MODELS OF GERIATRIC CARE, QUALITY IMPROVEMENT, AND PROGRAM DISSEMINATION Dissemination of the CAPABLE Model of Care in a Medicaid Waiver Program to Improve Physical Function Sandra L. Spoelstra, PhD, RN,* Alla Sikorskii, PhD, † Laura N. Gitlin, PhD, ‡ Monica Schueller, BA,* Margaret Kline, BS,* and Sarah L. Szanton, PhD, RN § BACKGROUND/OBJECTIVES: Of older adults, 42% report problems with daily function, and physical function is the most important consideration for aging individuals. Thus, we implemented a model of care focused on improv- ing physical function and examined health and use out- comes and satisfaction. DESIGN: A 3-year participatory, single-group pretrial/post- trial benchmarked to a usual care cohort that was evaluated prior to the study. SETTING: Four Medicaid home and community-based waiver sites in Michigan. PARTICIPANTS: The participants included 34 clinicians and 270 Medicaid beneficiaries 50 years and older. INTERVENTION: Community Aging in Place, Advancing Better Living for Elders (CAPABLE), an evidence-based model of care that improved physical function in older adults, was implemented using evidence-based strategies. MEASUREMENT: Characteristics (age, race, and sex), health outcomes (comorbidities, instrumental/activities of daily living [I/ADLs], pain, depression, and falls), and emer- gency department and hospitalization visits preintervention/ postintervention and in the usual care cohort were exam- ined. We also measured Medicaid beneficiary’s satisfaction with care for those who received CAPABLE. RESULTS: Improved mean Æ SD ADLs (preintervention, 8.51 Æ 3.08; postintervention, 7.80 Æ 2.86; P = .01) and IADLs (preintervention, 6.43 Æ 1.31; postintervention, 5.62 Æ 1.09; P < .01), a decrease in falls by 14% (from 34.8% preintervention to 20.8% postintervention; P < .01), and fewer hospitalizations (from 0.43 Æ 1.51 preinterven- tion to 0.23 Æ 0.60 postintervention; P = .03) were found. Post-CAPABLE means were significantly better compared with a usual care cohort for IADLs (6.73 Æ 1.27; P < .01) and hospitalizations (0.47 Æ 2.66; P < .01). Satisfaction with care was high, and 98.1% recommended CAPABLE as a way to help remain living in the community. CONCLUSION: Improved ADLs and IADLs, a reduction in fall rates, fewer hospitalizations, and high satisfaction with care occurred in this population as a result of the use of CAPA- BLE. CAPABLE may be one solution to helping vulnerable, low-income older adults with poor physical function to remain living in the community. J Am Geriatr Soc 67:363–370, 2019. Key words: physical function; Medicaid waiver; evi- dence-based model; adaptation; implementation T he World Report on Aging and Health confirms that physical function is the most important consideration for individuals who are aging. 1 Older adults want to be able to function day to day 2 so they can accomplish activities of daily living (ADLs) that are important to them. 3,4 A projected 72 million Americans are expected to reach the age of 65 years by 2030. 5 Of older adults in the United States, 42% report problems with daily function. 5 Functional challenges are expected to increase due to the obesity epidemic 6 and living longer with chronic conditions, 7 particularly among low-income adults. 8 Poor function is also the primary modifiable predictor of nursing home placement and a driver of increased healthcare cost. 9 It can also lead to an increased risk of falls and poor quality of life. 9 Given these issues, implementing evidence-based From the *Kirkhof College of Nursing, Grand Valley State University, Grand Rapids, Michigan; † Department of Psychiatry and Department of Statistics and Probability, Michigan State University, East Lansing, Michigan; ‡ College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania; and the § School of Nursing, Johns Hopkins University, Baltimore, Maryland. Address correspondence to Sandra Spoelstra, PhD, RN, 301 Michigan St, Room C352, Grand Rapids, MI 49504. E-mail: spoelsts@gvsu.edu. DOI: 10.1111/jgs.15713 JAGS 67:363–370, 2019 © 2018 The American Geriatrics Society 0002-8614/18/$15.00