A pilot randomized controlled trial of CAPABLE in permanent supportive housing for formerly homeless adults.

BACKGROUND: CAPABLE is a time-limited, evidence-based intervention that helps older adults live independently. It has not been previously tested for use among formerly homeless adults in permanent supportive housing (PSH) who experience accelerated aging that can jeopardize their ability to live independently and age in place. METHODS: A pilot randomized controlled trial with PSH tenants with an average age of 63 years old was conducted to examine the impact of CAPABLE on basic and instrumental activities of daily living (ADL) (and other function-related parameters). Twenty-seven PSH tenants received the intervention and 30 PSH tenants were assigned to a waitlist control group. RESULTS: Those who received the intervention showed improvements in five of seven health outcomes with small to medium effect sizes (Cohen's d = 0.20-0.47). When compared to the control group, the intervention group showed significantly greater improvements in two health outcomes-namely, reduction in limitations in instrumental ADL (p = 0.03) and depression (p = 0.01)-and greater effect sizes (d = 0.17-0.61). CONCLUSIONS: CAPABLE is an evidence-based practice that can be successfully implemented in PSH to improve outcomes in a population that experiences significant health disparities and premature decline. Further investigation with a larger sample is warranted.

Drivers and restrainers to adoption and spread of evidence-based health service delivery interventions: The case of CAPABLE.

CONTEXT: Very few programs improve physical function among older adults and those that do should achieve farther reach. METHODS: We used Force Field Analysis to examine drivers and restrainers for the CAPABLE program to impact the function of older adults throughout the United States. FINDINGS: We found 19 distinct drivers for CAPABLE. These include robust research findings demonstrating clinical and economic utility, expansion from an evidence-based program, grounding in theory, high value to older adults themselves, and common sense approach. A major policy environment shifting towards value-based payment and payer flexibility to experiment with social determinants significantly changed the perception of the program's value by key stakeholders. We found 8 distinct restrainers. CONCLUSIONS: Factors which drive and restrain CAPABLE provide lessons for other programs to move from research to sustainability. Policymakers, payers, and communities should look to proven programs as solutions to improve function for older adults and society.

A 2-Year Pragmatic Trial of Antibiotic Stewardship in 27 Community Nursing Homes.

OBJECTIVES: To determine if antibiotic prescribing in community nursing homes (NHs) can be reduced by a multicomponent antibiotic stewardship intervention implemented by medical providers and nursing staff and whether implementation is more effective if performed by a NH chain or a medical provider group. DESIGN: Two-year quality improvement pragmatic implementation trial with two arms (NH chain and medical provider group). SETTING: A total of 27 community NHs in North Carolina that are typical of NHs statewide, conducted before announcement of the US Centers for Medicare and Medicaid Services antibiotic stewardship mandate. PARTICIPANTS: Nursing staff and medical care providers in the participating NHs. INTERVENTION: Standardized antibiotic stewardship quality improvement program, including training modules for nurses and medical providers, posters, algorithms, communication guidelines, quarterly information briefs, an annual quality improvement report, an informational brochure for residents and families, and free continuing education credit. MEASUREMENTS: Antibiotic prescribing rates per 1000 resident days overall and by infection type; rate of urine test ordering; and incidence of Clostridium difficile and methicillin-resistant Staphylococcus aureus (MRSA) infections. RESULTS: Systemic antibiotic prescription rates decreased from baseline by 18% at 12 months (incident rate ratio [IRR] = 0.82; 95% confidence interval [CI] = 0.69-0.98) and 23% at 24 months (IRR = 0.77; 95% CI = 0.65-0.90). A 10% increase in the proportion of residents with the medical director as primary physician was associated with a 4% reduction in prescribing (IRR = 0.96; 95% CI = 0.92-0.99). Incidence of C. difficile and MRSA infections, hospitalizations, and hospital readmissions did not change significantly. No adverse events from antibiotic nonprescription were reported. Estimated 2-year implementation costs per NH, exclusive of medical provider time, ranged from $354 to $3653. CONCLUSIONS: Antibiotic stewardship programs can be successfully disseminated in community NHs through either NH administration or medical provider groups and can achieve significant reductions in antibiotic use for at least 2 years. Medical director involvement is an important element of program success. J Am Geriatr Soc 68:46-54, 2019.

Using RE-AIM to evaluate implementation of an evidence-based program: a case example from Minnesota.

UNLABELLED: The RE-AIM framework was used to evaluate the implementation experience of 14 organizations in Minnesota over 4 years as they adopted an evidence-based intervention for spousal caregivers. PURPOSE: To examine the implementation experience and describe sustainability issues. METHODS: Mixed-methods using data from qualitative interviews, cost data, and caregiver experience data. FINDINGS: Although the intervention was valued, most organizations were not able to continue providing the program. CONCLUSION: The results indicate a need for further translation or technical support to identify readiness and prepare the interventionist to offer the program, more robust recruitment methods, and additional funding strategies.

Factors Supporting Implementation among CDSMP Organizations.

Reaching individuals who can benefit from evidence-based health promotion and disability prevention programs is a goal of federal, state, and local agencies as well as researchers, providers, community agencies, and other stakeholders. Implementation effectiveness at the organizational level must be achieved in order to reach these individuals and sustain the program. This mixed methods study examined eight organizations within two states that successfully implemented the Chronic Disease Self-Management Program (CDSMP) and sustained it from 4 to 10 years. There were two types of organizations: aging services and health care. Internal and external implementation factors and influences were explored. Additional examination of state activities (as a key external agent supporting CDSMP implementation) was conducted. The examination found agreement among the eight organizations regarding why they had adopted the CDSMP - citing the alignment between the program and their organizations' mission and purpose to improve health status and promote better self-care, and the demonstrated value (benefits) of the program. Organizations were also alike in that they described the importance of an internal champion and supportive senior leader. Organizations differed in how they experienced and valued peer support and collaborative networks. Organizations also differed in how they filled their CDSMP workshops. Internal drivers and capability were more often discussed as facilitating successful implementation than external factors. However, state activities and external support enabled successful adoption - particularly funding and training. The primary challenges identified by this set of organizations included difficulty in recruiting participants (filling workshops) and irregular or insufficient funding sources. These challenges were identified as significant and represented barriers to sustaining the program.