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

辅助行走改善老年住院患者健康状况的随机试验

基本信息

批准号：
10675003
负责人：
MICHAEL B ROTHBERG
金额：
$ 164.8万
依托单位：
CLEVELAND CLINIC LERNER COM-CWRU
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-08-01 至 2027-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10675003
关键词：
Accelerometer Acute Adopted Adult Bed rest COVID-19 COVID-19 pandemic Characteristics Clinical Cost Measures Data Dedications Delirium Discipline of Nursing Dose Effectiveness Effectiveness of Interventions Elderly Eligibility Determination Health Health care facility Health system Home Hospital Costs Hospitalization Hospitals Iatrogenesis Injury Inpatients Intervention Knowledge Length of Stay Measures Medical Medicine Modeling Movement Nosocomial pneumonia Nurses Observational Study Occupations Operative Surgical Procedures Outcome Participant Patient Discharge Patient-Focused Outcomes Patients Physical therapy Physicians Pilot Projects Pneumonia Predictive Analytics Randomized Rehabilitation therapy Risk Risk Factors Safety Savings Skin Syndrome Techniques Testing Time Training Venous Thrombosis Work Wrist acute care aged care costs care episode cost deconditioning decubitus ulcer economic evaluation economic impact experience falls functional decline functional restoration functional status health economics hospital readmission human old age (65+)implementation science improved interest intervention cost loss of function multidisciplinary novel older patient patient mobility predictive modeling prevent program costs programs randomized trial treatment as usual venous thromboembolism

项目摘要

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.

项目概要/摘要对于老年人来说，长期住院可能会导致行动能力和独立性的严重丧失。每个每年有 1200 万 65 岁以上成年人住院，其中 30% 出院接受急性后护理设施。住院的风险之一是卧床休息，这与许多医院获得性感染有关并发症，包括跌倒、谵妄、静脉血栓形成和皮肤破损。医院流动计划尝试每天走动患者最多三次，但这项工作通常分配给护士，他们有许多相互竞争且往往更紧迫的任务。因此，行走的患者是最常见的忽视了护理职责。 COVID-19 大流行以及由此产生的影响加剧了这一问题护理人员短缺。小型研究考察了移动技术人员 (MT) 的好处，他们的唯一工作就是安全地移动患者。这些研究表明，MT 可以增加采取的步数，但它们太小，无法证明 MT 对其他结局的影响，例如患者是否住院并发症或他们是否可以回家而不是去急性后护理机构。医院犹豫不决采用机器翻译程序是因为他们认为这些程序昂贵且未经证实。我们建议开展一次大型随机试验，测试 MT 对 3000 名患者的短期和中期结果的影响 2 个卫生系统 5 家医院的 65 岁及以上老人。患者将被随机分配接受监督每天与 MT 一起行走最多 3 次或接受常规护理。所有参与者都将佩戴加速计他们的手腕在整个住院期间跟踪他们的运动。该研究有 3 个目标。首先我们来比较一下患者出院时（或 10 天）的活动能力，以评估 MT 对此结果的影响。我们是特别感兴趣的是使用 MT 是否会增加可以回家的患者的比例。急性后护理，以及活动能力的改善是否能持续 30 天。其次，我们将使用预测模型来确定哪些患者最有可能从这种干预中受益。第三，我们将评估干预措施对与护理事件相关的总体成本的影响，包括住院患者费用和出院后 30 天。这些信息对于说服卫生系统采用非常重要这种方法。

项目成果

期刊论文数量（1）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Assisted ambulation to improve health outcomes for older medical inpatients (AMBULATE): study protocol for a randomized controlled trial.

辅助行走以改善老年住院患者的健康结果（AMBULATE）：随机对照试验的研究方案。

DOI：
发表时间：
2023-07-24
期刊：
影响因子：
2.5
作者：
Johnson, Joshua K;Hamilton, Aaron C;Hu, Bo;Pack, Quinn R;Lindenauer, Peter K;Fox, Robert J;Hashmi, Ardeshir;Siegmund, Lee Anne;Burchill, Christian N;Taksler, Glen B;Goto, Toyomi;Stilphen, Mary;Rothberg, Michael B
通讯作者：
Rothberg, Michael B