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2023 HSR&D/QUERI National Conference Abstract

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1108 — Preventing Community Acquired Pressure Injuries in Spinal Cord Injury Using a Decision Support Tool in the SCI Clinic

Lead/Presenter: Lisa Burkhart,  COIN - Hines
All Authors: Burkhart LE (Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital), Smith A (Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital) Lavela S (Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital) Osteen C (Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital) Bartle B (Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital) Weaver F (Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital)

Objectives:
Describe how the Community Acquired Pressure Injury Prevention Field Implementation Tool (CAPP-FIT) decision support tool may prevent community-acquired pressure injuries (CAPrIs) among Veterans living with spinal cord injury (SCI) in the SCI clinic.

Methods:
The CAPP-FIT was grounded in qualitative research with Veterans with SCI and SCI providers and validated using a Delphi expert panel of 4 Veterans living with SCI, 3 caregivers, and 15 interprofessional healthcare providers. The CAPP-FIT is used prior to an established SCI clinic visit and includes: 1) a Veteran survey to identify risks, actions, and resources needed to prevent CAPrIs (programmed on an iPad app), and 2) a companion Provider Report immediately available listing Veteran responses to survey items identifying CAPrI risks with recommended evidence-based provider actions. The CAPP-FIT was piloted at one SCI Clinic for up to 6 clinic visits per participant. Veteran-identified risks were summarized. Chart review revealed use of evidence-based provider actions to address identified risks. Veteran satisfaction with the CAPP-FIT was measured with the Mobile App Rating Scale. Providers evaluate implementation during monthly meetings. CAPrI incidence is measured 6-months post initial CAPP-FIT implementation.

Results:
Seven providers are participating in the pilot. Out of the initial 63 Veteran participants, 98% identified required care needs associated with CAPrI risk factors. The most common risks identified at the initial CAPP-FIT implementation were an acute illness that affects CAPrI prevention (73%), mobility/activity issues (63%), and substance issues (54%). The CAPP-FIT stimulated provider interventions for 48% of Veteran-identified risks. Preliminary results of CAPrI incidence showed a decrease from an average of 27.4% in FY18-FY21 at the pilot site to 18% following 6 months post CAPP-FIT implementation. Almost all Veteran participants agreed the questions were relevant to the challenges they experience (94%) and indicated the CAPP-FIT made it easier to have conversations with their provider (94%). Veterans felt most providers discussed the risk factors identified in the CAPP-FIT (86%). During monthly meetings, providers agreed that the CAPP-FIT changed their practice to incorporate more community-focused preventive care questions and identified issues that would have gone unnoticed.

Implications:
Results indicate the CAPP-FIT reveals CAPrI risks and improves provider preventive care. It also improves communication between Veterans and providers and decreases the incidence of CAPrIs.

Impacts:
Persons with SCI are at high risk for pressure injuries, with 95% experiencing one severe pressure injury during their lifetime. CAPrIs cost the VA more than $89 million annually. The CAPP-FIT has the potential to improve preventive care, facilitate provider-Veteran communication, and decrease the incidence and costs of CAPrIs.