Annually, more than 35 million patients are hospitalized in the United States. Many of these will experience hospital-acquired loss of physical functioning due to a lack of mobility during their in-patient stay. Such loss includes difficulties performing basic activities, such as rising from a chair, toileting, or ambulating. This loss of function may increase hospital length of stay (LOS), nursing home placement, and decrease mobility and participation in community activities even years after hospitalization. Prevention of this hospital-acquired functional loss is critical. Even the sickest hospitalized patients (e.g., those in the intensive care unit \[ICU\]), can safely and feasibly benefit from early mobilization. In the non-ICU setting there is evidence that patient mobilization reduces LOS and hospital costs, while improving patient satisfaction and physical and psychological outcomes. The overall objective of this proposed project is to evaluate the implementation and impact of a transdisciplinary and multifaceted mobility program (Johns Hopkins Activity and Mobility Promotion - AMP) on clinical outcomes among hospitalized adults. In addition to clinical outcomes, we will identify barriers and facilitators to high-performance program adoption. Results of this project will provide critical new insights on the effectiveness of AMP and inform dissemination and implementation nationwide.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
16,676
Each study site will implement the Johns Hopkins AMP program at different times. The AMP program includes nursing staff training on the goals of AMP, how to complete mobility-focused outcome measures, set mobility goals, and to safely mobilize/ambulate patients. The AMP program also includes embedding these outcome measures and mobility goals into electronic medical records and producing weekly/monthly reports that show how often nursing staff score patient mobility and help patients meet daily activity goals.
Johns Hopkins Hospital
Baltimore, Maryland, United States
% of patients meeting daily mobility goal
Mobility goal is set and measured using the Johns Hopkins Highest Level of Mobility (JH-HLM) Scale
Time frame: 39 months
% of patients with mobility measurements documented daily
Mobility documentation to include Activity Measure for Post-Acute Care (AM-PAC) and JH-HLM
Time frame: 39 months
% of patients receiving physical and/or occupational therapy consults
To be extracted from electronic medical record
Time frame: 39 months
Hospital length of stay (days)
To be extracted from electronic medical record
Time frame: 39 months
Discharge disposition status
Count of where patients are discharged to (e.g,. home, inpatient rehab unit) assessed by extraction from electronic medical record.
Time frame: 39 months
Number of physical and occupational therapy visits received during inpatient stay
To be extracted from electronic medical record
Time frame: 39 months
Number of hospital-acquired morbidities
Includes falls, pressure injury, and venous thromboembolism. To be extracted from electronic medical record
Time frame: 39 months
Number of patients with 30-day readmissions
To be extracted from electronic medical record
Time frame: 39 months
Employee injuries resulting from patient mobilization
Number of employee injuries from facilitating patient mobility as assessed by medical record extraction
Time frame: 39 months
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