Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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4021 — Making Function Part of the Conversation: Clinician Perspectives on Measuring Functional Status in Primary Care

Lead/Presenter: Francesca Nicosia
All Authors: Nicosia FM (San Francisco Veterans Affairs Medical Center, University of California San Francisco ) Spar MJ (San Francisco Veterans Affairs Medical Center, University of California San Francisco ) Steinman MA (San Francisco Veterans Affairs Medical Center, University of California San Francisco ) Brown RT (San Francisco Veterans Affairs Medical Center, University of California San Francisco )

Objectives:
Understanding older adults' ability to perform basic daily activities ("functional status") allows clinicians to deliver interventions to improve functioning and quality of life, and to provide patient-centered care. Yet functional status is not routinely assessed in most non-geriatrics primary care settings. To inform a national U.S. Department of Veterans Affairs (VA) initiative to introduce standardized functional status assessment in primary care clinics, we conducted a qualitative study to evaluate providers' perspectives on barriers and facilitators to routine assessment.

Methods:
We used criterion sampling to identify 6 VA Medical Centers with varying strategies for documenting functional status. We conducted semi-structured interviews with clinicians (MDs and NPs) from primary care and geriatrics clinics at these sites. Interviews focused on clinician experience and opinions about functional status measurement, including barriers and facilitators to routine assessment. We analyzed transcripts iteratively using a hybrid deductive-inductive approach informed by the Consolidated Framework for Implementation Science (CFIR), study aims, and themes that emerged from interview data.

Results:
We interviewed 20 clinicians, including 14 from primary care clinics and 6 from geriatrics clinics. We identified 3 primary domains related to barriers and facilitators to routine assessment. First, we found that contextual factors in the clinic strongly influence routine assessment, including clarity of roles and responsibilities, documentation requirements, and time pressures. Second, characteristics of the assessment instrument are important, including the balance of structure and flexibility, ability to track change over time, and integration in clinic workflow and electronic health records. Third, provider experience and beliefs impact readiness to embrace assessment, including familiarity with assessment and experience with using functional status information to inform clinical decision-making.

Implications:
Interviews revealed several modifiable barriers to routine functional status assessment, including lack of a documentation requirement, usability of the assessment instrument, and lack of knowledge about how function can be used to inform clinical decision-making.

Impacts:
These findings will directly inform the design and implementation of a standardized approach to measurement of functional status that can be adapted across varied VA primary care settings.