QUERI – Quality Enhancement Research Initiative

Optimizing Function and Independence QUERI

Durham, NC

Principal Investigators: S. Nicole Hastings, MD (Corresponding PI, Durham VA), Courtney Van Houtven, PhD (Durham VA), Kelli Allen, PhD (Durham VA) and Virginia Wang, PhD (Durham VA)

Principal Operational Partners: VA Office of Geriatrics and Extended Care (GEC), VA Caregiver Support Program, Physical Medicine and Rehabilitation Services, Office of VA Voluntary Services, and the VA Mid-Atlantic Healthcare Network.

Executive Summary;

The overall goals of the Optimizing Function and Independence QUERI (Function QUERI) are to:

• Implement and evaluate evidence-based clinical programs focused on maximizing function and independence in vulnerable Veterans, and
• Promote the rapid translation of research findings into practice through implementation strategies promoting flexibility of clinical programs and a focus on teams.

Functional status (e.g., an 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.

Program Objectives:

The Optimizing Function and Independence QUERI aims to:

• Adapt a novel complexity-science based implementation intervention to promote team readiness (CONNECT) for use in a diverse mix of clinical settings and VAMCs;
• Implement and evaluate three clinical programs - STRIDE, Group physical therapy (PT) for Knee Osteoarthritis, and HI-FIVES (Helping Invested Families Improve Veterans' Experiences Study) - that fill gaps in current clinical care for Veterans at risk for functional decline and disability;
• Examine the impact of CONNECT and team processes on implementation across projects; and
• Develop a Team Building and Readiness Toolkit for VA clinical programs to distill and disseminate findings from Function QUERI implementation activities.

MyVA Goals: Build a collaborative, inclusive and results-oriented culture that inspires trust in order to improve the employee experience.

Program 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. These clinical programs address three high-priority gaps in clinical care identified by their national partners in the National Offices of Geriatrics and Extended Care, Physical Medicine and Rehabilitation Services, and the VA 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).

Project Summaries:

Project 1: Targets prevention of disability related to immobility during hospitalization through a supervised walking program (STRIDE).

Project 2 (Quality Improvement): Focuses on improving function in patients with symptomatic knee osteoarthritis through expanded access to physical therapy in a group-based model (Group PT for Knee Osteoarthritis).

Project 3: Promotes functional ability and avoiding nursing home placement through caregiver training at the time of referral for home care services (HI-FIVES).