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Principal Investigator: MICHAEL B ROTHBERG
Organization: CLEVELAND CLINIC LERNER COM-CWRU
Fiscal Year: 2024
Award: $1,632,009
Funding agency: National Institute on Aging
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.
Terms: <21+ years old><65 and older><65 or older><65 years of age and older><65 years of age or more><65 years of age or older><65+ years><65+ years old><> 65 years><Accelerometer><Acute><Adopted><Adult><Adult Human><Aged 65 and Over><Bed Sores><Bed rest><Bedrest><Bedsore><COVID crisis><COVID epidemic><COVID pandemic><COVID-19><COVID-19 crisis><COVID-19 epidemic><COVID-19 era><COVID-19 global health crisis><COVID-19 global pandemic><COVID-19 health crisis><COVID-19 pandemic><COVID-19 period><COVID-19 public health crisis><COVID-19 years><CV-19><Characteristics><Clinical><Coronavirus Infectious Disease 2019><Cost Measures><Cost metrics><Data><Dedications><Delirium><Discharge from Health Care Facility><Discharge from Healthcare Facility><Discipline of Nursing><Dose><Effectiveness><Effectiveness of Interventions><Eligibility><Eligibility Determination><Health><Health Facilities><Health care facility><Health system><Healthcare Facility><Home><Hospital Admission><Hospital Costs><Hospital acquired complications><Hospital complications><Hospitalization><Hospitalization cost><Hospitals><Iatrogenesis><Injury><Inpatients><Intervention><Intervention Strategies><Jobs><Knowledge><Length of Stay><Measures><Medical><Medical Rehabilitation><Medicine><Modeling><Movement><Nosocomial pneumonia><Number of Days in Hospital><Nurses><Nursing><Nursing Field><Nursing Profession><Observation research><Observation study><Observational Study><Observational research><Occupations><Operative Procedures><Operative Surgical Procedures><Outcome><Participant><Patient Discharge><Patient outcome><Patient-Centered Outcomes><Patient-Focused Outcomes><Patients><Phlebothrombosis><Physiatric Procedure><Physical Medicine Procedure><Physical Therapeutics><Physical therapy><Physicians><Physiotherapy><Pilot Projects><Pneumonia><Predictive Analytics><Pressure Sore><Pressure Ulcer><Professional Positions><Protocol Screening><Randomization trial><Randomized><Rehabilitation><Rehabilitation therapy><Risk><Risk Factors><SARS-CoV-2 epidemic><SARS-CoV-2 global health crisis><SARS-CoV-2 global pandemic><SARS-CoV-2 pandemic><SARS-coronavirus-2 epidemic><SARS-coronavirus-2 pandemic><Safety><Savings><Severe Acute Respiratory Syndrome CoV 2 epidemic><Severe Acute Respiratory Syndrome CoV 2 pandemic><Severe acute respiratory syndrome coronavirus 2 epidemic><Severe acute respiratory syndrome coronavirus 2 pandemic><Skin><Surgical><Surgical Interventions><Surgical Procedure><Syndrome><Techniques><Testing><Time><Training><Venous Thrombosis><Work><Wrist><above age 65><accelerometry><activity monitor><activity tracker><acute care><adulthood><after age 65><age 65 and greater><age 65 and older><age 65 or older><age > 65><age of 65 years onward><aged 65 and greater><aged 65+><aged ≥65><body movement><care as usual><care costs><care episode><care facilities><computer based prediction><coronavirus disease 2019><coronavirus disease 2019 crisis><coronavirus disease 2019 epidemic><coronavirus disease 2019 global health crisis><coronavirus disease 2019 global pandemic><coronavirus disease 2019 health crisis><coronavirus disease 2019 pandemic><coronavirus disease 2019 public health crisis><coronavirus disease crisis><coronavirus disease epidemic><coronavirus disease pandemic><coronavirus disease-19><coronavirus disease-19 global pandemic><coronavirus disease-19 pandemic><coronavirus infectious disease-19><cost><cost measurement><decline in function><decline in functional status><deconditioning><decubitus ulcer><delirious><economic analysis><economic assessment><economic evaluation><economic impact><elderly patient><experience><falls><functional decline><functional restoration><functional status><functional status decline><health economics><healthcare-associated pneumonia><homes><hospital acquired pneumonia><hospital associated pneumonia><hospital days><hospital length of stay><hospital re-admission><hospital readmission><hospital related complications><hospital stay><hospital-associated complications><human old age (65+)><iatrogenic><iatrogenically><iatrogenicity><implementation science><improved><injuries><interest><intervention cost><interventional strategy><loss of function><multidisciplinary><nosocomial complications><novel><nurse><old age><older adult><older adulthood><older patient><over 65 years><patient mobility><patient oriented outcomes><pilot study><predictive modeling><pressure injury><prevent><preventing><program costs><programs><randomisation><randomization><randomized trial><randomly assigned><re-admission><re-hospitalization><readmission><rehab therapy><rehabilitative><rehabilitative therapy><rehospitalization><restore function><restore functionality><restore lost function><severe acute respiratory syndrome coronavirus 2 global health crisis><severe acute respiratory syndrome coronavirus 2 global pandemic><surgery><treatment as usual><usual care><venous thromboembolism><≥65 years>