Surgical pause | Empower | TAP | CAPABLE | |
---|---|---|---|---|
Description | “Surgical Pause” involves systematic screening for frailty using the Risk Analysis Index (RAI) prior to surgery, triggering care pathways that clarify goals pre-operatively | “Eliminating Medications through Patient Ownership of End Results” (EMPOWER) is a direct-to-consumer booklet sent to older adults receiving a high-risk medication on a chronic basis paired with academic detailing for prescribers | “Tailored Activities Program” (TAP) is a 4-month structured, manualized intervention led by an occupational therapist (OT) that trains caregivers of patients with dementia to deliver activities tailored to the care recipients’ interests and capabilities | “Community Aging in Place – Advancing Better Living for Elders” (CAPABLE) utilizes a nurse, occupational therapist, and handyperson to identify and facilitate the functional goals related to aging in place of low-income older adults with 1 ADL or 2 IADL impairments |
Core components | • Prior to surgical decision making, patient completes the RAI • Patients with RAI ≥ 37 referred for goal clarification conversation • Clinician(s) and patient review treatment plan, with or without surgery, to align with patient’s overarching goals and values | • Identifying patient panel • Mail EMPOWER brochure which includes a self-assessment of risks for medication, presentation of evidence of harms, medication education, and suggestions for conversation with provider • Provider prescriber education | • OT formal training • OT conducts home assessment to identify Veterans’ preserved capabilities and interests • OT develops 3 tailored activity prescriptions • Caregiver and Veteran participate in at least 3 TAP sessions | • OT and nurse formal training • Staffing components: • OT assess functional abilities, home accessibility, and safety then collaborates with Veteran to create up to 3 ADL/IDAL goals • Nurse—assesses medical status and develops 3 nursing goals • Handy Person—completes home modifications/repairs |
Example adaptations | • Which staff screen • Strategy for communicating results to surgeon • In-person versus virtual training • Which clinician completes goal clarification conversation | • Format of brochure • Timing of brochure mailing and communication with prescriber • Which staff mail the brochure • Number of mailings | • Other health professionals (social worker, psychologist, RN) may also implement TAP with OT supervision • Location of session • Number of visits | • Referral source • Addressing more critical and expensive home repairs • Number of sessions conducted virtually vs in home after the initial assessment |
Patient eligibility | • Age 65 + • RAI ≥ 37 • Considering “major surgery” as defined by a VASQIP-eligible CPT code | • Age 65 + • Community-dwelling (i.e., not residing in a nursing home) • Receiving a prescription for a targeted drug class for at least 90 of the last 120 days from a VA prescriber | • Age 65 + • Has a dementia diagnosis • Has an adult caregiver willing/able to participate • Can participate in at least two basic ADLs | • Age 65 + • Low income • At least 1 ADL or 2 IADL deficiencies • Able to ambulate around house independently with or without an assistive device |
Potential setting | Preoperative clinics (e.g., surgery, anesthesia, primary care, medical subspecialties) | Primary care, mental health | Home care, home-based primary care, caregiver support program | Home care |