“Implementation of CAPABLE in the Michigan Medicaid Waiver”
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, nurse and occupational therapy intervention supported by assistive devices and home modifications. The investigators build on prior work that translated CAPABLE and conducted preliminary testing of a package of implementation strategies entitled "MiCAP". This R15 application will 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). The 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, emergency room 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 the investigators learn what intensity of implementation strategies are needed to adopt evidence in a waiver. The investigators will engage students as members of the team and building the College of Nursing's research capacity.
Behavioral - MiCAP with IF
Sites will conduct MiCAP strategies described as follows. Relationship Building; Assess readiness to implement of the site; Internal Facilitator (IF) Champion Coalition Building, which will include IFs training in CAPABLE and facilitation and online IF coalition meetings; Facilitation by the IF, which will include training the clinicians, reviewing home visits with the clinician to assure CAPABLE was provided; IF developing a clinical team for implementation of CAPABLE and leading interdisciplin ...read more on ClinicalTrials.org
Behavioral - MiCAP with IF and EF
Sites will conduct MiCAP strategies described above in "MiCAP with IF" with an addition of External Facilitation. Centralized Oversight will be conducted by External Facilitators. External Facilitators will train in facilitation. The work of the External Facilitators will be tailored (i.e., type of discipline) to each site's needs. Intervention and implementation strategy fidelity data will be placed in a dashboard and will be provided to External Facilitators. External Facilitators will use the ...read more on ClinicalTrials.org
Statewide Implementation of CAPABLE-Community Aging in Place, Advancing Better Living for Elders in the Michigan Medicaid Home and Community Based Waiver Program