Table 1 Overview of optimizing function and independence QUERI (Function QUERI) projects
Overview of projects | Group PT | STRIDE | iHI-FIVES |
|---|---|---|---|
Outpatient physical therapy | Inpatient walking assistance | Caregiver (CG) skills training | |
Context of clinical program | |||
Relevant clinical service | Physical medicine and rehabilitation (PM&R) | Inpatient general medicine | Caregiver (CG) support program or other service lines that support CGs |
Nature of clinical program tasks | Existing task, alternative mode of delivery | New task | Existing task, alternative mode of delivery |
Team formation | Existing team (processes) | Existing team (formation) New team (processes) | New team (formation) Existing team (processes) |
Program delivery: boundary spanning? | No | Yes: general medicine, nursing, physical therapy | Both (across service lines, within CSP or GRECC) |
Team membership: roles in program delivery | • Physicians: referral • Physical Therapist: initial evaluation, lead sessions • Physical Therapy Assistant: co-lead sessions | • Physicians: referral • Registered nurse: coordination, assessment • Physical therapist: assessment, walking, supervise walks • Nurse assistant, physical therapy assistant, volunteer: supervise walks | • Physicians: referral • Social worker: referral and training • CG support coordinator: training • Registered nurse: training • Psychologist: training |
Noted challenges in program delivery to be addressed by CONNECT | • Awareness of Group PT outside PM&R • Clarity of roles • Established procedures • Interaction within the PM&R service | • Clarity of roles • Availability of staff resources • Communicating relevant clinical information and “prescribed dose” of STRIDE | • Awareness of the CSP and its mission in clinical units • Clarity of roles, fragmented/duplicative services for CG support across service lines, enhance continuity of caregiver support |
Outcomes of interest | |||
Implementation outcomes | ✓ Penetration ✓ Fidelity ✓ Provider experience | ✓ Penetration ✓ Fidelity ✓ Team processes ✓ Provider experience | ✓ Penetration ✓ Fidelity ✓ Team processes ✓ Provider experience |
Patient/service-level outcomes | ✓ Function ✓ Pain ✓ Wait times ✓ Patient satisfaction ✓ Provider satisfaction ✓ Budget impact | ✓ Discharge to SNF ✓ Physical function ✓ Community mobility ✓ HRQoL, sleep, depression ✓ Hospital LOS ✓ Patient satisfaction ✓ Budget impact | ✓ Days in community ✓ CG Depressive symptoms ✓ CG Burden ✓ CG Satisfaction with VA care received ✓ Budget impact |