teams (CONNECT). The overall goals of Function QUERI program of work are to: 1. Adapt a novel implementation intervention to promote team readiness (CONNECT) for use in a diverse mix of VA clinical settings; 2. Implement and evaluate three clinical programs, STRIDE, Group PT for Knee OA, and HI- FIVES, that fill gaps in current clinical care for Veterans at risk for functional decline; 3. Examine the impact of CONNECT and team processes on implementation across projects; 4. Develop a Team Building and Readiness Toolkit for VA clinical programs to synthesize findings from Function QUERI implementation activities. Anticipated Impact: Through our implementation strategies and focus on teams, we directly address BPE and myVA priorities of promoting rapid translation of research findings into practice and improving employee engagement and experience. Function QUERI will achieve an immediate impact on care within VHA by providing access to evidence-based clinical services for Veterans at risk of disability. Our long-term impact will be to enhance VA’s capacity for clinical innovation through the development of a toolkit for Team Building and Readiness for Implication to enhance uptake of evidence-based programs.