ABSTRACT
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, self-directed,
nurse and occupational therapy intervention supported by assistive devices and home modifications. We build
on prior work that translated CAPABLE and conducted preliminary testing of a package of implementation
strategies entitled “MiCAP”. This R15 AREA application is a Stage Ib, 3-year, adaptive, randomized, Hybrid-3,
mixed trial to 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). Knowledge-to-Action guides our approach and the Consolidated Framework for Implementation
Research guides implementation. Our 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, ER 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 we learn what intensity of implementation strategies are needed to adopt
evidence in a waiver, providing information on how to transform programs that care for our nation's most
vulnerable older adults. We will engage students as members of our team, assisting with data collection,
analysis, and reporting of results; and building our College of Nursing's research capacity.
