Preventing Hospital-Acquired Disability: An Intervention to Improve Older Adult Patient Ambulation

项目摘要/摘要 高达65%的65岁及以上的成年人在住院期间将失去独立行走的能力 主要是因为他们在逗留期间没有从事步行活动。现在失去了独立行走的能力 被确认为医院获得性残疾和严重的患者安全问题。老年人花费更多 住院期间80%以上的时间躺在床上，只有4%的时间进行走动。新产品的成本 据估计，美国每年有260亿美元用于支付增加的医疗费用 和长期护理需求。最近住院和限制活动与 在老年人中出现新的功能障碍。尽管病人的行走可能属于 多个医疗保健提供者(护士、物理和职业治疗以及医生)、护士的领域 传统上负责促进和维持患者的功能活动能力。但护士们 由于多个个人和组织障碍，患者不经常出行 让病人站起来走路。要求护士做更多的事情并不能解决对住院造成的伤害 老年人或因出院后对卫生保健资源的需求增加而不断增加的费用。创新型 需要护理模式，以解决和克服阻碍护士步入老年的障碍 病人。我们的护理模式的试点研究结果，通过基于系统的干预动员老年人 (Movin)显示了患者步行和护理变化的统计意义上的显著增加 实践和单位文化，已经在学习单位持续了3年多。我们的下一步是 使用不完全阶梯楔形整群随机设计对四名成人医疗人员进行随机对照试验 两家医院的住院部。该项目的主要假设是Movin将改善功能 通过改变护理实践和步行文化来改善老年患者的预后 住院部。具体目的是：1)测试Movin改善老年人功能能力的有效性 成人患者在出院时、出院后1、3和6个月；2)测试Movin to 减少老年人在出院时以及出院后1、3和6个月的医疗保健利用率；2a)分析 基于不同计划成本和健康利用率指标的Movin投资回报 医院；以及3)衡量护士行为和单位文化的变化，并确定持续的系统障碍 这影响了Movin在住院病房和不同医院之间的翻译。我们计划实现以下目标 这些目标的首要目标是消除住院老年人丧失独立行走能力。 这一拟议的项目有可能预防身体残疾的发展(丧失独立性 步行)和功能下降，改善老年人在住院期间和住院后的整体生活质量 留下来，降低医疗保健利用率。拟议的项目有能力立即翻译 到其他医院，以提高全美老年人的护理质量。

Project Summary/Abstract Up to 65% of adults aged 65 and over will lose their ability to independently ambulate during hospitalization primarily because they were not engaged in walking during their stay. Loss of independent ambulation is now identified as a hospital acquired disability and a significant patient safety concern. Older adults spend greater than 80% of the time in bed during hospitalization and only engage in ambulation 4% of the time. Costs for new onset disability in the United States are estimated to be 26 billion dollars annually to cover increased medical and long term care needs. Having a recent hospitalization and restricted activity were strongly associated with development of a new functional impairment in older persons. Although patient ambulation may fall within the domain of multiple healthcare providers (nurses, physical and occupational therapy, and physicians), nurses have traditionally been responsible for promoting and maintaining patients’ functional mobility. But nurses infrequently ambulate patients due to multiple personal and organizational barriers that prevent them from getting patients up to walk. Asking nurses to do more will not fix the harm that is being caused to hospitalized older adults or mounting costs due to increased need for health care resources post discharge. Innovative models of care are needed that address and overcome barriers that prevent nurses from walking older patients. Pilot study results of our model of care, Mobilizing Older adults Via a systems-based INtervention (MOVIN) have demonstrated statistically significant increases in patient ambulation and change in nursing practice and unit culture, which have been sustained on the study unit for over 3 years. Our next step is to conduct an RCT using an incomplete stepped wedge cluster randomization design across four adult medical inpatient units in two hospitals. The overarching hypothesis of this project is that MOVIN will improve functional outcomes for older adult patients by producing a change in nursing practice and culture of ambulation on inpatient units. Specific aims are to: 1) test the effectiveness of MOVIN to improve functional ability of older adult patients at discharge, and 1, 3, and 6 months post discharge; 2) test the effectiveness of MOVIN to reduce healthcare utilization of older adults at discharge, and 1, 3, and 6 months post discharge; 2a) analyze a return on investment of MOVIN based on program costs and health utilization measures across different hospitals; and 3) measure change in nurse behaviors and unit culture and identify ongoing systems barriers that impact translation of MOVIN across inpatient units and different hospitals. We propose to accomplish these aims with the overarching goal of eliminating loss of independent ambulation in hospitalized older adults. This proposed project has the potential to prevent development of physical disability (loss of independent ambulation) and functional decline, improve overall quality of life for older adults during and after their hospital stay, and decrease healthcare utilization. The proposed project has the capacity to be immediately translated to other hospitals to improve care quality to older adults across the United States.