AMP Step Wedge Trial

Study Overview
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Brief Summary
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Annually, more than 35 million patients are hospitalized in the United States. Many of these will experience hospital-acquired loss of physical functioning due to a lack of mobility during their in-patient stay. Such loss includes difficulties performing basic activities, such as rising from a chair, toileting, or ambulating. This loss of function may increase hospital length of stay (LOS), nursing home placement, and decrease mobility and participation in community activities even years after hospitalization. Prevention of this hospital-acquired functional loss is critical. Even the sickest hospitalized patients (e.g., those in the intensive care unit [ICU]), can safely and feasibly benefit from early mobilization. In the non-ICU setting there is evidence that patient mobilization reduces LOS and hospital costs, while improving patient satisfaction and physical and psychological outcomes. The overall objective of this proposed project is to evaluate the implementation and impact of a transdisciplinary and multifaceted mobility program (Johns Hopkins Activity and Mobility Promotion - AMP) on clinical outcomes among hospitalized adults. In addition to clinical outcomes, we will identify barriers and facilitators to high-performance program adoption. Results of this project will provide critical new insights on the effectiveness of AMP and inform dissemination and implementation nationwide.

Official Title
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Activity and Mobility Promotion (AMP): Implementation and Impact of a Multifaceted Intervention to Increase Mobility in Hospital Patients

Conditions
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Immobility, Disability

Intervention / Treatment
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* Other: AMP Implementation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All adult patients admitted to study hospital unit Analysis will only include those with lengths of stay >=3 days Exclusion Criteria: Patients with active do-not-resuscitate (DNR) order <18 years old

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Interventional Model Description: Step-wedge clinical trial
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: AMP Implementation<br> | Other: AMP Implementation<br>* Each study site will implement the Johns Hopkins AMP program at different times. The AMP program includes nursing staff training on the goals of AMP, how to complete mobility-focused outcome measures, set mobility goals, and to safely mobilize/ambulate patients. The AMP program also includes embedding these outcome measures and mobility goals into electronic medical records and producing weekly/monthly reports that show how often nursing staff score patient mobility and help patients meet daily activity goals.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| % of patients meeting daily mobility goal | Mobility goal is set and measured using the Johns Hopkins Highest Level of Mobility (JH-HLM) Scale | 39 months | 
| % of patients with mobility measurements documented daily | Mobility documentation to include Activity Measure for Post-Acute Care (AM-PAC) and JH-HLM | 39 months | 
| % of patients receiving physical and/or occupational therapy consults | To be extracted from electronic medical record | 39 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hospital length of stay (days) | To be extracted from electronic medical record | 39 months | 
| Discharge disposition status | Count of where patients are discharged to (e.g,. home, inpatient rehab unit) assessed by extraction from electronic medical record. | 39 months | 
| Number of physical and occupational therapy visits received during inpatient stay | To be extracted from electronic medical record | 39 months | 
| Number of hospital-acquired morbidities | Includes falls, pressure injury, and venous thromboembolism. To be extracted from electronic medical record | 39 months | 
| Number of patients with 30-day readmissions | To be extracted from electronic medical record | 39 months | 
| Employee injuries resulting from patient mobilization | Number of employee injuries from facilitating patient mobility as assessed by medical record extraction | 39 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Activity, Mobility, Hospital-acquired disability