Help Optimise and Mobilise Elders (H.O.M.E)
试验速览
- 阶段
- 不适用
- 发起方
- 入组人数
- 90
- 试验地点
- 4
- 主要终点
- Change in maximum distance walked
研究概览
简要总结
During hospitalisations, older inpatients commonly face issues such as immobility, loss of independence, and functional decline. This leads them down the cascade of dependency with consequent increased risk of adverse outcomes, institutionalisation as well as higher post-acute care costs. The investigators hypothesize that by implementing a mobility intervention in the inpatient setting, patients would be able to maintain their function upon discharge and avoid the cascade of dependency. As such, the investigators aim to do this by implementing and evaluating a mobility intervention, while optimising reversible factors affecting mobility among inpatients admitted to a geriatric unit in Singapore. The investigators will also examine the cost impact of a mobility focused model of care and also adopt the effectiveness-implementation hybrid Type 2 design where both effectiveness and implementation spheres are tested simultaneously.
详细描述
Aim 1: To examine the effectiveness of multicomponent, mobility-focused model of care in reducing iatrogenic complications and improving patient outcomes. Adopting the Institute for Healthcare Improvement's (IHI) 4Ms framework ("Mobility", "Mentation, "Medication", and "What Matters"), the investigators will examine the effectiveness of timely and individually catered mobility interventions which not only increase mobilization but also optimize factors inhibiting mobility for elderly inpatients. It is hypothesized that the mobility outcomes, such as maximum distance walked and mobilization frequency will be significantly improved for patients who receive the intervention compared to those who receive standard care.
Aim 2: To examine the cost impact of a mobility-focused model of care. The investigators will examine whether the cost of these multicomponent, mobility-focused interventions can be offset from cost savings from early mobilisation benefits, by comparing healthcare utilization costs between-groups. Further to that, a cost effectiveness analysis will be performed should functional effectiveness be observed. For the primary cost impact objective, it is hypothesized that the cost savings arising from reduction in bed days of hospitalization and other medical costs incurred during study period will outweigh the cost of implementing this model of care. In addition, it is also hypothesized that the proposed intervention will be cost-effective through achieving better functional outcomes for patients, with lower costs required.
Aim 3: To evaluate the implementation outcomes of multicomponent, mobility-focused model of care in the process of this intervention. It is hypothesized that this intervention will have good acceptability, feasibility, penetration, implementation costs and sustainability.
研究设计
- 研究类型
- Interventional
- 分配方式
- Non Randomized
- 干预模型
- Parallel
- 主要目的
- Prevention
- 盲法
- None
入排标准
- 年龄范围
- 21 Years 至 110 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Newly admitted patients to the geriatric service
- •Aged 75 years and above
- •Mobile with or without the use of a walking aid
排除标准
- •Vancomycin-resistant enterococcus (VRE) status
- •Requires droplet or airborne precautions
- •Critically ill
- •Haemodynamically instability
- •Requires more than 4-hourly parameters
- •Systolic blood pressure <90 mmHg
- •Heart rate >100beats/min
- •Non-ambulant patients
- •With advanced dementia (Functional Assessment Staging Scale [FAST] 7 dementia)
- •Fulfills direct admission to another subspecialty unit
结局指标
主要结局
Change in maximum distance walked
时间窗: Upon admission and at the point of discharge (an average of 10 days after inclusion. Analysis will take into account the variability of length of stay)
The total distance covered by the research participant (in meter)
Mobilisation frequency
时间窗: Through the duration of admission
Number of times mobilised. The average mobilisation frequency will be calculated by dividing the sum by the number of admission days.
次要结局
- Change in modified barthel score(Upon admission, at discharge (an average of 10 days after inclusion. Analysis will take into account the variability of length of stay), and one-month post discharge)
- Change in gait speed(Upon admission and at discharge (an average of 10 days after inclusion. Analysis will take into account the variability of length of stay))
- Inpatient length of stay and discharge location(The duration of admission and upon discharge (an average of 10 days after inclusion. Analysis will take into account the variability of length of stay))
- Presence of common iatrogenic complications such as delirium, injurious falls, pressure ulcers, and venous thromboembolisms(At discharge (an average of 10 days after inclusion. Analysis will take into account the variability of length of stay))
- Gross amount of patient's bill during index admission, considering subsidy level(At discharge (an average of 10 days after inclusion. Analysis will take into account the variability of length of stay))
- The intervention related costs for group therapy(At discharge (an average of 10 days after inclusion. Analysis will take into account the variability of length of stay))