Feasibility, Usability, and Satisfaction of a Decision Support Tool to Prevent Community-Acquired Pressure Injuries for Use in the Spinal Cord Injury Clinic.

BACKGROUND: Community-acquired pressure injuries (CAPrIs) are common and costly among individuals living with spinal cord injury (SCI). OBJECTIVES: Describe feasibility, usability, and satisfaction of a decision support tool to prevent CAPrIs in individuals with SCI and effect of the Community-Acquired Pressure Injury Prevention-Field Implementation Tool (CAPP-FIT) on CAPrI incidence 6 months post CAPP-FIT implementation. METHODS: Preparation for the pilot included redesigning clinic workflow and training providers using a simulation with a standardized patient. The CAPP-FIT was piloted with community-dwelling veterans with scheduled in-person and telehealth clinic visits. Processes were assessed using contextual inquiry and monthly provider meetings. Feasibility, usability, and satisfaction were assessed using the mobile application rating scale with veterans and focus groups with providers. CAPrI incidence 6 months post CAPP-FIT intervention was assessed using a propensity match of veterans who did not receive the CAPP-FIT intervention. A modified Poisson regression with difference in differences was used to estimate the incidence rate ratio of CAPrIs. RESULTS: Participants included 7 providers (3 registered nurses, 2 nurse practitioners, 2 physicians). Veteran participants (n=103) had a mean age of 64; 50% White, 33% Black; 56% with paraplegia; and 72% with incomplete injury. Veteran participants were satisfied with the CAPP-FIT, agreed questions were relevant, and improved their conversations with providers. Providers felt the CAPP-FIT was easy to use, improved communications, and promoted preventive care. Participants experienced a lower CAPrI incidence rate compared with a propensity-matched sample at the pilot site, with the decrease among CAPP FIT participants being more pronounced than among non-participants. However, the difference in difference was not statistically significant with IRR: 0.23, 95% CI: 0.048-1.066 (P=0.060). CONCLUSIONS: The CAPP-FIT seems to be a useful tool in the SCI Clinic to prevent CAPrIs in veterans with SCI, but further testing is warranted.