# Implementing a Decision Support Tool to prevent Community-Acquired Pressure injury in Spinal Cord Injury (SCI) in the Spinal Cord Injury Clinic.

> **NIH VA I01** · EDWARD HINES JR VA HOSPITAL · 2024 · —

## Abstract

Spinal cord injury (SCI) is a permanent condition affecting every aspect of life including health, daily
activities, and participation and quality of life. Persons with SCI are at high risk of pressure injury (PrI)
throughout their lives due to loss of sensation, nerve damage and immobility. PrIs are local areas of
damage to the skin and underlying soft tissue caused by pressure and shear commonly located over
bony prominences. While most PrIs are hospital- or nursing home-acquired, in people with SCI, PrIs
typically develop in the community. Community-acquired pressure injuries (CAPrIs) are common,
devastating, and costly. This grant proposal is a type 1 hybrid stepped wedge randomized design at six
additional SCI Clinics to assess the efficacy and implementation of a decision support tool, called the
Community Acquired Pressure Injury Prevention Field Implementation Tool (CAPP-FIT) previously
developed and piloted at one site. The CAPP-FIT includes: 1) a Veteran survey to identify risks,
actions, and resources needed to prevent CAPrIs and 2) a companion Provider Report immediately
available in print or downloaded into the electronic health record listing Veteran responses to survey
items with recommended evidence-based provider actions. The Veteran survey can be completed at
home via a secured email or by using an iPad in the clinic. There are three aims in the proposal, guided
by the RE-AIM framework. Aim 1 is implementing the CAPP-FIT at the seven geographically diverse
VA SCI clinics, including workflow redesign, provider training, and evaluation of provider readiness. The
CAPP-FIT will be implemented in a staggered fashion consistent with the stepped wedge design. After
CAPP-FIT implementation, each site will determine how the CAPP-FIT will be maintained in clinical
practice to support sustainability (maintenance phase). Aim 2 assesses efficacy, assessing provider
and Veteran satisfaction in CAPrI use, new CAPrI incidence for 6 months post-initial CAPP-FIT
implementation, and overall and CAPrI-associated hospitalizations. Aim 3 assesses implementation
using RE-AIM. Reach is the proportion of providers and Veterans participating in the intervention.
Adoption is assessed by the proportion of Veteran-identified modifiable risk factors acted upon by SCI
providers, as well as a comparison of non-modifiable risk factors of participating and non-participating
VA SCI clinics. Implementation is assessed by describing completed CAPP-FITs during
implementation, describing Veteran CAPrI risk factors, and describing provider identified facilitators and
barriers to implementation. Maintenance is assessed by describing how each clinic will continue to
integrate CAPP-FIT into workflow and by describing the number of providers using the CAPP-FIT
during maintenance phase.

## Key facts

- **NIH application ID:** 10862256
- **Project number:** 1I01HX003704-01A2
- **Recipient organization:** EDWARD HINES JR VA HOSPITAL
- **Principal Investigator:** Elizabeth Burkhart
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2024-08-01 → 2028-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10862256

## Citation

> US National Institutes of Health, RePORTER application 10862256, Implementing a Decision Support Tool to prevent Community-Acquired Pressure injury in Spinal Cord Injury (SCI) in the Spinal Cord Injury Clinic. (1I01HX003704-01A2). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10862256. Licensed CC0.

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