PONE-D-23-34956Improving measurement of functional status among older adults in primary care: a pilot studyPLOS ONE

Dear Dr. Brown,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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De-Chih Lee, Ph.D.

Academic Editor

PLOS ONE

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5. In the online submission form, you indicated that "The underlying data for this study consists of surveys and in-depth, qualitative interviews with (1) older Veterans and (2) employees of the U.S. Veterans Health Administration. It is not possible to create a minimal data set with this survey and qualitative data as this study did not obtain ethical approval or informed consent from participants to publicly share underlying survey and qualitative data sets. Relevant excerpts from transcripts are included within the paper. The datasets generated and/or analyzed during this study are not publicly available but may be available upon request at the Center for Health Equity Research and Promotion of the U.S. Department of Veterans Affairs administrative offices, at 215-823-5817."

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Additional Editor Comments:

Please make minor revisions according to the comments of the two reviewers.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

**********

3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: No

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Comments PLOS One

Dear Editor,

This article deals with a very interesting topic. The relevance of this article is undeniable. Additionally, the article is well structured, the methods of analysis are relevant, and the tables are informative. However, before its publication, some changes need to be made.

You will find my comments below.

Sincerely yours

------------------------

In the fidelity section on page 32, you should be careful with confidence intervals given your sample (n=21). I therefore suggest that the authors give the limits of these results.

Reviewer #2: Thank you for the opportunity to review this excellent manuscript on improving measurement of functional status among older adults in primary care. This is a well written paper on an important topic that will be of great interest to readers seeking way to improve care of older adults. Please consider the following suggestions which may strengthen this manuscript:

- Introduction - consider using the term 'person centered' instead of 'patient centered' (see here https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6069658/)

- consider adding understanding frailty after 'assessing prognosis'

- page 5, paragraph two - consider giving an example of routine outpatient screenings in the VA (do you mean things like PHQ2 for depression?)

- page 9 - para 2 - was it any kind of clinica appointment or only routine PCP (vs urgent visit)?

- page 13 - would specific on the last line that it was pandemic related restrictions that limited ethnographic observations

Methods - this is so clearly delineated and easy for the reader to follow, thank you!

Would describe a bit about what the educational session entailed (maybe as a supplemental table that outlines the session?)

Results

Table 2 - in the legend would list what you included in your definition of ADLs (Bathing etc) and iADLS

page 22 - can you give an example of the types of practice changes participants reported intending to try?

The results section is easy to follow and clearly reported.

Discussion:

- consider explaining why you picked age 75 and older for the intervention and how that might affect prevalence of functional impairment in your pilot

- page 35 last line - again consider 'person-centered' instead of patient centered

- page 36, first paragraph - what do you mean by "just need for help"?

- page 36 - second last para, the adoption and reach repeats nearly verbatim what's in the opening of the discussion so would rephrase

- consider mentioning here or in the intro the importance of this work to the VA's goal of becoming an Age-Friendly health system (could cite https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.18070 and/or https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10204932/

This is such a well written article on such an important topic - thank you for the incredible work you are doing!

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Reviewer #1: No

Reviewer #2: No

**********

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Attachments

Attachment

Submitted filename: Comments PLOS One - DJS.pdf

PONE-D-23-34956R1Improving measurement of functional status among older adults in primary care: a pilot studyPLOS ONE

Dear Dr. Brown,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Apr 19 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

De-Chih Lee, Ph.D.

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments:

Some references are out of date. Unless it's an important theory, please find more recent references to replace these older ones if possible.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: No

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Thank you for giving me the opportunity to revise this new version of the article. I am satisfied with the corrections made by the authors. The authors have taken into account my recommendations and suggestions. Consequently, the article can be published as is.

Reviewer #2: Thank you for thoroughly addressing all the reviewer comments. This is an excellently done manuscript and I enjoyed the opportunity to review it - congratulations on this important work!

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

**********

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Improving measurement of functional status among older adults in primary care: a pilot study

PONE-D-23-34956R2

Dear Dr. Brown,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Kind regards,

De-Chih Lee, Ph.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

All comments have been addressed.

Reviewers' comments: