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

项目总结/摘要：与原始提交资料相比无变更 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。失去独立的大使馆， 被确定为医院获得性残疾和重大患者安全问题。老年人花费更多 住院期间80%以上的时间卧床，仅4%的时间从事家务劳动。新的费用 据估计，美国每年需要260亿美元来支付增加的医疗费用。 长期护理需求。最近住院和活动受限与 老年人出现新的功能障碍。虽然患者的体重可能属于 多个医疗保健提供者（护士，物理和职业治疗，以及医生），护士 传统上负责促进和维持患者的功能活动性。但护士 由于多重个人和组织障碍，患者很少走动， 让病人站起来走路。要求护士做更多的工作并不能解决对住院病人造成的伤害 老年人或由于出院后对医疗保健资源的需求增加而导致的成本上升。创新 护理模式需要解决和克服的障碍，防止护士走老年人 患者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）已证明，在统计学上显着增加病人的american和变化，护理 实践和单位文化，这已经持续了3年以上的研究单位。我们的下一步是 使用不完全阶梯式楔形分组随机化设计，在4名成人医学受试者中进行RCT。 两家医院的住院部。该项目的首要假设是，MOVIN将改善功能 通过改变护理实践和护理文化对老年患者的影响 住院部具体目的是：1）检验MOVIN改善老年人功能能力的有效性 成年患者出院时和出院后1、3和6个月; 2）测试MOVIN的有效性， 减少老年人出院时和出院后1、3和6个月的医疗保健利用; 2a）分析 MOVIN的投资回报率基于计划成本和不同地区的健康利用措施 医院;和3）测量护士行为和单位文化的变化，并确定正在进行的系统障碍 这影响到MOVIN在住院部和不同医院的翻译。我们建议实现 这些目标的总体目标是消除住院老年人的独立性丧失。 该拟议项目有可能防止身体残疾的发展（丧失独立能力）。 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 减少医疗保健的使用。拟议的项目有能力立即翻译 到其他医院，以提高护理质量，以老年人在美国各地。

Project Summary/Abstract: NO CHANGE FROM ORIGINAL SUBMISSION 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.