Optimizing Function and Independence Through STRIDE (QUE 16-170)
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 13,857
- 试验地点
- 2
- 主要终点
- Proportion of Patients Discharged to Skilled Nursing Facility
研究概览
简要总结
Optimizing Function and Independence Through STRIDE aims to implement the STRIDE inpatient hospital mobility program at 8 VAMC sites in a stepped-wedge design and evaluate patient outcomes before and after the program is implemented, as well as the efficacy of a usual vs enhanced implementation design.
详细描述
Background/Purpose. A key contributor to hospital-associated disability is immobility during hospitalization. While fewer than 5% of patients have physician orders for bed rest, hospitalized older adults spend only 3% of their time standing or walking. The hazards of immobility in the hospital have been recognized for more than two decades, but there are currently no VA-system wide approaches to address this important gap in clinical care.
STRIDE is a supervised inpatient walking program developed by an interdisciplinary team of investigators, clinicians and administrators at the Durham VA and funded by the VHA Office of GEC. STRIDE consists of a one-time gait and balance assessment conducted by a physical therapist, followed by daily supervised walks by a recreation therapy assistant for the duration of the hospital stay. Program evaluation has demonstrated high satisfaction among Veteran participants and reduced need for post-acute institutional care. As a result, the Durham VAMC funded STRIDE as a permanent program that currently serves over 650 Veterans annually, and the VHA Office of GEC funded a dissemination grant to launch the program at another medical center. The investigators' initial experience with STRIDE implementation suggests interprofessional relationships and team dynamics are key determinants to the success of a new hospital-based clinical program that requires collaborative processes involving multiple disciplines.
As part of the investigators' Optimizing Function and Independence QUERI, the investigators plan to implement the STRIDE clinical program at 8 VAMC sites in a stepped-wedge design with sites randomized to implementation strategy and start date.
Objectives. The investigators plan to conduct an evaluation to examine the impact of STRIDE on patient outcomes.
Key questions: Do STRIDE participants have fewer discharges to skilled nursing facilities and shorter lengths of stay? Do STRIDE participants have better physical function and higher health-related quality of life at 30 days post-discharge? What is the value of STRIDE from the Veteran's perspective? The investigators also plan to conduct a mixed method evaluation that examines implementation outcomes and provider team experience that will not be reported here.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Crossover
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 年龄范围
- 60 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Inclusion/Exclusion listed here apply to subset of patients providing consent for telephone interviews:
- •Able and willing to provide informed consent (does not lack decision-making capacity)
- •Discharged from a participating hospital within the preceding 30 days
- •Age >= 60
- •Index admission for medical illness
- •Community-dwelling (i.e. not in a nursing home or institutional care) prior to hospital visit
- •Ability to ambulate safely and independently (does not need help walking across a small room)
- •Valid telephone number in the medical record
- •Admitted to a STRIDE ward and discharged from a STRIDE ward
- •Index hospital stay was in a ward identified to participate in the STRIDE program
排除标准
- •Patient deceased
- •Index hospital stay was < 2 business days
- •Currently hospitalized
- •Current high-risk suicide flag in medical record
- •Diagnosis of cognitive impairment or dementia
- •Difficulty with or unable to communicate on the telephone, or no telephone access
- •Discharged to another hospital or acute care setting
- •Transferred into index hospital from another hospital
- •Bedrest order not lifted for at least 2 days on STRIDE ward
结局指标
主要结局
Proportion of Patients Discharged to Skilled Nursing Facility
时间窗: Assessed at hospital discharge, an average of 7 days
Discharge to skilled nursing facility (versus home) will be assessed via administrative data pulls and chart review (not patient report).
Hospital Length of Stay (Days)
时间窗: Assessed at hospital discharge, an average of 7 days
Hospital length of stay will be assessed via administrative data pulls (not patient report)
次要结局
- Proportion Highly Satisfied With Care(30 days following hospital discharge, hospital stay an average of 6 days)
- Health Utility(30 days following hospital discharge, hospital stay an average of 6 days)
- Health-related Quality of Life(30 days following hospital discharge, hospital stay an average of 6 days)
- Mobility in the Environment(30 days following hospital discharge, hospital stay an average of 6 days)
- Patient Physical Function - Disability(30 days following hospital discharge, hospital stay an average of 6 days)
- Patient Physical Function - Limitations(30 days following hospital discharge, hospital stay an average of 6 days)
- Patient Physical Function(30 days following hospital discharge, hospital stay an average of 6 days)