A Randomized Trial of Gamification and Coaching to Improve Mobility after Hospitalization

项目总结/摘要 患有慢性病的中老年人和成年人的残疾事件中有一半发生在住院后。通常这 连锁反应始于行动不便，这种情况影响了美国3100万成年人，并导致损失 独立性，增加医疗保健利用率和早期死亡率。住院后更高水平的身体活动 出院与减少残疾有关;然而，促进和维持健康的前瞻性干预措施， 目前缺乏体力活动。我们已经成功地试验了一种新的方法， 在出院成人中进行为期12周的干预期间，游戏化和社会支持促进身体活动 医院（N=232）。干预导致老年人和中年人的身体活动增加 患者（年龄50至65岁），具有较高的社会参与度和较低的基线步数。 我们提出的研究将建立在这项试点的结果，以针对更广泛的高危成人住院的1/3， 受体力活动影响的慢性门诊护理敏感性疾病（高血压、糖尿病和轻中度 心力衰竭）。由于在试点研究中发现高社会支持会导致更大的影响，我们将添加虚拟健康 指导干预设计，以帮助患者提高他们的支持水平。这项研究的目的是增加 出院后的体力活动，以减少与急性疾病相关的意外行动能力残疾， 以减少急性和急性后护理的使用。我们还将评估这种方法在更长时间内的可持续性。 阶段（6个月干预，6个月随访），并定性评估与较高或较低的 在具有显著民族/种族和社会经济多样性的人群中的表现。为了实现这些目标，我们 组建了一个行为经济学、老年医学、护理科学、临床试验和 实施.我们将研究这种方法在宾夕法尼亚大学医学院出院患者中的新应用 并在出院后随访12个月。我们将重点关注4个具体目标：1）评估 使用游戏化与社会激励和个性化辅导进行6个月干预的有效性， 年龄≥ 50岁、有残疾风险的慢性疾病成人的体力活动（主要结局）; 2）评估 在6个月随访期间增加体力活动的可持续性（次要结局）; 3）评估 研究期间体力活动对残疾和急性护理利用的影响（次要结局）;以及 4)进行混合方法过程评价，以探索与对 干预措施。我们的方法与NIA的战略重点一致，即制定有效的干预措施以维持功能 预防或减少残疾，并通过国家努力建立一个老龄友好的卫生系统， 推广可扩展、可持续和具有成本效益的干预措施。

PROJECT SUMMARY / ABSTRACT Half of incident disability in older and middle-aged, adults with chronic conditions occurs after hospitalization. Often this cascade begins with mobility disability, a condition which affects 31 million adults in the United States and leads to loss of independence, increased health care utilization, and earlier mortality. Higher levels of physical activity after hospital discharge are associated with reduced disability; however, prospective interventions to promote and sustain healthy physical activity are currently lacking. We have successfully piloted a novel approach using behaviorally designed gamification and social support for physical activity promotion during a 12-week intervention among adults discharged from the hospital (N=232). The intervention led to larger increases in physical activity among older and middle-aged patients (age 50 to 65), those with higher social engagement, and lower baseline step counts. Our proposed study will build on results of this pilot to target a broader population of at-risk adults hospitalized for 1 of 3 chronic Ambulatory Care Sensitive Conditions affected by physical activity (hypertension, diabetes, and mild-moderate heart failure). Since high social support was found to lead to larger effects in the pilot study, we will add a virtual health coach to the intervention design to help patients increase their support levels. The goals are of this study are to increase physical activity after discharge from the hospital to reduce incident mobility disability associated with acute illness and to reduce acute and post-acute care utilization. We will also evaluate the sustainability of this approach over a longer period (6 months intervention, 6 months follow up) and qualitatively assess factors associated with higher or lower performance in a population with significant ethnic/racial and socioeconomic diversity. To achieve these goals, we have assembled an expert multidisciplinary team in behavioral economics, geriatrics, nursing science, clinical trials and implementation. We will study the novel application of this approach to patients who are discharged from Penn Medicine hospitals and follow them for 12 months after discharge. We will focus on 4 specific aims: 1) To evaluate the effectiveness of a 6-month intervention using gamification with social incentives and personalized coaching to increase physical activity among adults age ≥ 50 with chronic conditions at risk for disability (primary outcome); 2) To evaluate the sustainability of increased physical activity during a 6-month follow-up period (secondary outcome); 3) To evaluate the impact of physical activity on disability and acute care utilization during the study period (secondary outcomes); and 4) To conduct a mixed-methods process evaluation to explore factors associated with strong or poor response to the interventions. Our approach aligns with NIA's strategic priority to develop effective interventions to maintain function and prevent or reduce disability and also with national efforts to create an Aging Friendly Health System through the spread of scalable, sustainable, and cost-effective interventions.