Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
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.
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.
In 2023, the following updates were made after results were initially uploaded to clinical trials as follows: primary outcome description and results were modified to reflect discharge to skilled nursing facility versus discharge to home and modifications were made to the sample and discharge to skilled nursing home and length of stay outcomes due to receipt of more complete data sources for use to determine eligibility and to assess the primary outcome.
Not provided
Not provided
Not provided
Not provided
| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Intervention | Experimental | Implementation of STRIDE program |
|
| Usual Care | No Intervention | Pre-implementation before STRIDE program |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| STRIDE | Behavioral | Implementation of STRIDE inpatient hospital mobility program |
|
| Measure | Description | Time Frame |
|---|---|---|
| Proportion of Patients Discharged to Skilled Nursing Facility | Discharge to skilled nursing facility (versus home) will be assessed via administrative data pulls and chart review (not patient report). | Assessed at hospital discharge, an average of 7 days |
| Hospital Length of Stay (Days) | Hospital length of stay will be assessed via administrative data pulls (not patient report) | Assessed at hospital discharge, an average of 7 days |
| Measure | Description | Time Frame |
|---|---|---|
| Patient Physical Function - Disability | Analysis of physical function will be measured by the Late Life Function and Disability Instrument (LL-FDI) - Disability Component. Raw scores transformed to scaled scores ranging from 0-100, with higher scores reflecting higher functioning. | 30 days following hospital discharge, hospital stay an average of 6 days |
| Measure | Description | Time Frame |
|---|---|---|
| Sleep | Analysis of sleep functioning will be assessed with the sleep subscale of the Patient-Reported Outcomes Measurement Information System (PROMIS-29). Raw scores converted to t-scores ranging from 32.0 to 73.3. Higher scores indicate more sleep disturbance. | 30 days following hospital discharge, hospital stay an average of 6 days |
Inclusion Criteria:
Inclusion/Exclusion listed here apply to subset of patients providing consent for telephone interviews:
Exclusion Criteria:
Not provided
Not provided
Not provided
Not provided
Not provided
Not provided
| Name | Affiliation | Role |
|---|---|---|
| Susan N. Hastings, MD MHSc | Durham VA Medical Center, Durham, NC | Principal Investigator |
| Courtney H Van Houtven, PhD | Durham VA Medical Center, Durham, NC | Principal Investigator |
| Virginia Wang, PhD | Durham VA Medical Center, Durham, NC | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Durham VA Medical Center, Durham, NC | Durham | North Carolina | 27705-3875 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 38632179 | Derived | Kaufman BG, Hastings SN, Meyer C, Stechuchak KM, Choate A, Decosimo K, Sullivan C, Wang V, Allen KD, Van Houtven CH. The business case for hospital mobility programs in the veterans health care system: Results from multi-hospital implementation of the STRIDE program. Health Serv Res. 2024 Dec;59 Suppl 2(Suppl 2):e14307. doi: 10.1111/1475-6773.14307. Epub 2024 Apr 17. | |
| 37276590 |
| Label | URL |
|---|---|
| Function QUERI program | View source |
Not provided
A de-identified, anonymized dataset will be available upon request. Prior to distribution, a local privacy officer and study statistician will certify that the dataset contains no protected health information (PHI). Data will be provided to requestor in electronic format.
Sufficient data and descriptors will be made available to duplicate statistical analysis and confirm conclusions in publication.
No data or statistical code that could lead to re-identification of individuals will be released.
Data will be stored & maintained in an approved, secured location as described in the VA Research Data Inventory Form.
The study statistician will create de-identified, publication-specific datasets that includes all variables presented in the study publication.
Data will only be released per appropriate authorizations or agreements. Written agreements will specify that recipients are prohibited from taking steps to re-identify any individual whose data are included in the dataset.
Not provided
Available upon request.
Data will only be released per appropriate authorizations or agreements. Written agreements will specify that recipients are prohibited from taking steps to re- identify any individual whose data are included in the dataset.
Not provided
Not provided
Not provided
Not provided
| ID | Title | Description |
|---|---|---|
| FG000 | Intervention | Implementation of STRIDE program STRIDE: Implementation of STRIDE inpatient hospital mobility program |
| FG001 | Usual Care | Pre-implementation before STRIDE program |
| Title | Milestones | Reasons Not Completed | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
Patient-hospitalizations
| ID | Title | Description |
|---|---|---|
| BG000 | Intervention | Implementation of STRIDE program STRIDE: Implementation of STRIDE inpatient hospital mobility program |
| BG001 | Usual Care | Pre-implementation before STRIDE program |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Proportion of Patients Discharged to Skilled Nursing Facility | Discharge to skilled nursing facility (versus home) will be assessed via administrative data pulls and chart review (not patient report). | Discharge to skilled nursing facility was analyzed for the first hospitalization for each patient during the study period. Patients can be in both intervention and usual care groups if hospitalized during the respective intervention and usual care time periods; however, for this outcome patients will be analyzed in only one group, based upon the earliest of their hospitalizations if had more than one. | Posted | Mean | Standard Error | proportion of patients | Assessed at hospital discharge, an average of 7 days |
|
6 months post discharge, hospital stay an average of 7 days
Not provided
Not provided
| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Intervention | Implementation of STRIDE program STRIDE: Implementation of STRIDE inpatient hospital mobility program |
Not provided
Not provided
Not provided
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| S. Nicole Hastings | HSRD ADAPT | 919-286-6936 | susan.hastings@va.gov |
Not provided
| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Apr 2, 2020 | Apr 2, 2021 | Prot_SAP_000.pdf |
Not provided
Stepped Wedge Cluster Randomized Trial - a form of crossover design with unidirectional crossover (from control to experimental) but with randomization of when each cluster undertakes the transition. In the stepped wedge design, there is a staggered roll-out of the intervention, where the time and sequence of clusters that will start the intervention at each period determined by random allocation.
Not provided
Not provided
Not provided
Not provided
| Patient Physical Function - Limitations | Analysis of physical function will be measured by the Late Life Function and Disability Instrument (LL-FDI) - Limitations Component -Instrumental Role Domain. Raw scores transformed to scaled scores ranging from 0-100, with higher scores reflecting higher functioning. | 30 days following hospital discharge, hospital stay an average of 6 days |
| Patient Physical Function | Analysis of physical function will be measured by the Late Life Function and Disability Instrument (LL-FDI) - Function Component - Basic Lower Extremity Functioning Domain. Raw scores transformed to scaled scores ranging from 0-100, with higher scores reflecting higher functioning. | 30 days following hospital discharge, hospital stay an average of 6 days |
| Proportion Highly Satisfied With Care | Analysis of satisfaction with care will be measured with the Consumer Assessment of Healthcare Providers and Systems (CAHPS)-based item "Would you recommend this hospital to other Veterans if they needed care for a condition such as yours?" Responses were categorized into two categories: highly satisfied (responses of "Definitely Yes") and less satisfied (responses of "Probably Yes", "Probably No", and "Definitely No"). | 30 days following hospital discharge, hospital stay an average of 6 days |
| Health Utility | Analysis of health utility, a health-related quality of life measure, will be assessed with the ICEpop CAPability measure for adults (ICECAP-A). Tariff values for an overall state are calculated by summing the values across the individual attributes (Feeling settled and secure; Love, friendship and support; Being independent; Achievement and progress; and Enjoyment and pleasure). Tariff values can range from 0 to 1, with higher values reflecting greater quality of life. | 30 days following hospital discharge, hospital stay an average of 6 days |
| Health-related Quality of Life | Analysis of health-related quality of life will be measured by the Euroqol (EQ-5D). Response profiles are mapped to a score via a crosswalk. Scores range from -0.109 to 1.0, with higher scores reflecting a higher quality of life. | 30 days following hospital discharge, hospital stay an average of 6 days |
| Mobility in the Environment | Analysis of mobility in the environment will be assessed by the Life Space Questionnaire. The composite score incorporates use of equipment, need for personal help, and frequency of movement. Scores range from 0-120 with higher scores reflecting greater mobility. | 30 days following hospital discharge, hospital stay an average of 6 days |
| Proportion of Participants Self-reporting at Least One Fall |
Veterans self-reporting at least one fall in the 30 days since discharge from an eligible hospitalization, as queried during a telephone survey. |
| 30 days following hospital discharge, hospital stay an average of 6 days |
| PROMIS-29 Pain Subscale | Analysis of pain will be assessed with the pain subscale of the Patient-Reported Outcomes Measurement Information System (PROMIS-29). Raw scores converted to t-scores ranging from 41.6 to 75.6. Higher scores indicate higher (worse) pain interference. | 30 days following hospital discharge, hospital stay an average of 6 days |
| Depression | Analysis of depression will be assessed with the Center for Epidemiologic Studies Depression Scale (CESD-10). Scores range from 0-30, with higher scores reflecting more depressive symptoms | 30 days following hospital discharge, hospital stay an average of 6 days |
| Hastings SN, Stechuchak KM, Choate A, Van Houtven CH, Allen KD, Wang V, Colon-Emeric C, Jackson GL, Damush TM, Meyer C, Kappler CB, Hoenig H, Sperber N, Coffman CJ. Effects of Implementation of a Supervised Walking Program in Veterans Affairs Hospitals : A Stepped-Wedge, Cluster Randomized Trial. Ann Intern Med. 2023 Jun;176(6):743-750. doi: 10.7326/M22-3679. Epub 2023 Jun 6. |
| 35906589 | Derived | Wang V, D'Adolf J, Decosimo K, Robinson K, Choate A, Bruening R, Sperber N, Mahanna E, Van Houtven CH, Allen KD, Colon-Emeric C, Damush TM, Hastings SN. Adapting to CONNECT: modifying a nursing home-based team-building intervention to improve hospital care team interactions, functioning, and implementation readiness. BMC Health Serv Res. 2022 Jul 29;22(1):968. doi: 10.1186/s12913-022-08270-1. |
| 33076997 | Derived | Hastings SN, Stechuchak KM, Choate A, Mahanna EP, Van Houtven C, Allen KD, Wang V, Sperber N, Zullig L, Bosworth HB, Coffman CJ. Implementation of a stepped wedge cluster randomized trial to evaluate a hospital mobility program. Trials. 2020 Oct 16;21(1):863. doi: 10.1186/s13063-020-04764-7. |
| 29678137 | Derived | Wang V, Allen K, Van Houtven CH, Coffman C, Sperber N, Mahanna EP, Colon-Emeric C, Hoenig H, Jackson GL, Damush TM, Price E, Hastings SN. Supporting teams to optimize function and independence in Veterans: a multi-study program and mixed methods protocol. Implement Sci. 2018 Apr 20;13(1):58. doi: 10.1186/s13012-018-0748-3. |
| BG002 | Total | Total of all reporting groups |
| patient hospitalizations |
|
| years |
| patient hospitalizations |
|
| Sex: Female, Male | Count of Units | patient hospitalizations | patient hospitalizations |
|
| Ethnicity (NIH/OMB) | Count of Units | patient hospitalizations | patient hospitalizations |
|
| Race (NIH/OMB) | Count of Units | patient hospitalizations | patient hospitalizations |
|
| Region of Enrollment | Number | patient hospitalizations | patient hospitalizations |
|
| OG001 | Usual Care | Pre-implementation before STRIDE program |
|
|
|
| Primary | Hospital Length of Stay (Days) | Hospital length of stay will be assessed via administrative data pulls (not patient report) | Length of stay was analyzed for the first hospitalization for each patient during the study period. Patients can be in both intervention and usual care groups if hospitalized during the respective intervention and usual care time periods; however, for this outcome patients will be analyzed in only one group, based upon the earliest of their hospitalizations if had more than one. | Posted | Mean | Standard Error | Days | Assessed at hospital discharge, an average of 7 days |
|
|
|
|
| Secondary | Patient Physical Function - Disability | Analysis of physical function will be measured by the Late Life Function and Disability Instrument (LL-FDI) - Disability Component. Raw scores transformed to scaled scores ranging from 0-100, with higher scores reflecting higher functioning. | Veterans completing a telephone survey 30 days after discharge from an eligible hospitalization. While Veterans may have multiple eligible hospitalizations, in the study framework Veterans can only be surveyed once. | Posted | Mean | Standard Error | score on a scale | 30 days following hospital discharge, hospital stay an average of 6 days |
|
|
|
|
| Secondary | Patient Physical Function - Limitations | Analysis of physical function will be measured by the Late Life Function and Disability Instrument (LL-FDI) - Limitations Component -Instrumental Role Domain. Raw scores transformed to scaled scores ranging from 0-100, with higher scores reflecting higher functioning. | Veterans completing a telephone survey 30 days after discharge from an eligible hospitalization. While Veterans may have multiple eligible hospitalizations, in the study framework Veterans can only be surveyed once. | Posted | Mean | Standard Error | score on a scale | 30 days following hospital discharge, hospital stay an average of 6 days |
|
|
|
|
| Secondary | Patient Physical Function | Analysis of physical function will be measured by the Late Life Function and Disability Instrument (LL-FDI) - Function Component - Basic Lower Extremity Functioning Domain. Raw scores transformed to scaled scores ranging from 0-100, with higher scores reflecting higher functioning. | Patient telephone survey 30 days post discharge | Posted | Mean | Standard Error | score on a scale | 30 days following hospital discharge, hospital stay an average of 6 days |
|
|
|
|
| Secondary | Proportion Highly Satisfied With Care | Analysis of satisfaction with care will be measured with the Consumer Assessment of Healthcare Providers and Systems (CAHPS)-based item "Would you recommend this hospital to other Veterans if they needed care for a condition such as yours?" Responses were categorized into two categories: highly satisfied (responses of "Definitely Yes") and less satisfied (responses of "Probably Yes", "Probably No", and "Definitely No"). | Veterans completing a telephone survey 30 days after discharge from an eligible hospitalization. While Veterans may have multiple eligible hospitalizations, in the study framework Veterans can only be surveyed once. | Posted | Mean | Standard Error | proportion of patients | 30 days following hospital discharge, hospital stay an average of 6 days |
|
|
|
|
| Secondary | Health Utility | Analysis of health utility, a health-related quality of life measure, will be assessed with the ICEpop CAPability measure for adults (ICECAP-A). Tariff values for an overall state are calculated by summing the values across the individual attributes (Feeling settled and secure; Love, friendship and support; Being independent; Achievement and progress; and Enjoyment and pleasure). Tariff values can range from 0 to 1, with higher values reflecting greater quality of life. | Patients completing a telephone survey 30 days post discharge | Posted | Mean | Standard Error | score on a scale | 30 days following hospital discharge, hospital stay an average of 6 days |
|
|
|
|
| Secondary | Health-related Quality of Life | Analysis of health-related quality of life will be measured by the Euroqol (EQ-5D). Response profiles are mapped to a score via a crosswalk. Scores range from -0.109 to 1.0, with higher scores reflecting a higher quality of life. | Veterans completing a telephone survey 30 days after discharge from an eligible hospitalization. While Veterans may have multiple eligible hospitalizations, in the study framework Veterans can only be surveyed once. | Posted | Mean | Standard Error | score on a scale | 30 days following hospital discharge, hospital stay an average of 6 days |
|
|
|
|
| Secondary | Mobility in the Environment | Analysis of mobility in the environment will be assessed by the Life Space Questionnaire. The composite score incorporates use of equipment, need for personal help, and frequency of movement. Scores range from 0-120 with higher scores reflecting greater mobility. | Veterans completing a telephone survey 30 days after discharge from an eligible hospitalization. While Veterans may have multiple eligible hospitalizations, in the study framework Veterans can only be surveyed once. | Posted | Mean | Standard Error | score on a scale | 30 days following hospital discharge, hospital stay an average of 6 days |
|
|
|
|
| Other Pre-specified | Sleep | Analysis of sleep functioning will be assessed with the sleep subscale of the Patient-Reported Outcomes Measurement Information System (PROMIS-29). Raw scores converted to t-scores ranging from 32.0 to 73.3. Higher scores indicate more sleep disturbance. | Veterans completing a telephone survey 30 days after discharge from an eligible hospitalization. While Veterans may have multiple eligible hospitalizations, in the study framework Veterans can only be surveyed once. | Posted | Mean | Standard Error | score on a scale | 30 days following hospital discharge, hospital stay an average of 6 days |
|
|
|
|
| Other Pre-specified | Proportion of Participants Self-reporting at Least One Fall | Veterans self-reporting at least one fall in the 30 days since discharge from an eligible hospitalization, as queried during a telephone survey. | Veterans completing a telephone survey 30 days after discharge from an eligible hospitalization. While Veterans may have multiple eligible hospitalizations, in the study framework Veterans can only be surveyed once. | Posted | Mean | Standard Error | proportion of patients | 30 days following hospital discharge, hospital stay an average of 6 days |
|
|
|
|
| Other Pre-specified | PROMIS-29 Pain Subscale | Analysis of pain will be assessed with the pain subscale of the Patient-Reported Outcomes Measurement Information System (PROMIS-29). Raw scores converted to t-scores ranging from 41.6 to 75.6. Higher scores indicate higher (worse) pain interference. | Veterans completing a telephone survey 30 days after discharge from an eligible hospitalization. While Veterans may have multiple eligible hospitalizations, in the study framework Veterans can only be surveyed once. | Posted | Mean | Standard Error | score on a scale | 30 days following hospital discharge, hospital stay an average of 6 days |
|
|
|
|
| Other Pre-specified | Depression | Analysis of depression will be assessed with the Center for Epidemiologic Studies Depression Scale (CESD-10). Scores range from 0-30, with higher scores reflecting more depressive symptoms | Veterans completing a telephone survey 30 days after discharge from an eligible hospitalization. While Veterans may have multiple eligible hospitalizations, in the study framework Veterans can only be surveyed once. | Posted | Mean | Standard Error | score on a scale | 30 days following hospital discharge, hospital stay an average of 6 days |
|
|
|
|
| 0 |
| 7,134 |
| 0 |
| 7,134 |
| 0 |
| 7,134 |
| EG001 | Usual Care | Pre-implementation before STRIDE program | 0 | 6,723 | 0 | 6,723 | 0 | 6,723 |
Not provided
Not provided
| Superiority |
| Superiority |
| Superiority |
| Superiority |
| Superiority |
| Superiority |
| Superiority |
| Superiority |
| Superiority |
| Superiority |
| Superiority |
| Superiority |