Optimizing Function and Independence Through STRIDE
| Status: | Enrolling by invitation |
|---|---|
| Healthy: | No |
| Age Range: | 60 - Any |
| Updated: | 3/27/2019 |
| Start Date: | October 5, 2017 |
| End Date: | September 30, 2021 |
Optimizing Function and Independence Through STRIDE (QUE 16-170)
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.
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.
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.
Methodology. The investigators will compare patients discharged from sites before and after
the STRIDE program is implemented to assess discharge to skilled nursing facilities and
length of stay (approx. n=2000). A subset of patients participating in the STRIDE program and
a comparison group will be surveyed 30 days post-hospital discharge to assess outcomes
including health status, physical function, and quality of life. A subset of patients will be
interviewed one week post-discharge to gain feedback about the STRIDE program and perceived
benefits of a hospital inpatient mobility program.
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.
Methodology. The investigators will compare patients discharged from sites before and after
the STRIDE program is implemented to assess discharge to skilled nursing facilities and
length of stay (approx. n=2000). A subset of patients participating in the STRIDE program and
a comparison group will be surveyed 30 days post-hospital discharge to assess outcomes
including health status, physical function, and quality of life. A subset of patients will be
interviewed one week post-discharge to gain feedback about the STRIDE program and perceived
benefits of a hospital inpatient mobility program.
Inclusion Criteria:
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
Exclusion Criteria:
- 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
We found this trial at
1
site
Durham, North Carolina 27705
Principal Investigator: Courtney H Van Houtven, PhD
Phone: (919) 286-6936
Click here to add this to my saved trials
