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| ID | Type | Description | Link |
|---|---|---|---|
| A549000 | Other Identifier | UW Madison | |
| NUR/FACULTY AFFAIRS/ADMIN | Other Identifier | UW Madison | |
| Protocol Version 08/19/2024 | Other Identifier | UW Madison | |
| 1R01HS026733-01A1 | U.S. AHRQ Grant/Contract | View source |
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| Name | Class |
|---|---|
| Agency for Healthcare Research and Quality (AHRQ) | FED |
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The MOVIN (Mobilizing Older adult patients Via a systems-based Intervention) randomized controlled trial is designed to evaluate the impact of the MOVIN intervention on improving the functional ability of older adult hospital patients and reducing their healthcare utilization post-hospitalization. MOVIN is a program to increase patient ambulation while hospitalized. The study's hypothesis is that MOVIN will improve functional outcomes for hospitalized older adult patients by producing a change in nursing practice and culture of ambulation on inpatient units. MOVIN is a unit-based intervention. Therefore all patients on this unit are exposed to the intervention once it is implemented regardless of whether or not they participate in the trial. The study will enroll 360-420 total hospitalized participants 65 years and older for the duration of their stay. It will also enroll any nurses 18 years and older who worked on the units during the study and are willing to fill out surveys.
Up to 65% of hospitalized older adults will lose the ability to ambulate independently during their hospital stay. Loss of independent ambulation has been identified as a hospital-acquired disability and is a critical patient safety concern, resulting in permanent loss of function for 50% of older adults one-year post discharge. Functional loss is associated with multiple negative outcomes including a 33% increase in new nursing home placement, increase in length of hospital stay, need for home health services, falls, caregiver burden, decreased quality of life, and increased mortality. Given the rapid increase in the elderly population, loss of independent ambulation primarily due to the process of care in hospital settings may significantly increase future healthcare costs and further exacerbate concerns related to patient care quality.
Lack of walking during hospitalization has been directly linked to loss of independent ambulation in older adults. Nurses are responsible for promoting and maintaining patient independent mobility. However, the investigators research has identified multiple personal and organizational barriers that prevent nurses from walking patients. The investigators have developed and pilot tested a novel systems based multi-component intervention to improve ambulation of older adult patients, Mobilizing Older adult patients Via a systems-based INtervention (MOVIN).
MOVIN is comprised of five components: 1) psychomotor skills training; 2) communication tools; 3) ambulation pathways; 4) ambulation resources; and 5) unit ambulation culture. The Investigators pilot study of MOVIN demonstrated a statistically significant increase in frequency and weekly distance of patient ambulation as well as changes in nursing practice and unit culture. Notably, these changes have been sustained for greater than two years after completion of the study.
The investigators' goal is to eliminate loss of independent ambulation in hospitalized older adults. In pursuit of this goal, the specific aims are to:
Specific Aim 1:Test the effectiveness of MOVIN to improve functional ability of older adult patients at discharge, and 1, 3 and 6 months post discharge
Specific Aim 2: Test the effectiveness of MOVIN to reduce healthcare utilization of older adults at discharge, and 1, 3 and 6 months post discharge
Specific Aim 3: Measure change in nurse behaviors and unit culture and identify ongoing systems barriers that impact translation of MOVIN across inpatient units and different hospitals.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Pre-intervention/control | No Intervention | 160-200 older adult patients (age 65 or older) will be recruited on four units across two hospitals (two units per hospital) over 6-8 months prior to implementation of the unit-based MOVIN intervention. | |
| Post-intervention | Experimental | 160-200 older adult patients (age 65 or older) will be recruited on four units across two hospitals (two units per hospital) over 6-8 months after MOVIN has been implemented on the unit. |
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| Nurses | Other | Nurses will complete surveys and provide qualitative data to assess barriers to implementation. Nurses will be invited to enroll in the survey/qualitative data arm during both Pre-intervention and Post-intervention phases. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| MOVIN | Other | MOVIN is a multi-component unit-based intervention comprised of five components that are implemented simultaneously in a hospital unit. The five components are: 1) psychomotor skills training, 2) unit ambulation culture, 3) communication, 4) resources, 5) ambulation environment. |
| Measure | Description | Time Frame |
|---|---|---|
| Aim 1: Change in Gait Speed | Gait Speed is a physical performance measure identified as a sensitive clinical indicator of health, mortality, healthcare utilization, and independence in ambulation, and is feasible to test in hospitalized older adults. A 4 meter walk test will be conducted on admission to the study, discharge from the hospital and at 3 months post discharge in the subjects home or the hospital or clinic. A trained member of the research team will conduct the gait speed test. Interrater reliability for the 4 meter walk test will be conducted between all members of the research team prior to collecting gait speed data on study participants. Change scores will be calculated as the difference among gait speeds measured at each time points. | Within 24 hours of hospital admission, Within 8 hours of hospital discharge, 3 months post-discharge; Up to 4 months total |
| Aim 1: Change in Self-report on Activities of Daily Living (ADL) | A trained member of the research team collected patients self-report of ADLs on admission to the study, discharge from the hospital, by phone at 1 month post intervention and 6 months post intervention, and in person at the 3 month post intervention visit using the Katz ADL Index. The Katz ADL Index is a self-report scale that measures six ADL on two levels (independent or requiring assistance of another). A score of 0-6 is possible, with higher scores indicating higher independence with ADLs and lower scores indicating higher dependence on others to perform ADLs. The scale demonstrates excellent reliability and predictive validity, and is sensitive to change in hospital settings. For the primary analysis, patients with a score of 6 were converted to a binary score of 1=Independent; all others were scored as 0=Dependent. | Within 24 hours of hospital admission, Within 8 hours of hospital discharge, 1 month post-discharge, 3 months post-discharge; 6 months post-discharge |
| Aim 1: Change in Life Space Assessment | The University of Alabama at Birmingham (UAB) Life Space Assessment (LSA) is a self-report scale of ambulation that measures spaces patients' move in, the frequency of moving into those spaces, and dependency in moving into those spaces. This scale has demonstrated reliability and predictive validity and sensitivity to change after hospital stay. Level scores are calculated by multiplying the life-space level (higher numbers indicate farther distances moved, e.g., 1-inside the home to 5-places outside of the person's town), degree of independence (higher scores indicate greater independence), and frequency of movement (higher scores equal greater frequency). Total scores range from 0 (totally bed-bound) to 120 (moved out of town every day without assistance). A trained member of the research team will collect patients self-report on Life Space. Change scores will be calculated as the difference among LSA ambulation measured at each time point. |
| Measure | Description | Time Frame |
|---|---|---|
| Aim 3: Frequency of Patient Ambulation (Percent of Patients Ambulated by Nursing Staff) | Unit-level data on the percent of patients ambulated by nursing staff (as recorded in the electronic health record) out of the total number of ambulatory patients on the unit. | 6 months pre-intervention, during the 14-week intervention period, and 6 months post-intervention; up to 16 months total |
| Measure | Description | Time Frame |
|---|---|---|
| Aim 3: Qualitative Assessment of Intervention Implementation | Enrolled nursing staff will be interviewed and interviews will be coded for themes. Themes will be summarized to report by participant count. | post-intervention (approximately 3-5 months after active intervention launch) |
| Aim 2: Physical Therapy (PT) Utilization |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Linsey M Steege, PhD | University of Wisconsin, Madison | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| UW School of Medicine and Public Health | Madison | Wisconsin | 53705 | United States |
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In this incomplete stepped-wedge design, Units were assigned randomly to Steps. Each Step contained exactly one Unit, and no Units dropped out. Within a Step, there was a Control period (pre-intervention); an Intervention run-in period, during which no Patients or Nursing Staff were enrolled (and therefore, this period is not shown in the Participant Flow table); and a Post-Intervention period. Patients and Nursing Staff were recruited in both Control and Post-Intervention periods.
| ID | Title | Description |
|---|---|---|
| FG000 | Step 1: Unit A | Pre-Intervention (Control) 12/27/2020-06/26/2021 (6 months) MOVIN Implementation Period 06/27/2021-10/09/2021 (approximately 3 months) Post-Intervention 10/10/2021-04/10/2022 (6 months) Adult patients (age 65 or older) will be recruited over 6-8 months after MOVIN has been implemented on the unit. Nurses will complete surveys and provide qualitative data to assess barriers to implementation. MOVIN is a multi-component unit-based intervention comprised of five components that are implemented simultaneously in a hospital unit. The five components are: 1) psychomotor skills training, 2) unit ambulation culture, 3) communication, 4) resources, 5) ambulation environment. |
| FG001 | Step 2: Unit B | Pre-Intervention (Control) 09/26/2021-03/26/2022 (6 months) MOVIN Implementation Period 03/27/2022-07/02/2022 (approximately 3 months) Post-Intervention 07/03/2022-12/31/2022 (6 months) Adult patients (age 65 or older) will be recruited over 6-8 months after MOVIN has been implemented on the unit. Nurses will complete surveys and provide qualitative data to assess barriers to implementation. MOVIN is a multi-component unit-based intervention comprised of five components that are implemented simultaneously in a hospital unit. The five components are: 1) psychomotor skills training, 2) unit ambulation culture, 3) communication, 4) resources, 5) ambulation environment. |
| FG002 | Step 3: Unit C | Pre-Intervention (Control) 07/24/2022-01/21/2023 (approximately 6 months) MOVIN Implementation Period 01/22/2023-06/10/2023 (approximately 4 months) Post-Intervention 06/11/2023-12/10/2023 (6 months) Adult patients (age 65 or older) will be recruited over 6-8 months after MOVIN has been implemented on the unit. Nurses will complete surveys and provide qualitative data to assess barriers to implementation. MOVIN is a multi-component unit-based intervention comprised of five components that are implemented simultaneously in a hospital unit. The five components are: 1) psychomotor skills training, 2) unit ambulation culture, 3) communication, 4) resources, 5) ambulation environment. |
| FG003 | Step 4: Unit D | Pre-Intervention (Control) 02/12/2023-08/12/2023 (6 months) MOVIN Implementation Period 08/13/2023-11/18/2023 (approximately 3 months) Post-Intervention 11/19/2023-05/19/2024 (6 months) Adult patients (age 65 or older) will be recruited over 6-8 months after MOVIN has been implemented on the unit. Nurses will complete surveys and provide qualitative data to assess barriers to implementation. MOVIN is a multi-component unit-based intervention comprised of five components that are implemented simultaneously in a hospital unit. The five components are: 1) psychomotor skills training, 2) unit ambulation culture, 3) communication, 4) resources, 5) ambulation environment. |
| Title | Milestones | Reasons Not Completed | ||||||||||||||||||||||||
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| Control (Pre-Intervention) |
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| Post-Intervention |
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Total number of baseline participants reflects the total of both Patient (N=387) and Nursing Staff (N=378) enrollees.
Age and sex were unknown for one pre-intervention patient and one post-intervention patient.
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| ID | Title | Description |
|---|---|---|
| BG000 | Pre-Intervention Patients | These participants were hospital patients who were eligible for enrollment and who enrolled in the study prior to the intervention. |
| BG001 | Pre-Intervention Nursing Staff |
| Units | Counts |
|---|---|
| Participants |
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| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Customized | Count of Participants |
| 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 | Aim 1: Change in Gait Speed | Gait Speed is a physical performance measure identified as a sensitive clinical indicator of health, mortality, healthcare utilization, and independence in ambulation, and is feasible to test in hospitalized older adults. A 4 meter walk test will be conducted on admission to the study, discharge from the hospital and at 3 months post discharge in the subjects home or the hospital or clinic. A trained member of the research team will conduct the gait speed test. Interrater reliability for the 4 meter walk test will be conducted between all members of the research team prior to collecting gait speed data on study participants. Change scores will be calculated as the difference among gait speeds measured at each time points. | One Pre-Intervention Patient and one Post-Intervention Patient were missing gait speed data at baseline. | Posted | Least Squares Mean | 95% Confidence Interval | m/s | Within 24 hours of hospital admission, Within 8 hours of hospital discharge, 3 months post-discharge; Up to 4 months total |
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Adverse event data were collected at three discrete timepoints: admission, discharge (which occurred a median of 4 days post-baseline; interquartile range 3-8 days post-baseline), and at the three month post-discharge assessment. At each timepoint, adverse event data were collected only during the assessment itself. The timing of hospital discharge relative to baseline depended on patient factors.
The only adverse event that was defined was a fall during a gait speed assessment. All falls that occurred during gait speed assessment were to be recorded. Gait speed assessments occurred at two timepoints during the hospital stay (admission and hospital discharge) and at three months post-discharge. Adverse events (including all-cause mortality, serious, and other AEs) were not monitored/assessed in nursing staff, so the number of nursing staff at risk is zero throughout.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Pre-Intervention Patients | These participants were hospital patients who were eligible for enrollment and who enrolled in the study prior to the intervention. |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Linsey Steege | University of Wisconsin-Madison | 608-263-5191 | lsteege@wisc.edu |
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| 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 | Aug 19, 2024 | Sep 30, 2025 | Prot_SAP_000.pdf |
| ICF | No | No | Yes | Informed Consent Form: Site 1 patient informed consent form | Feb 10, 2021 | Sep 30, 2025 | ICF_001.pdf |
| ICF | No | No | Yes | Informed Consent Form: Site 2 patient informed consent form | Oct 27, 2022 | Sep 30, 2025 | ICF_002.pdf |
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| ID | Term |
|---|---|
| D007049 | Iatrogenic Disease |
| ID | Term |
|---|---|
| D020969 | Disease Attributes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| ID | Term |
|---|---|
| D011795 | Surveys and Questionnaires |
| D017144 | Focus Groups |
| ID | Term |
|---|---|
| D003625 | Data Collection |
| D004812 | Epidemiologic Methods |
| D008919 | Investigative Techniques |
| D017531 | Health Care Evaluation Mechanisms |
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This study uses an incomplete stepped wedge cluster randomized controlled trial. In the incomplete stepped wedge design, inpatient units are randomly sequenced into the intervention. A baseline (control period) and 2 follow up data collection periods (intervention and post intervention period) occur for each unit. Incomplete stepped wedge cluster randomized trials are novel study designs that are particularly beneficial for evaluating service delivery interventions using a pragmatic design, when evaluations need to be completed at a system or population level, or it is impractical or cost prohibitive to roll out an intervention across multiple units simultaneously.
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| Surveys and Focus groups | Other | Nurses will answer surveys about nurse behavior, changes in self-efficacy, frequency and distance of patient ambulation, documentation of ambulation, qualitative data collected to determine barriers to implementation |
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| Within 24 hours of hospital admission, 1 month post-discharge, 3 months post-discharge; 6 months post-discharge |
| Aim 2: Hospital Readmissions | Hospital readmissions were collected via patient self-report and via medical record review by a trained researcher from the study team. Patient readmission was coded as 0=not readmitted, 1=readmitted. Reported value for each cell reflects a model-based estimate of the probability of readmission, a type of least squares mean appropriate for a binary variable. | 1 month post-discharge; 3 months post-discharge; 6 months post-discharge; Up to 7 months total |
| Aim 2: Emergency Department Visits | Emergency department (ED) visits will be collected via patient self report. Patient ED usage was coded as 0=no ED visit, 1=any ED visit. Reported value for each cell reflects a model-based estimate of the probability of an ED visit, a type of least squares mean appropriate for a binary variable. | 1 month post-discharge; 3 months post-discharge; 6 months post-discharge; Up to 7 months total |
| Aim 2: Length of Hospital Stay | Length of hospital stay will be collected via patient medical record review by a nurse researcher from the study team. | During hospital stay in the Pre-Intervention and Post-Intervention periods |
| Aim 2: Discharge Destination | Discharge destination (home, skilled nursing facility) was collected via patient medical record review by a nurse researcher from the study team. Patient discharge destination was coded as 1=discharged to home, 0=discharged to a skilled nursing facility. Reported value for each cell reflects a model-based estimate of the probability of discharge to home, a type of least squares mean appropriate for a binary variable. | Within 3 months post-discharge; Up to 4 months total |
| Aim 3: Distance of Patient Ambulation | Unit level data on ambulation. Each week, the total distance walked on that unit by all patients on the unit was recorded. We report the average total weekly distance walked, using a model-based least squares mean. The number of participants analyzed is large because this measure is unit-level and includes all patients observed on the unit during the study period, not only those enrolled in the full study, and will double count patients who were observed during more than one week. | 6 months pre-intervention, during the 14-week intervention period, and 6 months post-intervention; up to 16 months total |
| Aim 3: Barriers to Ambulation Survey | Data collected from enrolled nursing staff via paper copies or online link before and after the intervention. The Barriers to Patient Ambulation Survey assesses the nurses opinions regarding ambulation of hospitalized patients within the past 2 weeks. It is scored from 0-100 with higher scores indicating increased barriers to ambulation. | pre-intervention, post-intervention (up to about 20 weeks) |
| Aim 3: Ambulation Culture Survey | Data collected from enrolled nursing staff via paper copies or online link before and after the intervention. The Ambulation Culture Survey asks for opinions on ambulation culture. We report responses to the item, "How would you rate your unit/work area on patient care related to ambulation?" This item has a minimum score of 1 (Poor) and a maximum score of 5 (Excellent). Higher values represent a better outcome. | pre-intervention, post-intervention (up to about 20 weeks) |
| Aim 3: Nurse Fatigue Survey: Chronic Fatigue Subscale | Data collected from enrolled nursing staff via paper copies or online link before and after the intervention. The Nurse Fatigue Survey measures experience of fatigue and strain at work and home. It is a 15 item survey scored on a 7 point likert scale from 0 (strongly disagree) to 6 (strongly agree) with the 3 subscales of 5 questions each (chronic fatigue, acute fatigue and intershift recovery) scored separately. Items for each subscale are aggregated into a percent of the total highest possible points (30) resulting in a range of scores from 0-100%, higher scores indicate higher fatigue. | pre-intervention, post-intervention (up to about 20 weeks) |
| Aim 3: Nurse Fatigue Survey: Acute Fatigue Subscale | Data collected from enrolled nursing staff via paper copies or online link before and after the intervention. The Nurse Fatigue Survey measures experience of fatigue and strain at work and home. It is a 15 item survey scored on a 7 point likert scale from 0 (strongly disagree) to 6 (strongly agree) with the 3 subscales of 5 questions each (chronic fatigue, acute fatigue and intershift recovery) scored separately. Items for each subscale are aggregated into a percent of the total highest possible points (30) resulting in a range of scores from 0-100%, higher scores indicate higher fatigue. | pre-intervention, post-intervention (up to about 20 weeks) |
| Aim 3: Nurse Fatigue Survey: Intershift Recovery Subscale | Data collected from enrolled nursing staff via paper copies or online link before and after the intervention. The Nurse Fatigue Survey measures experience of fatigue and strain at work and home. It is a 15 item survey scored on a 7 point likert scale from 0 (strongly disagree) to 6 (strongly agree) with the 3 subscales of 5 questions each (chronic fatigue, acute fatigue and intershift recovery) scored separately. Items for each subscale are aggregated into a percent of the total highest possible points (30) resulting in a range of scores from 0-100%, higher scores indicate higher fatigue. | pre-intervention, post-intervention (up to about 20 weeks) |
| Aim 3: Professional Quality of Life Survey: Compassion Satisfaction | Data collected from enrolled nursing staff via paper copies or online link before and after the intervention. The Professional Quality of Life Survey measures positive and negative experiences within the last 30 days in a 30-item survey scored on a 5 point likert scale from 1 (never) to 5 (very often). The Compassion Satisfaction subscale has a range of scores from 10-50, with higher scores indicative of higher compassion satisfaction. Please note that for this subscale, scores were transformed before analysis using a Box-Cox (squared) transformation in order to meet the assumption of normally distributed model residuals; in effect the square-scale score has a range from 100-2500, where higher scores are still better. This results in reported least squares means that are very large compared to the original scale. | pre-intervention, post-intervention (up to about 20 weeks) |
| Aim 3: Professional Quality of Life Survey: Burnout | Data collected from enrolled nursing staff via paper copies or online link before and after the intervention. The Professional Quality of Life Survey measures positive and negative experiences within the last 30 days in a 30-item survey scored on a 5 point likert scale from 1 (never) to 5 (very often). There are 3 subscales: Compassion Satisfaction, Burnout, and Secondary Traumatic Stress, each subscale has a range of scores from 10-50, with higher scores indicative of higher compassion satisfaction, higher burnout, and higher secondary traumatic stress. | pre-intervention, post-intervention (up to about 20 weeks) |
| Aim 3: Professional Quality of Life Survey: Secondary Traumatic Stress | Data collected from enrolled nursing staff via paper copies or online link before and after the intervention. The Professional Quality of Life Survey measures positive and negative experiences within the last 30 days in a 30-item survey scored on a 5 point likert scale from 1 (never) to 5 (very often). There are 3 subscales: Compassion Satisfaction, Burnout, and Secondary Traumatic Stress, each subscale has a range of scores from 10-50, with higher scores indicative of higher compassion satisfaction, higher burnout, and higher secondary traumatic stress. | pre-intervention, post-intervention (up to about 20 weeks) |
Billing data will be used retrospectively to understand use of PT services on the intervention units at pre-intervention, intervention, and post-intervention data collection periods |
| 6 months pre-intervention, during the 14-week intervention period, and 6 months post-intervention; up to 16 months total |
| Patient Satisfaction: Participant Experience Scores From 1-5 on HCAHPS | The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPHS) is a participant self-reported survey that measures patient satisfaction. Participants rank their hospital experience from 1-5, where 5 is the best possible experience. | 6 months pre-intervention, during the 14-week intervention period, and 6 months post-intervention; up to 16 months total |
| Patient Satisfaction: Count of Participants With Responses to Strongly Disagree/Disagree/Agree/Strongly Agree Questions on HCAHPS | The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a participant self-reported survey that measures patient satisfaction. Reported here are the Participant Counts of Responses to Strongly disagree/Disagree/Agree/Strongly agree to the following questions: During this hospital stay, staff took my preferences and those of my family or caregiver into account in deciding what my health care needs would be when I left When I left the hospital, I had a good understanding of the things I was responsible for in managing my health When I left the hospital, I clearly understood the purpose for taking each of my medications Analysis will include shifts in the distribution of responses across response options, as well as changes in frequency/percentage of top-box responses (responses of "Strongly agree") relative to all responses. | 6 months pre-intervention, during the 14-week intervention period, and 6 months post-intervention; up to 16 months total |
| Patient Satisfaction: Count of Participants With Satisfaction Responses to Definitely no/Probably no/Probably Yes/Definitely Yes to the Following Question: Would You Recommend This Hospital to Your Friends and Family? | The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a participant self-reported survey that measures patient satisfaction. Reported here are the Participant Counts With Satisfaction Responses to Definitely no/Probably no/Probably yes/Definitely yes to the following question: Would you recommend this hospital to your friends and family? Analysis will include shifts in the distribution of responses across response options, as well as changes in frequency/percentage of top-box responses (responses of "Definitely Yes") relative to all responses. | 6 months pre-intervention, during the 14-week intervention period, and 6 months post-intervention; up to 16 months total |
| Patient Satisfaction: Hospital Experience Scores From 0-10 on HCAPHS | The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPHS) is a participant self-reported survey that measures patient satisfaction. Participants rank their hospital experience from 0-10, where 10 is the best possible hospital. | 6 months pre-intervention, during the 14-week intervention period, and 6 months post-intervention; up to 16 months total |
| Patient Satisfaction: Where Participants Went After Hospitalization | The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPHS) is a participant self-reported survey that measures patient satisfaction. Reported here are the Participant Counts of whether they went home, to someone else's home, or another facility after discharge. | 6 months pre-intervention, during the 14-week intervention period, and 6 months post-intervention; up to 16 months total |
| Patient Satisfaction: Count of Participants With Satisfaction Responses to Never, Sometimes, Usually, Always Questions on HCAHPS | Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a participant self-reported survey that measures patient satisfaction. Reported here are Participant Counts to questions with response options: Never, Sometimes, Usually, Always. Analysis will include shifts of distribution across response options and changes in frequency/percentage of top-box responses ("Always") relative to all responses. Questions include: During this hospital stay, how often did nurses treat you with courtesy and respect? how often did nurses listen carefully to you? how often did nurses explain things in a way you could understand? after you pressed the call button, how often did you get help as soon as you wanted it? how often were your room and bathroom kept clean? how often was the area around your room quiet at night? How often did you get help in getting to the bathroom or in using a bedpan as soon as you wanted? | 6 months pre-intervention, during the 14-week intervention period, and 6 months post-intervention; up to 16 months total |
| Patient Satisfaction: Count of Participants Answering Yes to Items on the HCAPHS | The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPHS) is a participant self-reported survey that measures patient satisfaction. Reported here are the Participant Counts of those who answered "Yes" to the following Yes or No questions:
| 6 months pre-intervention, during the 14-week intervention period, and 6 months post-intervention; up to 16 months total |
| Withdrawal by Subject |
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| Physician Decision |
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| Protocol Violation |
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| Lost to Follow-up |
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| Change in health status |
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| Post-Intervention Patients |
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| Post Intervention Nursing Staff |
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| COMPLETED | Nursing staff completed a one-timepoint survey, and so dropout was not tracked (i.e. all nursing staff were considered to have completed the study). |
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| NOT COMPLETED |
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These participants were nursing staff members who were eligible for enrollment and who enrolled in the study prior to the intervention.
| BG002 | Post-Intervention Patients | These participants were hospital patients who were eligible for enrollment and who enrolled in the study after the intervention. |
| BG003 | Post-Intervention Nursing Staff | These participants were nursing staff members who were eligible for enrollment and who enrolled in the study after the intervention. |
| BG004 | Total | Total of all reporting groups |
| Participants |
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| Sex/Gender, Customized | Count of Participants | Participants |
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| Ethnicity (NIH/OMB) | Count of Participants | Participants |
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| Race (NIH/OMB) | Count of Participants | Participants |
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| Region of Enrollment | Number | participants |
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| OG000 |
| Pre-Intervention Patients |
Patients recruited to the study during the Pre-Intervention (Control) period. These patients experienced the pre-interventional standard of care in their unit. |
| OG001 | Post-Intervention Patients | Patients recruited to the study during the Post-Intervention period, after the run-in/implementation period was complete. These patients experienced care in their unit once the intervention had been fully rolled-out. |
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| Primary | Aim 1: Change in Self-report on Activities of Daily Living (ADL) | A trained member of the research team collected patients self-report of ADLs on admission to the study, discharge from the hospital, by phone at 1 month post intervention and 6 months post intervention, and in person at the 3 month post intervention visit using the Katz ADL Index. The Katz ADL Index is a self-report scale that measures six ADL on two levels (independent or requiring assistance of another). A score of 0-6 is possible, with higher scores indicating higher independence with ADLs and lower scores indicating higher dependence on others to perform ADLs. The scale demonstrates excellent reliability and predictive validity, and is sensitive to change in hospital settings. For the primary analysis, patients with a score of 6 were converted to a binary score of 1=Independent; all others were scored as 0=Dependent. | Self-reported ADLs were missing for 20 patients in the Pre-Intervention period and 26 patients in the Post-Intervention period. | Posted | Count of Participants | Participants | Within 24 hours of hospital admission, Within 8 hours of hospital discharge, 1 month post-discharge, 3 months post-discharge; 6 months post-discharge |
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| Primary | Aim 1: Change in Life Space Assessment | The University of Alabama at Birmingham (UAB) Life Space Assessment (LSA) is a self-report scale of ambulation that measures spaces patients' move in, the frequency of moving into those spaces, and dependency in moving into those spaces. This scale has demonstrated reliability and predictive validity and sensitivity to change after hospital stay. Level scores are calculated by multiplying the life-space level (higher numbers indicate farther distances moved, e.g., 1-inside the home to 5-places outside of the person's town), degree of independence (higher scores indicate greater independence), and frequency of movement (higher scores equal greater frequency). Total scores range from 0 (totally bed-bound) to 120 (moved out of town every day without assistance). A trained member of the research team will collect patients self-report on Life Space. Change scores will be calculated as the difference among LSA ambulation measured at each time point. | Life Space Analysis data were missing for 20 patients in the Pre-Intervention period and 26 patients in the Post-Intervention period. | Posted | Least Squares Mean | Standard Error | score on a scale | Within 24 hours of hospital admission, 1 month post-discharge, 3 months post-discharge; 6 months post-discharge |
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| Primary | Aim 2: Hospital Readmissions | Hospital readmissions were collected via patient self-report and via medical record review by a trained researcher from the study team. Patient readmission was coded as 0=not readmitted, 1=readmitted. Reported value for each cell reflects a model-based estimate of the probability of readmission, a type of least squares mean appropriate for a binary variable. | Participants were included in the analysis if they remained in the study through at least 1 month post-discharge. 82 participants did not have hospital readmissions data for at least the first month post-discharge. | Posted | Least Squares Mean | 95% Confidence Interval | Marginal predicted probability | 1 month post-discharge; 3 months post-discharge; 6 months post-discharge; Up to 7 months total |
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| Primary | Aim 2: Emergency Department Visits | Emergency department (ED) visits will be collected via patient self report. Patient ED usage was coded as 0=no ED visit, 1=any ED visit. Reported value for each cell reflects a model-based estimate of the probability of an ED visit, a type of least squares mean appropriate for a binary variable. | Participants were included in the analysis if they remained in the study through at least 1 month post-discharge. 82 participants did not have ED use data for at least the first month post-discharge. | Posted | Least Squares Mean | 95% Confidence Interval | Marginal predicted probability | 1 month post-discharge; 3 months post-discharge; 6 months post-discharge; Up to 7 months total |
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| Primary | Aim 2: Length of Hospital Stay | Length of hospital stay will be collected via patient medical record review by a nurse researcher from the study team. | Patients were included if they remained in the study through discharge. Length of hospital stay was unavailable for 54 patients. | Posted | Least Squares Mean | 95% Confidence Interval | days | During hospital stay in the Pre-Intervention and Post-Intervention periods |
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| Primary | Aim 2: Discharge Destination | Discharge destination (home, skilled nursing facility) was collected via patient medical record review by a nurse researcher from the study team. Patient discharge destination was coded as 1=discharged to home, 0=discharged to a skilled nursing facility. Reported value for each cell reflects a model-based estimate of the probability of discharge to home, a type of least squares mean appropriate for a binary variable. | Patients were included if they remained in the study through discharge. 60 patients were removed from the study prior to that point and did not provide discharge destination data. | Posted | Least Squares Mean | 95% Confidence Interval | Marginal predicted probability | Within 3 months post-discharge; Up to 4 months total |
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| Primary | Aim 3: Distance of Patient Ambulation | Unit level data on ambulation. Each week, the total distance walked on that unit by all patients on the unit was recorded. We report the average total weekly distance walked, using a model-based least squares mean. The number of participants analyzed is large because this measure is unit-level and includes all patients observed on the unit during the study period, not only those enrolled in the full study, and will double count patients who were observed during more than one week. | We report for each unit the sum of all weekly counts of participants observed during the study period. This will double count participants who were observed during more than one week. The unit of analysis is the unit-week, i.e. each data point reflects the total distance walked among all patients recorded by nursing staff during one week on a specific hospital unit. | Posted | Least Squares Mean | 95% Confidence Interval | feet | 6 months pre-intervention, during the 14-week intervention period, and 6 months post-intervention; up to 16 months total | weeks | weeks |
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| Primary | Aim 3: Barriers to Ambulation Survey | Data collected from enrolled nursing staff via paper copies or online link before and after the intervention. The Barriers to Patient Ambulation Survey assesses the nurses opinions regarding ambulation of hospitalized patients within the past 2 weeks. It is scored from 0-100 with higher scores indicating increased barriers to ambulation. | Some surveys were incomplete and did not provide data for this outcome. | Posted | Least Squares Mean | Standard Error | score on a scale | pre-intervention, post-intervention (up to about 20 weeks) | surveys submitted | surveys submitted |
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| Primary | Aim 3: Ambulation Culture Survey | Data collected from enrolled nursing staff via paper copies or online link before and after the intervention. The Ambulation Culture Survey asks for opinions on ambulation culture. We report responses to the item, "How would you rate your unit/work area on patient care related to ambulation?" This item has a minimum score of 1 (Poor) and a maximum score of 5 (Excellent). Higher values represent a better outcome. | Data for the Ambulation Culture Survey were not available for N=31 nursing staff members. | Posted | Mean | 95% Confidence Interval | score on a scale | pre-intervention, post-intervention (up to about 20 weeks) |
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| Secondary | Aim 3: Frequency of Patient Ambulation (Percent of Patients Ambulated by Nursing Staff) | Unit-level data on the percent of patients ambulated by nursing staff (as recorded in the electronic health record) out of the total number of ambulatory patients on the unit. | We report for each unit the sum of all weekly counts of participants observed during the study period. This will double count participants who were observed during more than one week. The unit of analysis is the unit-week, i.e. each data point reflects the percentage of participants that were ambulated by nursing staff, as recorded by nursing staff during that week on that hospital unit. | Posted | Number | 95% Confidence Interval | percentage of participants per week | 6 months pre-intervention, during the 14-week intervention period, and 6 months post-intervention; up to 16 months total | weeks | weeks |
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| Secondary | Aim 3: Nurse Fatigue Survey: Chronic Fatigue Subscale | Data collected from enrolled nursing staff via paper copies or online link before and after the intervention. The Nurse Fatigue Survey measures experience of fatigue and strain at work and home. It is a 15 item survey scored on a 7 point likert scale from 0 (strongly disagree) to 6 (strongly agree) with the 3 subscales of 5 questions each (chronic fatigue, acute fatigue and intershift recovery) scored separately. Items for each subscale are aggregated into a percent of the total highest possible points (30) resulting in a range of scores from 0-100%, higher scores indicate higher fatigue. | Posted | Least Squares Mean | 95% Confidence Interval | percentage of points on a scale | pre-intervention, post-intervention (up to about 20 weeks) |
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| Secondary | Aim 3: Nurse Fatigue Survey: Acute Fatigue Subscale | Data collected from enrolled nursing staff via paper copies or online link before and after the intervention. The Nurse Fatigue Survey measures experience of fatigue and strain at work and home. It is a 15 item survey scored on a 7 point likert scale from 0 (strongly disagree) to 6 (strongly agree) with the 3 subscales of 5 questions each (chronic fatigue, acute fatigue and intershift recovery) scored separately. Items for each subscale are aggregated into a percent of the total highest possible points (30) resulting in a range of scores from 0-100%, higher scores indicate higher fatigue. | Posted | Least Squares Mean | 95% Confidence Interval | percentage of points on a scale | pre-intervention, post-intervention (up to about 20 weeks) |
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| Secondary | Aim 3: Nurse Fatigue Survey: Intershift Recovery Subscale | Data collected from enrolled nursing staff via paper copies or online link before and after the intervention. The Nurse Fatigue Survey measures experience of fatigue and strain at work and home. It is a 15 item survey scored on a 7 point likert scale from 0 (strongly disagree) to 6 (strongly agree) with the 3 subscales of 5 questions each (chronic fatigue, acute fatigue and intershift recovery) scored separately. Items for each subscale are aggregated into a percent of the total highest possible points (30) resulting in a range of scores from 0-100%, higher scores indicate higher fatigue. | Posted | Least Squares Mean | 95% Confidence Interval | percentage of points on a scale | pre-intervention, post-intervention (up to about 20 weeks) |
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| Secondary | Aim 3: Professional Quality of Life Survey: Compassion Satisfaction | Data collected from enrolled nursing staff via paper copies or online link before and after the intervention. The Professional Quality of Life Survey measures positive and negative experiences within the last 30 days in a 30-item survey scored on a 5 point likert scale from 1 (never) to 5 (very often). The Compassion Satisfaction subscale has a range of scores from 10-50, with higher scores indicative of higher compassion satisfaction. Please note that for this subscale, scores were transformed before analysis using a Box-Cox (squared) transformation in order to meet the assumption of normally distributed model residuals; in effect the square-scale score has a range from 100-2500, where higher scores are still better. This results in reported least squares means that are very large compared to the original scale. | 340 nursing staff members completed all items on the Compassion Satisfaction subscale. | Posted | Least Squares Mean | 95% Confidence Interval | score on a scale, squared | pre-intervention, post-intervention (up to about 20 weeks) |
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| Secondary | Aim 3: Professional Quality of Life Survey: Burnout | Data collected from enrolled nursing staff via paper copies or online link before and after the intervention. The Professional Quality of Life Survey measures positive and negative experiences within the last 30 days in a 30-item survey scored on a 5 point likert scale from 1 (never) to 5 (very often). There are 3 subscales: Compassion Satisfaction, Burnout, and Secondary Traumatic Stress, each subscale has a range of scores from 10-50, with higher scores indicative of higher compassion satisfaction, higher burnout, and higher secondary traumatic stress. | 339 nursing staff members completed all items on the Burnout subscale. | Posted | Least Squares Mean | 95% Confidence Interval | score on a scale | pre-intervention, post-intervention (up to about 20 weeks) |
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| Secondary | Aim 3: Professional Quality of Life Survey: Secondary Traumatic Stress | Data collected from enrolled nursing staff via paper copies or online link before and after the intervention. The Professional Quality of Life Survey measures positive and negative experiences within the last 30 days in a 30-item survey scored on a 5 point likert scale from 1 (never) to 5 (very often). There are 3 subscales: Compassion Satisfaction, Burnout, and Secondary Traumatic Stress, each subscale has a range of scores from 10-50, with higher scores indicative of higher compassion satisfaction, higher burnout, and higher secondary traumatic stress. | 338 nursing staff members completed all items on the Secondary Traumatic Stress subscale. | Posted | Least Squares Mean | 95% Confidence Interval | score on a scale | pre-intervention, post-intervention (up to about 20 weeks) |
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| Other Pre-specified | Aim 3: Qualitative Assessment of Intervention Implementation | Enrolled nursing staff will be interviewed and interviews will be coded for themes. Themes will be summarized to report by participant count. | Not Posted | post-intervention (approximately 3-5 months after active intervention launch) | Participants |
| Other Pre-specified | Aim 2: Physical Therapy (PT) Utilization | Billing data will be used retrospectively to understand use of PT services on the intervention units at pre-intervention, intervention, and post-intervention data collection periods | Not Posted | 6 months pre-intervention, during the 14-week intervention period, and 6 months post-intervention; up to 16 months total | Participants |
| Other Pre-specified | Patient Satisfaction: Participant Experience Scores From 1-5 on HCAHPS | The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPHS) is a participant self-reported survey that measures patient satisfaction. Participants rank their hospital experience from 1-5, where 5 is the best possible experience. | Not Posted | 6 months pre-intervention, during the 14-week intervention period, and 6 months post-intervention; up to 16 months total | Participants |
| Other Pre-specified | Patient Satisfaction: Count of Participants With Responses to Strongly Disagree/Disagree/Agree/Strongly Agree Questions on HCAHPS | The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a participant self-reported survey that measures patient satisfaction. Reported here are the Participant Counts of Responses to Strongly disagree/Disagree/Agree/Strongly agree to the following questions: During this hospital stay, staff took my preferences and those of my family or caregiver into account in deciding what my health care needs would be when I left When I left the hospital, I had a good understanding of the things I was responsible for in managing my health When I left the hospital, I clearly understood the purpose for taking each of my medications Analysis will include shifts in the distribution of responses across response options, as well as changes in frequency/percentage of top-box responses (responses of "Strongly agree") relative to all responses. | Not Posted | 6 months pre-intervention, during the 14-week intervention period, and 6 months post-intervention; up to 16 months total | Participants |
| Other Pre-specified | Patient Satisfaction: Count of Participants With Satisfaction Responses to Definitely no/Probably no/Probably Yes/Definitely Yes to the Following Question: Would You Recommend This Hospital to Your Friends and Family? | The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a participant self-reported survey that measures patient satisfaction. Reported here are the Participant Counts With Satisfaction Responses to Definitely no/Probably no/Probably yes/Definitely yes to the following question: Would you recommend this hospital to your friends and family? Analysis will include shifts in the distribution of responses across response options, as well as changes in frequency/percentage of top-box responses (responses of "Definitely Yes") relative to all responses. | Not Posted | 6 months pre-intervention, during the 14-week intervention period, and 6 months post-intervention; up to 16 months total | Participants |
| Other Pre-specified | Patient Satisfaction: Hospital Experience Scores From 0-10 on HCAPHS | The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPHS) is a participant self-reported survey that measures patient satisfaction. Participants rank their hospital experience from 0-10, where 10 is the best possible hospital. | Not Posted | 6 months pre-intervention, during the 14-week intervention period, and 6 months post-intervention; up to 16 months total | Participants |
| Other Pre-specified | Patient Satisfaction: Where Participants Went After Hospitalization | The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPHS) is a participant self-reported survey that measures patient satisfaction. Reported here are the Participant Counts of whether they went home, to someone else's home, or another facility after discharge. | Not Posted | 6 months pre-intervention, during the 14-week intervention period, and 6 months post-intervention; up to 16 months total | Participants |
| Other Pre-specified | Patient Satisfaction: Count of Participants With Satisfaction Responses to Never, Sometimes, Usually, Always Questions on HCAHPS | Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a participant self-reported survey that measures patient satisfaction. Reported here are Participant Counts to questions with response options: Never, Sometimes, Usually, Always. Analysis will include shifts of distribution across response options and changes in frequency/percentage of top-box responses ("Always") relative to all responses. Questions include: During this hospital stay, how often did nurses treat you with courtesy and respect? how often did nurses listen carefully to you? how often did nurses explain things in a way you could understand? after you pressed the call button, how often did you get help as soon as you wanted it? how often were your room and bathroom kept clean? how often was the area around your room quiet at night? How often did you get help in getting to the bathroom or in using a bedpan as soon as you wanted? | Not Posted | 6 months pre-intervention, during the 14-week intervention period, and 6 months post-intervention; up to 16 months total | Participants |
| Other Pre-specified | Patient Satisfaction: Count of Participants Answering Yes to Items on the HCAPHS | The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPHS) is a participant self-reported survey that measures patient satisfaction. Reported here are the Participant Counts of those who answered "Yes" to the following Yes or No questions:
| Not Posted | 6 months pre-intervention, during the 14-week intervention period, and 6 months post-intervention; up to 16 months total | Participants |
| 16 |
| 188 |
| 0 |
| 188 |
| 0 |
| 188 |
| EG001 | Pre-Intervention Nursing Staff | These participants were nursing staff members who were eligible for enrollment and who enrolled in the study prior to the intervention. | 0 | 0 | 0 | 0 | 0 | 0 |
| EG002 | Post-Intervention Patients | These participants were hospital patients who were eligible for enrollment and who enrolled in the study after the intervention. | 13 | 199 | 0 | 199 | 0 | 199 |
| EG003 | Post-Intervention Nursing Staff | These participants were nursing staff members who were eligible for enrollment and who enrolled in the study after the intervention. | 0 | 0 | 0 | 0 | 0 | 0 |
Not provided
Not provided
| D011787 | Quality of Health Care |
| D017530 | Health Care Quality, Access, and Evaluation |
| D011634 | Public Health |
| D004778 | Environment and Public Health |
| Missing |
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| Within 8 hours of hospital discharge |
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| 1 month post-discharge |
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| 3 months post-discharge |
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| 6 months post-discharge |
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| Superiority |
| We conducted a planned comparison of Pre-Intervention and Post-Intervention Patient Katz ADLs at 1 Month Post-Discharge. Katz ADLs were modeled as a binary variable. | Mixed Models Analysis | A generalized linear mixed model was fit with a binary outcome and a logit link. Patients were propensity-weighted by demographic and health factors. | 0.644 | The p-value is not adjusted for multiple comparisons. Significance tests on parameter estimates adjusted for unit- and person-level clusters. | Pairwise marginal prediction contrast | 0.39 | Standard Error of the Mean | 0.84 | 2-Sided | 95 | -1.25 | 2.03 | The estimate reflects the following contrast: (Log-odds of Independence for Post-Intervention Patients at 1 Month Post-Discharge - Log-odds of Independence for Pre-Intervention Patients at 1 Month Post-Discharge). | Superiority |
| We conducted a planned comparison of Pre-Intervention and Post-Intervention Patient Katz ADLs at 3 Months Post-Discharge. Katz ADLs were modeled as a binary variable. | Mixed Models Analysis | A generalized linear mixed model was fit with a binary outcome and a logit link. Patients were propensity-weighted by demographic and health factors. | 0.067 | The p-value is not adjusted for multiple comparisons. Significance tests on parameter estimates adjusted for unit- and person-level clusters. | Pairwise marginal prediction contrast | 1.72 | Standard Error of the Mean | 0.94 | 2-Sided | 95 | -0.12 | 3.56 | The estimate reflects the following contrast: (Log-odds of Independence for Post-Intervention Patients at 3 Months Post-Discharge - Log-odds of Independence for Pre-Intervention Patients at 3 Months Post-Discharge). | Superiority |
| We conducted a planned comparison of Pre-Intervention and Post-Intervention Patient Katz ADLs at 6 Months Post-Discharge. Katz ADLs were modeled as a binary variable. | Mixed Models Analysis | A generalized linear mixed model was fit with a binary outcome and a logit link. Patients were propensity-weighted by demographic and health factors. | 0.142 | The p-value is not adjusted for multiple comparisons. Significance tests on parameter estimates adjusted for unit- and person-level clusters. | Pairwise marginal prediction contrast | 1.49 | Standard Error of the Mean | 1.02 | 2-Sided | 95 | -0.50 | 3.48 | The estimate reflects the following contrast: (Log-odds of Independence for Post-Intervention Patients at 6 Months Post-Discharge - Log-odds of Independence for Pre-Intervention Patients at 6 Months Post-Discharge). | Superiority |
| We conducted a planned contrast of change in the probability of independence from Baseline to Discharge in the Pre-Intervention Patient and Post-Intervention Patient groups. The null hypothesis is that the two groups showed equivalent change in the probability of independence. | Mixed Models Analysis | A generalized linear mixed model was fit with a binary outcome and a logit link. Patients were propensity-weighted by demographic and health factors. | 0.527 | The p-value is not adjusted for multiple comparisons. Significance tests on parameter estimates adjusted for unit- and person-level clusters. | Difference-in-differences contrast test | 0.31 | Standard Error of the Mean | 0.49 | 2-Sided | 95 | -0.65 | 1.28 | The estimate reflects the following contrast: (Pre-Intervention Patients at Discharge - Pre-Intervention Patients at Baseline) - (Post-Intervention Patients at Discharge - Post-Intervention Patients at Baseline) | Superiority |
| We conducted a planned contrast of change in the probability of independence from Baseline to 1 Month Post-Discharge in the Pre-Intervention Patient and Post-Intervention Patient groups. The null hypothesis is that the two groups showed equivalent change in the probability of independence. | Mixed Models Analysis | A generalized linear mixed model was fit with a binary outcome and a logit link. Patients were propensity-weighted by demographic and health factors. | 0.795 | The p-value is not adjusted for multiple comparisons. Significance tests on parameter estimates adjusted for unit- and person-level clusters. | Difference-in-differences contrast test | -0.14 | Standard Error of the Mean | 0.54 | 2-Sided | 95 | -1.19 | 0.91 | The estimate reflects the following contrast: (Pre-Intervention Patients at 1 Month - Pre-Intervention Patients at Baseline) - (Post-Intervention Patients at 1 Month - Post-Intervention Patients at Baseline) | Superiority |
| We conducted a planned contrast of change in the probability of independence from Baseline to 3 Months Post-Discharge in the Pre-Intervention Patient and Post-Intervention Patient groups. The null hypothesis is that the two groups showed equivalent change in the probability of independence. | Mixed Models Analysis | A generalized linear mixed model was fit with a binary outcome and a logit link. Patients were propensity-weighted by demographic and health factors. | 0.075 | The p-value is not adjusted for multiple comparisons. Significance tests on parameter estimates adjusted for unit- and person-level clusters. | Difference-in-differences contrast test | 1.20 | Standard Error of the Mean | 0.67 | 2-Sided | 95 | -0.12 | 2.51 | The estimate reflects the following contrast: (Pre-Intervention Patients at 3 Months - Pre-Intervention Patients at Baseline) - (Post-Intervention Patients at 3 Months - Post-Intervention Patients at Baseline) | Superiority |
| We conducted a planned contrast of change in the probability of independence from Baseline to 6 Months Post-Discharge in the Pre-Intervention Patient and Post-Intervention Patient groups. The null hypothesis is that the two groups showed equivalent change in the probability of independence. | Mixed Models Analysis | A generalized linear mixed model was fit with a binary outcome and a logit link. Patients were propensity-weighted by demographic and health factors. | 0.201 | The p-value is not adjusted for multiple comparisons. Significance tests on parameter estimates adjusted for unit- and person-level clusters. | Difference-in-differences contrast test | 0.97 | Standard Error of the Mean | 0.76 | 2-Sided | 95 | -0.51 | 2.45 | The estimate reflects the following contrast: (Pre-Intervention Patients at 6 Months - Pre-Intervention Patients at Baseline) - (Post-Intervention Patients at 6 Months - Post-Intervention Patients at Baseline) | Superiority |
| 3 months post-discharge |
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| 6 months post-discharge |
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| Superiority |
| We conducted a planned comparison of Pre-Intervention and Post-Intervention Patient Life Space Analysis at 3 Months Post-Discharge. | Mixed Models Analysis | Patients were propensity-weighted by demographics (age/sex/race), health (BMI, mobility aid, comorbidities), and hospital factors (lines, alarms). | 0.576 | The p-value is not adjusted for multiple comparisons. Standard errors on parameter estimates adjusted for unit- and person-level clusters. | Pairwise marginal prediction contrast | 2.5 | Standard Error of the Mean | 4.4 | 2-Sided | 95 | -6.1 | 11.1 | The estimate reflects the following contrast: (Life Space Analysis for Post-Intervention Patients at 3 Months Post-Discharge - (Life Space Analysis for Pre-Intervention Patients at 3 Months Post-Discharge). | Superiority |
| We conducted a planned comparison of Pre-Intervention and Post-Intervention Patient Life Space Analysis at 6 Months Post-Discharge. | Mixed Models Analysis | Patients were propensity-weighted by demographics (age/sex/race), health (BMI, mobility aid, comorbidities), and hospital factors (lines, alarms). | 0.635 | The p-value is not adjusted for multiple comparisons. Standard errors on parameter estimates adjusted for unit- and person-level clusters. | Pairwise marginal prediction contrast | 1.9 | Standard Error of the Mean | 4.1 | 2-Sided | 95 | -6.0 | 9.9 | The estimate reflects the following contrast: (Life Space Analysis for Post-Intervention Patients at 6 Months Post-Discharge - (Life Space Analysis for Pre-Intervention Patients at 6 Months Post-Discharge). | Superiority |
| We conducted a planned contrast of change in Life Space Assessment scores from Baseline to 1 Month Post-Discharge in the Pre-Intervention Patient and Post-Intervention Patient groups. The null hypothesis is that the two groups showed equivalent change. | Mixed Models Analysis | Patients were propensity-weighted by demographics (age/sex/race), health (BMI, mobility aid, comorbidities), and hospital factors (lines, alarms). | 0.488 | The p-value is not adjusted for multiple comparisons. Standard errors on parameter estimates adjusted for unit- and person-level clusters. | Difference-in-differences contrast test | -4.0 | Standard Error of the Mean | 5.8 | 2-Sided | 95 | -15.4 | 7.3 | The estimate reflects the following contrast: (Pre-Intervention Patients at 1 Month - Pre-Intervention Patients at Baseline) - (Post-Intervention Patients at 1 Month - Post-Intervention Patients at Baseline) | Superiority |
| We conducted a planned contrast of change in Life Space Assessment scores from Baseline to 3 Months Post-Discharge in the Pre-Intervention Patient and Post-Intervention Patient groups. The null hypothesis is that the two groups showed equivalent change. | Mixed Models Analysis | Patients were propensity-weighted by demographics (age/sex/race), health (BMI, mobility aid, comorbidities), and hospital factors (lines, alarms). | 0.407 | The p-value is not adjusted for multiple comparisons. Standard errors on parameter estimates adjusted for unit- and person-level clusters. | Difference-in-differences contrast test | -3.4 | Standard Error of the Mean | 4.0 | 2-Sided | 95 | -11.3 | 4.6 | The estimate reflects the following contrast: (Pre-Intervention Patients at 3 Months - Pre-Intervention Patients at Baseline) - (Post-Intervention Patients at 3 Months - Post-Intervention Patients at Baseline) | Superiority |
| We conducted a planned contrast of change in Life Space Assessment scores from Baseline to 6 Months Post-Discharge in the Pre-Intervention Patient and Post-Intervention Patient groups. The null hypothesis is that the two groups showed equivalent change. | Mixed Models Analysis | Patients were propensity-weighted by demographics (age/sex/race), health (BMI, mobility aid, comorbidities), and hospital factors (lines, alarms). | 0.097 | The p-value is not adjusted for multiple comparisons. Standard errors on parameter estimates adjusted for unit- and person-level clusters. | Difference-in-differences contrast test | -3.9 | Standard Error of the Mean | 2.3 | 2-Sided | 95 | -8.5 | 0.7 | The estimate reflects the following contrast: (Pre-Intervention Patients at 6 Months - Pre-Intervention Patients at Baseline) - (Post-Intervention Patients at 6 Months - Post-Intervention Patients at Baseline) | Superiority |
| 3 months post-discharge |
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| 6 months post-discharge |
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| Superiority |
| We conducted a planned comparison of Pre-Intervention and Post-Intervention Hospital Readmissions at 3 Months Post-Discharge. | Random-effects logistic regression | Patients were propensity-weighted by demographics (age/sex/race), health (BMI, mobility aid, comorbidities), and hospital factors (lines, alarms). | 0.804 | The p-value is not adjusted for multiple comparisons. Standard errors on parameter estimates adjusted for person-level clusters. Hierarchical model incorporating unit did not converge and so unit level was removed. | Pairwise marginal prediction contrast | -0.077 | Standard Error of the Mean | 0.309 | 2-Sided | 95 | -0.683 | 0.530 | The estimate reflects the following contrast: (Hospital Readmissions for Post-Intervention Patients at 3 Months Post-Discharge - (Hospital Readmissions for Pre-Intervention Patients at 3 Months Post-Discharge). | Superiority |
| We conducted a planned comparison of Pre-Intervention and Post-Intervention Hospital Readmissions at 6 Months Post-Discharge. | Random-effects logistic regression | Patients were propensity-weighted by demographics (age/sex/race), health (BMI, mobility aid, comorbidities), and hospital factors (lines, alarms). | 0.739 | The p-value is not adjusted for multiple comparisons. Standard errors on parameter estimates adjusted for person-level clusters. Hierarchical model incorporating unit did not converge and so unit level was removed. | Pairwise marginal prediction contrast | 0.104 | Standard Error of the Mean | 0.312 | 2-Sided | 95 | -0.507 | 0.716 | Superiority | The estimate reflects the following contrast: (Hospital Readmissions for Post-Intervention Patients at 6 Months Post-Discharge - (Hospital Readmissions for Pre-Intervention Patients at 6 Months Post-Discharge). |
| 3 months post-discharge |
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| 6 months post-discharge |
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| Superiority |
| We conducted a planned comparison of Pre-Intervention and Post-Intervention Emergency Department Use at 3 Months Post-Discharge. | Random-effects logistic regression | Patients were propensity-weighted by demographics (age/sex/race), health (BMI, mobility aid, comorbidities), and hospital factors (lines, alarms). | 0.558 | The p-value is not adjusted for multiple comparisons. Standard errors on parameter estimates adjusted for person-level clusters. Hierarchical model incorporating unit did not converge and so unit level was removed. | Pairwise marginal prediction contrast | 0.183 | Standard Error of the Mean | 0.312 | 2-Sided | 95 | -0.428 | 0.794 | The estimate reflects the following contrast: (Emergency Department Usage for Post-Intervention Patients at 3 Months Post-Discharge - (Emergency Department Usage for Pre-Intervention Patients at 3 Months Post-Discharge). | Superiority |
| We conducted a planned comparison of Pre-Intervention and Post-Intervention Emergency Department Use at 6 Months Post-Discharge. | Random-effects logistic regression | Patients were propensity-weighted by demographics (age/sex/race), health (BMI, mobility aid, comorbidities), and hospital factors (lines, alarms). | 0.528 | The p-value is not adjusted for multiple comparisons. Standard errors on parameter estimates adjusted for person-level clusters. Hierarchical model incorporating unit did not converge and so unit level was removed. | Pairwise marginal prediction contrast | 0.196 | Standard Error of the Mean | 0.310 | 2-Sided | 95 | -0.412 | 0.804 | The estimate reflects the following contrast: (Emergency Department Usage for Post-Intervention Patients at 6 Months Post-Discharge - (Emergency Department Usage for Pre-Intervention Patients at 6 Months Post-Discharge). | Superiority |
| Superiority |
The estimate reflects the following comparison: (Destination for Post-Intervention Patients at Discharge - Destination for Pre-Intervention Patients at Discharge).
| Superiority |
| weeks |
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| Active Intervention |
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| Maintenance (over 6 months) |
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The direction of the comparison is post-treatment vs pre-treatment. |
| Superiority |
| An Interrupted Time Series Analysis (ITSA) was conducted to evaluate the effect of the intervention on the total distance ambulated per week, across combined units (Huitema & McKean, 2000; Linden & Adams, 2011; Linden, 2015). For this test we report the p-value for the parameter β4 that estimates the immediate effect of withdrawing the intervention. The null hypothesis was β4=0. | Interrupted Time Series Analysis | Significance tests on parameter estimates used Newey-West heteroskedasticity-consistent (robust) standard errors and adjusted for unit-level clusters. | 0.937 | The p-value was not adjusted for multiple comparisons. | Instantaneous cessation effect | -695.95 | Standard Error of the Mean | 1837.71 | 2-Sided | 95 | -4297.79 | 2905.90 | The direction of the comparison is post-treatment-offset vs pre-treatment-offset. | Superiority |
| Superiority |
| Superiority |
| weeks |
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| Active Intervention |
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| Maintenance (over 6 months) |
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The direction of the comparison is post-treatment vs pre-treatment. |
| Superiority |
| An Interrupted Time Series Analysis (ITSA) was conducted to evaluate the effect of the intervention on the percent of patients ambulated per week, across combined units (Huitema & McKean, 2000; Linden & Adams, 2011; Linden, 2015). For this test we report the p-value for the parameter β4 that estimates the immediate effect of withdrawing the intervention. The null hypothesis was β4=0. | Interrupted Time Series Analysis | Significance tests on parameter estimates used Newey-West heteroskedasticity-consistent (robust) standard errors and adjusted for unit-level clusters. | .038 | The p-value was not adjusted for multiple comparisons. | Instantaneous cessation effect | -5.49 | Standard Error of the Mean | 2.64 | 2-Sided | 95 | -10.67 | -0.31 | The direction of the comparison is post-treatment vs pre-treatment. | Superiority |
| Superiority |
| Superiority |
| Superiority |
The direction of the comparison is post-treatment vs pre-treatment. The magnitude of this estimate is large because the input scores were transformed.
| Superiority |
| Superiority |
| Superiority |