# PAtient-centered mUltidiSciplinary care for vEterans undergoing surgery (PAUSE): a hybrid 1 clinical effectiveness-implementation intervention trial

> **NIH VA I01** · VETERANS ADMIN PALO ALTO HEALTH CARE SYS · 2021 · —

## Abstract

Background: Frailty is a syndrome of reduced physiologic reserve associated with higher postoperative
mortality and adverse outcomes. Our preliminary work shows that institution-wide frailty screening and
introducing a “pre-surgical pause” reduces 6-month mortality by threefold. However, a knowledge gap exists in
the nature of the intervention and which stakeholders should be involved in the “pre-surgical pause”.
Multidisciplinary care models for complex patients are highly effective in oncology, wound care and primary
care. We propose a new intervention i.e. PAtient-centered mUltidiSciplinary care for vEterans undergoing
surgery (PAUSE), where experts from diverse fields will contribute to surgical decision-making and
optimization of outcomes for high-risk Veterans.
Impact: Aging Veterans are a fast-growing population with significant need for high-quality surgical care. This
study will build a structured multidisciplinary workflow to improve clinical and quality outcomes and provide
high-value care per VA priorities for frail and high-risk Veterans that aligns with their goals and expectations.
Innovation: This is the first study in the VA to implement a multidisciplinary care model for surgical care. The
intervention employs an innovative hybrid 1 clinical effectiveness-implementation design to evaluate novel
Veteran-centric outcomes of 30- and 180-day mortality, non-home discharge, rehospitalizations and home-
time. A detailed formative evaluation (FE) will evaluate provider and system factors that impact uptake of the
PAUSE intervention. Further, the study has support from three national operational partners: National Surgery
Office (NSO), Office of Geriatrics and Extended Care, and Palliative Care and Hospice Program.
Specific Aims: Our goals for this project are three-fold: (1) to test the effectiveness of the PAUSE trial
intervention vs usual care in improving 30- and 180-day mortality, non-home discharge, rehospitalizations and
home-time for patients undergoing surgical evaluation; (2) to test moderators of the PAUSE intervention
effectiveness (treatment effect heterogeneity), especially specialty, frailty severity and risk status; and (3) to
use a mixed-method formative evaluation to understand the factors that influence fidelity, adaptation, and
implementation of the PAUSE intervention. We hypothesize that the PAUSE intervention will lead to a
decrease in 30- and 180-day mortality, rehospitalizations, non-home discharge and increase home-time for all
Veterans (Aim 1). The effect size for the outcomes will be greater for frail patients in certain specialties (Aim 2).
The concurrent FE will highlight key barriers/facilitators for future implementation (Aim 3).
Methodology: The PAUSE trial is a pragmatic, stepped wedge randomized clinical trial designed to capture a
cohort of 25,000 Veterans scheduled for elective surgery at 3 large tertiary care VAMCs (Palo Alto, Houston
and Nashville) and 7 specialty groups: general, vascular, orthopedi...

## Key facts

- **NIH application ID:** 10187856
- **Project number:** 1I01HX003215-01A1
- **Recipient organization:** VETERANS ADMIN PALO ALTO HEALTH CARE SYS
- **Principal Investigator:** Shipra Arya
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2021-05-01 → 2025-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10187856

## Citation

> US National Institutes of Health, RePORTER application 10187856, PAtient-centered mUltidiSciplinary care for vEterans undergoing surgery (PAUSE): a hybrid 1 clinical effectiveness-implementation intervention trial (1I01HX003215-01A1). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10187856. Licensed CC0.

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