Nearly half of older adults report problems with function, which can lead to difficulty with activities of daily living and nursing home placement. Thus, there is a need to implement evidence-based models of care to improve function and those factors that support function in older adults living in the community. One such model is Community Aging in Place, Advancing Better Living for Elders (CAPABLE), a person-centered, self-directed, nurse and occupational therapy intervention supported by assistive devices and home modifications. We build on prior work that translated CAPABLE and conducted preliminary testing of a package of implementation strategies entitled ?MiCAP?. This R15 AREA application is a Stage Ib, 3-year, adaptive, randomized, Hybrid-3, mixed trial to test site-level adoption and sustainability of CAPABLE after deploying the MiCAP package of implementation strategies (readiness assessment, training, facilitation, champions, coalition building, and audit and feedback). Knowledge-to-Action guides our approach and the Consolidated Framework for Implementation Research guides implementation. Our real world setting is 18 Medicaid Home and Community Based Service ?waiver? program sites in Michigan that care for community dwelling disabled older adults. Baseline measures of characteristics, leadership and readiness (site), and attitude and efficacy (clinicians) will be obtained. Investigators will train facilitators (Champions) at each site who will train an interdisciplinary team of nurses, occupational therapists, and social workers who will then provide CAPABLE. A facilitator coalition will be formed to share best implementation practices. The Stages-of-Implementation tool will be used to assess success. Sites will be randomized to internal facilitation alone or internal facilitation plus external facilitation. Post-intervention data from waiver sites and clinicians will be collected. Medicaid beneficiary-level outcomes will be examined (activities of daily living, instrumental activities of daily living, pain, depression, falls, ER and hospital use) over 9-months to report on intervention efficacy in this population. This work will impact implementation science by testing two approaches to implementation of an evidence-based intervention to improve outcomes among older adults in a Medicaid Waiver program. This natural setting approach has high generalizability for waivers, as we learn what intensity of implementation strategies are needed to adopt evidence in a waiver, providing information on how to transform programs that care for our nation's most vulnerable older adults. We will engage students as members of our team, assisting with data collection, analysis, and reporting of results; and building our College of Nursing's research capacity.
PROJECT RELEVANCE Nearly half of older adults report problems with function, thus, implementation of evidence-based models of care to improve function should be seen as a public health priority. The goal of this proposal is to conduct a randomized controlled trial to test a package of implementation strategies in an interdisciplinary evidence- based model of care to improve function and those factors that influence poor function in community dwelling disabled older adults. This work impacts implementation science by testing approaches to implementation of evidence to improve outcomes among older adults in a Medicaid Waiver program and has high generalizability, as we learn what strategies are needed to adopt evidence, potentially transforming programs that care for our nation's most vulnerable older adults.
