Annals of Internal Medicine, Год журнала: 2023, Номер 176(11), С. 1575 - 1575
Опубликована: Окт. 16, 2023
Язык: Английский
Implementation Science Communications, Год журнала: 2024, Номер 5(1)
Опубликована: Янв. 12, 2024
Abstract Background STRIDE is a supervised walking program designed to address the negative consequences of immobility during hospitalization for older adults. In an 8-hospital stepped wedge randomized controlled trial, was associated with reduced odds hospital discharge skilled nursing facility. has potential become system-wide approach hospital-associated disability in Veteran’s Affairs; however, critical questions remain about how best scale and sustain program. The overall study goal compare impact two strategies on penetration (primary), fidelity, adoption implementation outcomes. Methods Replicating Effective Programs will be used as framework underlying all support activities. parallel, cluster we use stratified blocked randomization assign hospitals ( n = 32) either foundational support, comprised standard, low-touch activities, or enhanced which includes addition tailored, high-touch activities if do not meet benchmarks at 6 8 months following start date. All begin until occurs. primary outcome defined proportion eligible hospitalizations ≥ 1 walks 10 months. Secondary outcomes are fidelity additionally examined 13 16 Fidelity assessed percentage days “full dose” program, more documented one walk than 5 min. Program binary patients not. Analyses also include patient-level effectiveness (e.g., home, length stay) staffing labor costs. We employ convergent mixed-methods explore understand pre-implementation contextual factors related differences hospital-level adoption. Discussion Our results dually inform practices promoting successful evidence-based hospital-based This information may other programs by advancing our understanding apply scale-up national strategies. Trial registration registered June 1, 2021, ClinicalTrials.gov (identifier NCT04868656 ).
Язык: Английский
Процитировано
4
Journal of the American Geriatrics Society, Год журнала: 2025, Номер unknown
Опубликована: Янв. 9, 2025
Abstract Background The Age‐Friendly Health System (AFHS) initiative seeks to improve care for older adults through assessing and acting on the 4Ms (What Matters, Medication, Mentation, Mobility). Department of Veterans Affairs (VA) joined in 2020, from 2022 2023, VA led its first Action Community, a 7‐month online educational series teach clinicians about implementing across settings. Methods Community was designed spread awareness Veterans, interprofessional team knowledge providing guided by 4Ms, support AFHS implementation multiple included synchronous webinars, Practice coaching calls, office hours. A learner experience questionnaire administered at completion Community. Results Totally 186 teams enrolled representing 78/171 (45.6%) medical centers (VAMCs), 36 US states 20 types Participants reported high rates satisfaction confidence their ability apply skills learned. Overall, 58 earned Level 1, Participant recognition, 43 also 2, Committed Care Excellence recognition Institute Healthcare Improvement. Conclusions facilitated learning supported earning offers promising model spreading other large health systems. Further work is underway evaluate impact this clinical process outcomes measures.
Язык: Английский
Процитировано
0
Health Services Research, Год журнала: 2024, Номер 59(S2)
Опубликована: Апрель 17, 2024
Abstract Objective To conduct a business case analysis for Department of Veterans Affairs (VA) program STRIDE (A S sis T ed Ea R ly Mob I lization hospitalize D older V E terans), which was designed to address immobility hospitalized adults. Data Sources and Study Setting This secondary primary data from VA 8‐hospital implementation trial conducted by the Function Independence Quality Enhancement Research Initiative (QUERI). In partnership with operational partners, we estimated resources needed delivery in out as well national facilitation VA. A scenario using wage Bureau Labor Statistics informs decisions outside Design budget impact compared costs two strategies (Replicating Effective Programs [REP]+CONNECT REP‐only). simulate scenarios implementation, number eligible hospitalizations nationally varied key parameters (e.g., enrollment rates) evaluate uncertainty. Collection Personnel time outcomes were collected hospitals (2017–2019). Hospital average daily census 2022 improve relevance future implementation. Principal Findings Average $9450 REP+CONNECT $5622 REP‐only; less than $30 per participant both non‐VA hospital settings. Number walks had most on ranged 1 5 participant. sensitivity analyses, cost increased $35 if physical therapist assistant conducts walks. Among study hospitals, mean rates higher among (12%) REP‐only (4%) $66 $100 enrolled. Conclusions is low‐cost intervention, participation has biggest delivering STRIDE. Trial Registration ClinicalsTrials.gov NCT03300336. Prospectively registered 3 October 2017.
Язык: Английский
Процитировано
2
BMC Geriatrics, Год журнала: 2024, Номер 24(1)
Опубликована: Дек. 20, 2024
Язык: Английский
Процитировано
2
PM&R, Год журнала: 2024, Номер unknown
Опубликована: Июль 5, 2024
Abstract Introduction The timely translation of evidence‐based programs into real‐world clinical settings is a persistent challenge due to complexities related organizational context and team function, particularly in inpatient settings. Strategies are needed promote quality improvement efforts implementation new programs. Objective This study examines the role CONNECT, complexity science‐based intervention readiness, for enhancing ‘Assisted Early Mobility Hospitalized Older Veterans’ program (STRIDE), an inpatient, supervised walking program. Design We conducted stepped‐wedge cluster randomized trial using convergent mixed‐methods design. Within each randomly assigned sequence, Veterans Affairs Medical Centers (VAMCs) were receive standardized support only or additional training via CONNECT intervention. Data obtained from hospital administrative electronic health records, surveys, semi‐structured interviews with clinicians before after STRIDE. Setting Eight U.S. VAMCs. Participants Three hundred fifty‐three survey participants STRIDE 294 surveys implementation. Ninety‐two interview participants. Intervention complexity‐science–based improve function. Main Outcome Measures outcomes included reach fidelity. Secondary validated measures function (i.e., communication, coordination, clarity). Results At four VAMCs was higher (mean 12.4% vs. 3.8%), fidelity similar non‐CONNECT VAMC delivery teams receiving reported improvements domains, Qualitative findings highlight CONNECT's impact influence characteristics contextual factors, including cohesion, leadership support, clarity, on Conclusion may greater STRIDE, but among suggest that not be sufficient overcome structural barriers capacity.
Язык: Английский
Процитировано
1
Australasian Journal on Ageing, Год журнала: 2024, Номер unknown
Опубликована: Май 21, 2024
Abstract Objective To assess whether enhanced daily weekend physiotherapy (EWP) for patients with hip fracture was associated improved clinical outcomes. Methods We retrospectively analysed all previously ambulatory adults admitted to our tertiary hospital, comparing ‘usual’ (‘control’) care (09/19–03/20) EWP (09/20–03/21). Outcomes included Day‐7 mobility ≥20 m (primary), additional measures, specified postoperative complications, new residential facility placement, acute length‐of‐stay (LOS) and 30‐day death. Results Amongst 235 eligible (128 control, 107 EWP), 66% were female, mean age 80.4 years (SD 10.5), 20% from 49% (114/235) mobilising without aid at baseline (no between‐group differences; p ≥ .20). Median LOS 10 days (IQR 6–15), total hospital 21 12–37) 3% ( n = 6) died by Day 30. distance mobilised 25 7–50) versus (3–40) .06). No developed pressure injury (0 vs. 6, .02); other outcomes similar between groups. Adjusting age, residence, cognitive impairment, American Society of Anesthesiologist score preadmission mobilisation aids, independently increased likelihood 7 (aOR 1.83, 95% CI 1.04–3.23, .03). Conclusions Enhanced improvement in early mobility, but not assessed. These data would be strengthened randomised controlled trial exploring more intense physiotherapy, cost–benefit analysis patient experience measures.
Язык: Английский
Процитировано
0
Springer eBooks, Год журнала: 2024, Номер unknown, С. 85 - 91
Опубликована: Янв. 1, 2024
Язык: Английский
Процитировано
0
American Journal of Kidney Diseases, Год журнала: 2024, Номер 84(2), С. 141 - 142
Опубликована: Июнь 1, 2024
Язык: Английский
Процитировано
0
Seminars in Oncology Nursing, Год журнала: 2024, Номер 40(4), С. 151660 - 151660
Опубликована: Июль 15, 2024
Язык: Английский
Процитировано
0
Journal of the American Geriatrics Society, Год журнала: 2024, Номер 72(10), С. 3210 - 3218
Опубликована: Июль 29, 2024
Abstract Background There is increasing recognition of the importance maximizing program‐setting fit in scaling and spreading effective programs. However, context hospital‐based mobility programs, there limited information on how settings could consider local modify program characteristics or implementation activities to enhance fit. To fill this gap, we examined site‐initiated adaptations STRIDE, a for older Veterans, at eight Veterans Affairs facilities across United States. Methods STRIDE was implemented hospitals stepped‐wedge cluster randomized trial. During pre‐implementation phase, sites were encouraged adapt optimize align with their hospital's resources, needs, culture. Recommended included those related staffing models, marketing, documentation. assess number types adaptations, multiple data sources reviewed, including support notes from site‐level calls group‐based learning collaborative sessions. Adaptations classified based Framework Reporting Modifications‐Enhanced (FRAME), attention what adapted, when, why, by whom. We reviewed that did not sustain defined as continued delivery during post‐implementation period. Results A total 25 reported seven sites. five areas: documentation ( n = 13), patient eligibility criteria 5), enhancements 3), model 2), marketing recruitment 2). More than one‐half planned. common both sustaining non‐sustaining Conclusions within designed flexible mind. Identifying areas planned unplanned such may contribute more efficient national scaling. Future research should evaluate relationship between implementation.
Язык: Английский
Процитировано
0