Outcomes of Mobilisation of Vulnerable Elders in Ontario (MOVE ON): a multisite interrupted time series evaluation of an implementation intervention to increase patient mobilisation

Barbara Liu; Julia E Moore; Ummukulthum Almaawiy; Wai-Hin Chan; Sobia Khan; Joycelyne Ewusie; Jemila S Hamid; Sharon E Straus; MOVE ON Collaboration

doi:10.1093/ageing/afx128

Outcomes of Mobilisation of Vulnerable Elders in Ontario (MOVE ON): a multisite interrupted time series evaluation of an implementation intervention to increase patient mobilisation

Age Ageing. 2018 Jan 1;47(1):112-119. doi: 10.1093/ageing/afx128.

Authors

Barbara Liu^{1

2}, Julia E Moore³, Ummukulthum Almaawiy¹, Wai-Hin Chan³, Sobia Khan³, Joycelyne Ewusie⁴, Jemila S Hamid^{3

4}, Sharon E Straus^{2

3}; MOVE ON Collaboration

Affiliations

¹ Regional Geriatric Program of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
² Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
³ Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
⁴ McMaster University, Ontario, Canada.

Abstract

Background: older patients admitted to hospitals are at risk for hospital-acquired morbidity related to immobility. The aim of this study was to implement and evaluate an evidence-based intervention targeting staff to promote early mobilisation in older patients admitted to general medical inpatient units.

Methods: the early mobilisation implementation intervention for staff was multi-component and tailored to local context at 14 academic hospitals in Ontario, Canada. The primary outcome was patient mobilisation. Secondary outcomes included length of stay (LOS), discharge destination, falls and functional status. The targeted patients were aged ≥ 65 years and admitted between January 2012 and December 2013. The intervention was evaluated over three time periods-pre-intervention, during and post-intervention using an interrupted time series design.

Results: in total, 12,490 patients (mean age 80.0 years [standard deviation 8.36]) were included in the overall analysis. An increase in mobilisation was observed post-intervention, where significantly more patients were out of bed daily (intercept difference = 10.56%, 95% CI: [4.94, 16.18]; P < 0.001) post-intervention compared to pre-intervention. Hospital median LOS was significantly shorter during the intervention period (intercept difference = -3.45 days, 95% CI: [-6.67,-0.23], P = 0.0356) compared to pre-intervention. It continued to decrease post-intervention with significantly fewer days in hospital (intercept difference= -6.1, 95% CI: [-11,-1.2]; P = 0.015) in the post-intervention period compared to pre-intervention.

Conclusions: this is a large-scale study evaluating an implementation strategy for early mobilisation in older, general medical inpatients. The positive outcome of this simple intervention on an important functional goal of getting more patients out of bed is a striking success for improving care for hospitalised older patients.

Keywords: acute care hospital; frail; implementation; mobilisation; older people.

Publication types

Multicenter Study
Pragmatic Clinical Trial
Research Support, Non-U.S. Gov't

MeSH terms

Accidental Falls / prevention & control
Age Factors
Aged
Aged, 80 and over
Aging*
Early Ambulation / methods*
Exercise*
Female
Geriatric Assessment
Hospitals, University
Humans
Interrupted Time Series Analysis
Length of Stay
Male
Ontario
Patient Admission*
Patient Discharge
Time Factors
Treatment Outcome
Vulnerable Populations*