Randomized Trial of Assisted Ambulation to Improve Health Outcomes for Older Medical Inpatients

辅助行走改善老年住院患者健康状况的随机试验

基本信息

批准号：
10675003
负责人：
MICHAEL B ROTHBERG
金额：
$ 164.8万
依托单位：
CLEVELAND CLINIC LERNER COM-CWRU
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-08-01 至 2027-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10675003
关键词：
Accelerometer Acute Adopted Adult Bed rest COVID-19 COVID-19 pandemic Characteristics Clinical Cost Measures Data Dedications Delirium Discipline of Nursing Dose Effectiveness Effectiveness of Interventions Elderly Eligibility Determination Health Health care facility Health system Home Hospital Costs Hospitalization Hospitals Iatrogenesis Injury Inpatients Intervention Knowledge Length of Stay Measures Medical Medicine Modeling Movement Nosocomial pneumonia Nurses Observational Study Occupations Operative Surgical Procedures Outcome Participant Patient Discharge Patient-Focused Outcomes Patients Physical therapy Physicians Pilot Projects Pneumonia Predictive Analytics Randomized Rehabilitation therapy Risk Risk Factors Safety Savings Skin Syndrome Techniques Testing Time Training Venous Thrombosis Work Wrist acute care aged care costs care episode cost deconditioning decubitus ulcer economic evaluation economic impact experience falls functional decline functional restoration functional status health economics hospital readmission human old age (65+)implementation science improved interest intervention cost loss of function multidisciplinary novel older patient patient mobility predictive modeling prevent program costs programs randomized trial treatment as usual venous thromboembolism

项目摘要

Project Summary/Abstract For older adults, prolonged hospitalization can lead to a devastating loss of mobility and independence. Each year, 12 million adults over the age of 65 are hospitalized, and 30% are discharged to a post-acute care facility. One of the risks of hospitalization is bed rest, which is associated with a number of hospital-acquired complications, including falls, delirium, venous thrombosis and skin breakdown. Hospital mobility programs attempt to ambulate patients up to three times daily, but this work is generally assigned to nurses, who have many competing and often more pressing tasks. Consequently, ambulating patients is the most frequently overlooked nursing duty. This problem has been exacerbated by the COVID-19 pandemic and the resulting nursing shortage. Small studies have examined the benefits of mobility technicians (MTs), whose sole job is to safely ambulate patients. These studies have demonstrated that MTs can increase steps taken, but they are too small to prove the impact of MTs on other outcomes, such as whether patients have in-hospital complications or whether they can go home instead of to a post-acute care facility. Hospitals are hesitant to adopt MT programs because they perceive them to be expensive and unproven. We propose to conduct a large randomized trial to test the impact of MTs on short and intermediate term outcomes for 3000 patients aged 65 years and older at 5 hospitals in 2 health systems. Patients will be randomized to receive supervised ambulation up to 3 times daily with a MT or to receive usual care. All participants will wear an accelerometer on their wrist to track their movement throughout the hospital stay. The study has 3 aims. First, we will compare the mobility of patients at discharge (or 10 days) to assess the impact of the MTs on this outcome. We are particularly interested in whether the use of MTs will increase the proportion of patients who can go home vs. post-acute care, and whether the improvements in mobility are sustained at 30 days. Second, we will use predictive modeling to identify which patients are most likely to benefit from this intervention. Third, we will assess the impact of the intervention on overall costs associated with the episode of care, including inpatient costs and the 30 days after discharge. This information will be important to convince health systems to adopt this approach.

项目摘要/摘要对于老年人，长时间的住院可能会导致毁灭性的移动性和独立性丧失。每个年份，65岁以上的1200万成年人住院，30％被送往急性后护理设施。住院的风险之一是床休息，这与许多医院经验有关并发症，包括瀑布，del妄，静脉血栓形成和皮肤破裂。医院流动计划试图每天最多三次，但通常将这项工作分配给有许多人竞争，而且通常更紧迫的任务。因此，卧床患者是最常见的忽略了护理职责。 COVID-19的大流行使这个问题加剧了，由此产生的护理短缺。小型研究检查了流动技术人员（MTS）的好处，其唯一工作是安全地行动患者。这些研究表明，MTS可以增加采取的步骤，但它们是太小而无法证明MT对其他结果的影响，例如患者是否患有院内并发症或是否可以回家而不是急性护理机构。医院犹豫不决采用MT计划是因为他们认为它们是昂贵且未经证实的。我们建议进行大型随机试验测试MT对3000名患者的短期和中期结果的影响在2个卫生系统中的5家医院及65岁以上。患者将被随机接受监督每天使用MT或接受常规护理的行动最多3次。所有参与者都会在他们的手腕跟踪整个医院的运动。该研究有3个目标。首先，我们将比较出院（或10天）患者的活动能力评估MTS对此结果的影响。我们是特别感兴趣的是，使用MTS是否会增加可以回家V的患者比例。急性后护理，以及30天的移动性是否持续。第二，我们将使用预测建模以确定哪些患者最有可能受益于此干预措施。第三，我们会的评估干预措施对与护理情节相关的总体成本的影响，包括住院费用和出院后30天。说服卫生系统采用这些信息将很重要这种方法。