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

项目总结/摘要 对于老年人来说，长期住院可能导致行动能力和独立性的毁灭性丧失。每个 每年有1200万65岁以上的成年人住院，30%的人出院后接受急性病后护理 设施。住院治疗的风险之一是卧床休息，这与许多医院获得性 并发症，包括福尔斯、谵妄、静脉血栓形成和皮肤破裂。医院移动方案 我试图每天最多走动三次，但这项工作通常分配给护士， 许多竞争性的、往往更紧迫的任务。因此，走动的病人是最常见的 被忽视的护士职责COVID-19大流行及由此产生的 护士短缺一些小型研究调查了移动技术人员（MT）的好处，他们的唯一工作是 让患者安全行走。这些研究表明，MT可以增加所采取的步骤，但它们是 太小，无法证明MT对其他结局的影响，例如患者是否在住院期间 并发症或他们是否可以回家，而不是到急性后护理设施。医院犹豫不决， 采用机器翻译程序，因为他们认为这些程序昂贵且未经证实。我们建议进行一项 一项大型随机试验，旨在检测MT对3000例患者短期和中期结局的影响 2个卫生系统5家医院的65岁及以上老人。患者将随机接受监督治疗 每天最多3次使用MT或接受常规护理。所有参与者都将佩戴加速计， 他们的手腕来跟踪他们在整个住院期间的运动。这项研究有三个目标。首先，我们将比较 出院时（或10天）患者的活动性，以评估MT对该结局的影响。我们 特别感兴趣的是使用MT是否会增加可以回家的患者比例，而不是 急性期后护理，以及活动能力的改善是否在30天内持续。第二，我们将使用 预测模型，以确定哪些患者最有可能从这种干预中受益。三是 评估干预措施对与护理阶段相关的总成本的影响，包括住院费用 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。

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.