Clinical trial NCT03887572: Adaption of Mobilizing Older Adult Patients Via a Systems-based Intervention for a Non-Academic Hospital
Official title: Getting Older Patients Walking: Adaption of MOVIN (Mobilizing Older Adult Patients Via a Systems-based INtervention) for Implementation in a Non-Academic Hospital
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Early Mobility
Older Adults
Hospital Acquired Condition
Lead sponsor: University of Wisconsin, Madison
Sponsor class: OTHER
Collaborators: name: Wake Forest University Health Sciences
name: National Institutes of Health (NIH)
First posted: 2019-03-25
Enrollment: 40
Sex: ALL
Minimum age (years): 65
Standard ages: OLDER_ADULT
Accepts healthy volunteers: no
Observational model: CASE_CONTROL
Time perspective: PROSPECTIVE
Sampling method: PROBABILITY_SAMPLE
Study population: Patients admitted to the study intervention unit will be recruited to evaluate the implementation of MOVIN based on Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM framework). Patients (N=40) will be recruited during pre (n=20) and post (n=20)-intervention periods to provide an evaluation of effectiveness. Inclusion criteria for patients will consist of age 65 years or older, able to walk with or without assistance, have an ambulation order, and able to speak and understand English.

Brief summary: This observational study is designed to adapt, create actionable implementation, and to access market demand of the Mobilizing Older adults Via a systems-based Intervention (MOVIN) toolkit. MOVIN is a program to increase ambulation while hospitalized at non-academic facilities. MOVIN is a unit-based intervention. Therefore all patients on this unit are exposed to the intervention once it is implemented regardless of whether or not they participate in the trial. The study will enroll 40 total hospitalized participants 65 years and older for the duration of their stay.

Detailed description: Up to 65% of hospitalized older adults will lose the ability to ambulate independently during their hospital stay. Loss of independent ambulation has been identified as a hospital-acquired disability and is a critical patient safety concern, resulting in permanent loss of function for 50% of older adults one-year post discharge. Functional loss is associated with multiple negative outcomes including a 33% increase in new nursing home placement, increase in length of hospital stay, need for home health services, falls, caregiver burden, decreased quality of life, and increased mortality. Given the rapid increase in the elderly population, loss of independent ambulation primarily due to the process of care in hospital settings may significantly increase future healthcare costs and further exacerbate concerns related to patient care quality.

Lack of walking during hospitalization has been directly linked to loss of independent ambulation in older adults. Nurses are responsible for promoting and maintaining patient independent mobility. However, our research has identified multiple personal and organizational barriers that prevent nurses from walking patients. We have developed and pilot tested a novel systems based multi-component intervention to improve ambulation of older adult patients, Mobilizing Older adult patients Via a systems-based INtervention (MOVIN). MOVIN is comprised of five components: 1) psychomotor skills training; 2) communication tools; 3) ambulation pathways; 4) ambulation resources; and 5) unit ambulation culture. Our pilot study of MOVIN demonstrated a statistically significant increase in frequency and weekly distance of patient ambulation as well as changes in nursing practice and unit culture. Notably, these changes have been sustained for greater than two years after completion of the study.

Our goal is to translate our positive research results into an actionable implementation package that can be used to disseminate MOVIN to hospitals nationwide and improve the quality of care and functional outcomes for older adult patients. In pursuit of this goal, our specific aims are to:

1. Adapt MOVIN and develop and refine a MOVIN toolkit for implementation in a non-academic hospital.
2. Implement MOVIN in an inpatient adult general medical unit in a non-academic hospital with an on-site clinical team leading the intervention and evaluate using the RE-AIM framework to collect preliminary data for a future dissemination study.
3. Assess market demand for the intervention and develop a customer value statement in collaboration with the ICTR Dissemination and Implementation Program.

Eligibility criteria: Inclusion Criteria:

* age 65 years or older
* able to walk with or without assistance
* absence of a medical order for bedrest or activity restriction
* have an ambulation order
* able to speak and understand English.

Exclusion Criteria:

* activated Power of Attorney
* a score of 11+ on Orientation Memory Cognition Test (OMCT)
* a score \<2 on a Mini Cog
* lower extremity amputation
* terminal diagnosis (Comfort Care)
* on hospice
* bed rest order
* wheelchair bound

Primary outcomes:
measure: Change in gait speed
timeFrame: Hospital admission, hospital discharge, 3 months post-discharge; Up to 4 months total
measure: Change in Self-report on Katz Activity of Daily Living (ADL) Index
timeFrame: Hospital admission, hospital discharge, 1 month post-discharge, 3 months post-discharge; Up to 4 months total
measure: Change in Life Space Assessment
timeFrame: Hospital admission, hospital discharge, 1 month post-discharge, 3 months post-discharge; Up to 4 months total
Secondary outcomes:
measure: Patient Experience with Ambulation
timeFrame: 1 month post-discharge; Up to 2 months total
measure: Age
timeFrame: Within 3 months post-discharge; Up to 4 months total
measure: Gender
timeFrame: Within 3 months post-discharge; Up to 4 months total
measure: Race
timeFrame: Within 3 months post-discharge; Up to 4 months total
measure: Ethnicity
timeFrame: Within 3 months post-discharge; Up to 4 months total
measure: Social support
timeFrame: Post-discharge; Up to 1 month
measure: Location admitted from
timeFrame: Within 3 months post-discharge; Up to 4 months total
measure: Reason for admission
timeFrame: Within 3 months post-discharge; Up to 4 months total
measure: Use of an ambulation assistive device
timeFrame: Within 3 months post-discharge; Up to 4 months total
measure: Presence of external lines
timeFrame: Within 3 months post-discharge; Up to 4 months total
measure: Body Mass Index
timeFrame: Within 3 months post-discharge; Up to 4 months total
measure: Fall risk
timeFrame: Within 3 months post-discharge; Up to 4 months total
measure: Fall reported
timeFrame: Within 3 months post-discharge; Up to 4 months total
measure: Length of stay
timeFrame: Within 3 months post-discharge; Up to 4 months total
measure: Discharge destination
timeFrame: Within 3 months post-discharge; Up to 4 months total
measure: Charlson Comorbidity Index
timeFrame: Within 3 months post-discharge; Up to 4 months total
Other outcomes:
Locations:
city: Milwaukee
country: United States
facility: Aurora St. Luke's Medical Center
state: Wisconsin
Study officials:
affiliation: University of Wisconsin, Madison
name: Linsey M Steege, PhD
role: PRINCIPAL_INVESTIGATOR
References: