Initiative To Promote a Culture of Mobility in Hospitals Yields Encouraging Results

August 21, 2020

New Care Delivery Model Designed To Promote Mobility Improvement

Cambridge, MA – Hospitals nationwide participate in effort to improve outcomes for older hospitalized patients. Immobility during hospitalization contributes to poor patient outcomes, yet many hospitals routinely use bed and chair alarms that discourage mobility as part of their fall prevention programs. This approach often confines older adults to their beds throughout their hospital stay, putting them at increased risk of falls, delirium, pressure ulcers, functional decline, increased healthcare costs and death.

In a paper published in the Journal of the American Geriatrics Society, lead author Songprod Jonathan Lorgunpai, MD, Geriatrician at Mount Auburn Hospital and Instructor in Medicine at Harvard Medical School, and colleagues report on an initiative designed to enhance implementation of hospital mobility programs aimed at improving quality of care and outcomes for older adults.

Working with the Center for Medicare & Medicaid Innovation (CMMI), the team developed a new care delivery model designed to promote quality improvement related to mobility in hospitals participating in CMMI’s bundled payment programs. The Mobility Action Group (MACT) Change Package provided more than 40 participating hospitals across the United States with an innovative framework of peer support, expert faculty, and resources to create a successful culture of mobility in the care of hospitalized older adults.

“The overarching goal of the initiative was to improve mobility and decrease use of bed and chair alarms with hospitalized older adults,” said Lorgunpai, who is also the Mount Auburn Hospital Site Director for the Harvard Multi-Campus Geriatric Medicine Fellowship Program. “The Mobility Action Group (MACT) Change Package provides a conceptual framework, roadmap, and step-by-step guide to help hospital mobility teams set and meet their mobilization goals.”

As part of the resources provided through the program, nine learning sessions were held via webinar between April 27 and October 5, 2017 to provide foundational concepts and to address questions posed by participants. Discussion topics included forming and sustaining mobility teams; reducing use of chair and bed alarms; using volunteers and professional staff to assist in mobility support; educating patients and families about the importance of mobility; and measuring patient outcomes.

Seventy-six percent of participating sites in medical, surgical, and intensive care units successfully implemented mobility programs, with 43 percent of mobility programs fully implemented and an additional 33 percent partially implemented by the end of the active initiative. Fifty-four percent reported a high likelihood that their mobility program would continue long-term. There was a more than twofold increase in the proportion of patients who received at least three walks per day and a 1.8-fold reduction in the use of bed or chair alarms across sites.

“The Change Package was an essential tool and starting point for each hospital, while the peer support and assistance they received through the group meetings proved to be another key factor in their success,” said study senior author Sharon K. Inouye, MD, MPH, Director of the Aging Brain Center in the Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife.

“I’m very encouraged by the results of this effort,” said Lorgunpai. “While additional research is needed to determine if this approach can improve patient outcomes such as decreased falls, functional decline, and readmissions, this initiative demonstrates that emphasizing system-wide change through a flexible approach can catalyze a culture of mobility in hospitals and improve care of older adults.”

Additional co-authors include Bruce Finke, Isaac Burrows and Shari M. Ling of the Centers for Medicare and Medicaid Services, Cynthia J. Brown of the University of Alabama at Birmingham, Fred H. Rubin of the University of Pittsburgh Medical Center Shadyside, Heidi R. Wierman of Maine Medical Center, Susan J. Heisey of Inova Health System, Sarah Gartaganis of Hebrew SeniorLife, and Matthew Press of the University of Pennsylvania Health System.

This work was supported in part by the Health and Aging Policy Fellowship, and by technical support from the Hospital Elder Life Program. Inouye’s time was supported in part by grants no. R24AG054259 (SKI), K07AG041835 (SKI) from the National Institute on Aging, and by the Milton and Shirley F. Levy Family Chair at Hebrew SeniorLife/Harvard Medical School.

About Mount Auburn Hospital

Mount Auburn Hospital was founded in 1886. A teaching hospital of Harvard Medical School, its mission is to provide clinically excellent care with compassion and to teach students of medicine and the health professions.

Mount Auburn Hospital is a part of Beth Israel Lahey Health, a healthcare system that brings together academic medical centers and teaching hospitals, community and specialty hospitals, more than 4,700 physicians and 39,000 employees in a shared mission to expand access to great care and advance the science and practice of medicine through groundbreaking research and education.

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