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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/摘要对于老年人来说，长期住院可能会导致严重的行动不便和独立性丧失。每个人每年，有1200万65岁以上的成年人住院，30%的人已出院接受急性后护理设施。住院的风险之一是卧床休息，这与许多医院获得的并发症，包括跌倒、精神错乱、静脉血栓形成和皮肤破裂。医院流动计划尝试每天最多移动病人三次，但这项工作通常分配给护士，他们有许多竞争激烈、往往更紧迫的任务。因此，运送病人的频率最高。忽视了护理职责。新冠肺炎大流行和随之而来的护士短缺。小型研究考察了移动技术员(MT)的好处，他们的唯一工作是安全地运送病人。这些研究表明，MTS可以增加采取的步骤，但它们是太小，无法证明MTS对其他结果的影响，例如患者是否住院或者他们是否可以回家，而不是去急诊后的护理机构。医院在犹豫是否要采用MT计划是因为他们认为这些计划昂贵且未经验证。我们建议进行一项在3000名患者中测试MTS对短期和中期结果的影响的大型随机试验年龄65岁及以上，在2个卫生系统的5家医院工作。患者将被随机安排接受监督每天带着MT步行最多3次，或接受常规护理。所有参与者都将佩戴加速度计他们的手腕跟踪他们在医院逗留期间的运动。这项研究有三个目标。首先，我们将比较患者出院时(或10天)的活动能力，以评估MTS对这一结果的影响。我们是尤其感兴趣的是，MTS的使用是否会增加患者可以回家的比例，急诊后护理，以及活动能力的改善是否持续到30天。第二，我们将使用预测性建模，以确定哪些患者最有可能从这种干预中受益。第三，我们将评估干预对包括住院患者在内的与护理事件相关的总成本的影响费用和出院后30天。这些信息对于说服卫生系统采用这种方法。