Francesca M Nicosia1,2, Malena J Spar1,2, Michael A Steinman1,2, Sei J Lee1,2, Rebecca T Brown1,2,3. 1. San Francisco Veterans Affairs (VA) Medical Center, San Francisco, California. 2. Division of Geriatrics, University of California, San Francisco, San Francisco, California. 3. Division of Geriatric Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania.
Abstract
OBJECTIVES: Although there is increasing interest in using functional status to guide clinical decision making, function is seldom routinely assessed in primary care. We explored clinician perspectives on barriers and facilitators to routine measurement of older adults' functional status in primary care settings. DESIGN: Qualitative study using semistructured interviews. SETTING: Primary care and geriatrics clinics at six Veterans Affairs Medical Centers. PARTICIPANTS: Twenty-four primary care providers, including 17 from primary care clinics and 7 from geriatrics clinics. MEASUREMENTS: We conducted interviews to elicit clinician perspectives about functional status measurement, including barriers and facilitators to routine assessment. We analyzed transcripts iteratively using a hybrid inductive and deductive thematic approach. RESULTS: Interviews revealed three distinct aspects to measuring function: screening and assessment, documentation, and use of data to inform care. Barriers and facilitators to screening and assessment included time availability, clinic processes, and degree of interdisciplinary environment. Barriers and facilitators to documentation included the usability and integration of electronic instruments into workflows and the availability of a standardized location to document function in the electronic medical record. Barriers and facilitators to use of data included the availability of a standardized location to retrieve data on function, the availability of appropriate referrals and services, and provider knowledge of available resources to address functional impairments. To address these barriers, providers emphasized the critical importance of connecting measurement of function directly to improved patient care. CONCLUSION: Although clinicians emphasized the importance of measuring function, they also cautioned against additional workload burdens, cumbersome electronic documentation, and measurement of function without ensuring that these data are used to improve care. Approaches to functional status measurement must address these barriers to improve care and outcomes for older adults. J Am Geriatr Soc 67:493-502, 2019.
OBJECTIVES: Although there is increasing interest in using functional status to guide clinical decision making, function is seldom routinely assessed in primary care. We explored clinician perspectives on barriers and facilitators to routine measurement of older adults' functional status in primary care settings. DESIGN: Qualitative study using semistructured interviews. SETTING: Primary care and geriatrics clinics at six Veterans Affairs Medical Centers. PARTICIPANTS: Twenty-four primary care providers, including 17 from primary care clinics and 7 from geriatrics clinics. MEASUREMENTS: We conducted interviews to elicit clinician perspectives about functional status measurement, including barriers and facilitators to routine assessment. We analyzed transcripts iteratively using a hybrid inductive and deductive thematic approach. RESULTS: Interviews revealed three distinct aspects to measuring function: screening and assessment, documentation, and use of data to inform care. Barriers and facilitators to screening and assessment included time availability, clinic processes, and degree of interdisciplinary environment. Barriers and facilitators to documentation included the usability and integration of electronic instruments into workflows and the availability of a standardized location to document function in the electronic medical record. Barriers and facilitators to use of data included the availability of a standardized location to retrieve data on function, the availability of appropriate referrals and services, and provider knowledge of available resources to address functional impairments. To address these barriers, providers emphasized the critical importance of connecting measurement of function directly to improved patient care. CONCLUSION: Although clinicians emphasized the importance of measuring function, they also cautioned against additional workload burdens, cumbersome electronic documentation, and measurement of function without ensuring that these data are used to improve care. Approaches to functional status measurement must address these barriers to improve care and outcomes for older adults. J Am Geriatr Soc 67:493-502, 2019.
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