Effects of Implementation of a Supervised Walking Program in Veterans Affairs Hospitals : A Stepped-Wedge, Cluster Randomized Trial
dc.contributor.author | Hastings, Susan N. | |
dc.contributor.author | Stechuchak, Karen M. | |
dc.contributor.author | Choate, Ashley | |
dc.contributor.author | Van Houtven, Courtney Harold | |
dc.contributor.author | Allen, Kelli D. | |
dc.contributor.author | Wang, Virginia | |
dc.contributor.author | Colón-Emeric, Cathleen | |
dc.contributor.author | Jackson, George L. | |
dc.contributor.author | Damush, Teresa M. | |
dc.contributor.author | Meyer, Cassie | |
dc.contributor.author | Kappler, Caitlin B. | |
dc.contributor.author | Hoenig, Helen | |
dc.contributor.author | Sperber, Nina | |
dc.contributor.author | Coffman, Cynthia J. | |
dc.contributor.department | Medicine, School of Medicine | |
dc.date.accessioned | 2024-05-14T18:51:13Z | |
dc.date.available | 2024-05-14T18:51:13Z | |
dc.date.issued | 2023 | |
dc.description.abstract | Background: In trials, hospital walking programs have been shown to improve functional ability after discharge, but little evidence exists about their effectiveness under routine practice conditions. Objective: To evaluate the effect of implementation of a supervised walking program known as STRIDE (AssiSTed EaRly MobIlity for HospitalizeD VEterans) on discharge to a skilled-nursing facility (SNF), length of stay (LOS), and inpatient falls. Design: Stepped-wedge, cluster randomized trial. (ClinicalTrials.gov: NCT03300336). Setting: 8 Veterans Affairs hospitals from 20 August 2017 to 19 August 2019. Patients: Analyses included hospitalizations involving patients aged 60 years or older who were community dwelling and admitted for 2 or more days to a participating medicine ward. Intervention: Hospitals were randomly assigned in 2 stratified blocks to a launch date for STRIDE. All hospitals received implementation support according to the Replicating Effective Programs framework. Measurements: The prespecified primary outcomes were discharge to a SNF and hospital LOS, and having 1 or more inpatient falls was exploratory. Generalized linear mixed models were fit to account for clustering of patients within hospitals and included patient-level covariates. Results: Patients in pre-STRIDE time periods (n = 6722) were similar to post-STRIDE time periods (n = 6141). The proportion of patients with any documented walk during a potentially eligible hospitalization ranged from 0.6% to 22.7% per hospital. The estimated rates of discharge to a SNF were 13% pre-STRIDE and 8% post-STRIDE. In adjusted models, odds of discharge to a SNF were lower among eligible patients hospitalized in post-STRIDE time periods (odds ratio [OR], 0.6 [95% CI, 0.5 to 0.8]) compared with pre-STRIDE. Findings were robust to sensitivity analyses. There were no differences in LOS (rate ratio, 1.0 [CI, 0.9 to 1.1]) or having an inpatient fall (OR, 0.8 [CI, 0.5 to 1.1]). Limitation: Direct program reach was low. Conclusion: Although the reach was limited and variable, hospitalizations occurring during the STRIDE hospital walking program implementation period had lower odds of discharge to a SNF, with no change in hospital LOS or inpatient falls. | |
dc.eprint.version | Author's manuscript | |
dc.identifier.citation | Hastings SN, Stechuchak KM, Choate A, et al. Effects of Implementation of a Supervised Walking Program in Veterans Affairs Hospitals : A Stepped-Wedge, Cluster Randomized Trial [published correction appears in Ann Intern Med. 2023 Nov;176(11):1575]. Ann Intern Med. 2023;176(6):743-750. doi:10.7326/M22-3679 | |
dc.identifier.uri | https://hdl.handle.net/1805/40740 | |
dc.language.iso | en_US | |
dc.publisher | American College of Physicians | |
dc.relation.isversionof | 10.7326/M22-3679 | |
dc.relation.journal | Annals of Internal Medicine | |
dc.rights | Publisher Policy | |
dc.source | PMC | |
dc.subject | Hospitalization | |
dc.subject | Hospitals | |
dc.subject | Length of stay | |
dc.subject | Patient discharge | |
dc.subject | Veterans | |
dc.title | Effects of Implementation of a Supervised Walking Program in Veterans Affairs Hospitals : A Stepped-Wedge, Cluster Randomized Trial | |
dc.type | Article |