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Evaluation of strategies to support implementation of a hospital walking program: protocol for a type III effectiveness-implementation hybrid trial.

Publication ,  Journal Article
Kappler, CB; Coffman, CJ; Stechuchak, KM; Choate, A; Meyer, C; Zullig, LL; Hughes, JM; Drake, C; Sperber, NR; Kaufman, BG; Van Houtven, CH ...
Published in: Implement Sci Commun
January 12, 2024

BACKGROUND: STRIDE is a supervised walking program designed to address the negative consequences of immobility during hospitalization for older adults. In an 8-hospital stepped wedge randomized controlled trial, STRIDE was associated with reduced odds of hospital discharge to skilled nursing facility. STRIDE has the potential to become a system-wide approach to address hospital-associated disability in Veteran's Affairs; however, critical questions remain about how best to scale and sustain the program. The overall study goal is to compare the impact of two strategies on STRIDE program penetration (primary), fidelity, and adoption implementation outcomes. METHODS: Replicating Effective Programs will be used as a framework underlying all implementation support activities. In a parallel, cluster randomized trial, we will use stratified blocked randomization to assign hospitals (n = 32) to either foundational support, comprised of standard, low-touch activities, or enhanced support, which includes the addition of tailored, high-touch activities if hospitals do not meet STRIDE program benchmarks at 6 and 8 months following start date. All hospitals begin with foundational support for 6 months until randomization occurs. The primary outcome is implementation penetration defined as the proportion of eligible hospitalizations with ≥ 1 STRIDE walks at 10 months. Secondary outcomes are fidelity and adoption with all implementation outcomes additionally examined at 13 and 16 months. Fidelity will be assessed for STRIDE hospitalizations as the percentage of eligible hospital days with "full dose" of the program, defined as two or more documented walks or one walk for more than 5 min. Program adoption is a binary outcome defined as ≥ 5 patients with a STRIDE walk or not. Analyses will also include patient-level effectiveness outcomes (e.g., discharge to nursing home, length of stay) and staffing and labor costs. We will employ a convergent mixed-methods approach to explore and understand pre-implementation contextual factors related to differences in hospital-level adoption. DISCUSSION: Our study results will dually inform best practices for promoting successful implementation of an evidence-based hospital-based walking program. This information may support other programs by advancing our understanding of how to apply and scale-up national implementation strategies. TRIAL REGISTRATION: This study was registered on June 1, 2021, at ClinicalTrials.gov (identifier NCT04868656 ).

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Published In

Implement Sci Commun

DOI

EISSN

2662-2211

Publication Date

January 12, 2024

Volume

5

Issue

1

Start / End Page

8

Location

England

Related Subject Headings

  • 4206 Public health
  • 4203 Health services and systems
 

Citation

APA
Chicago
ICMJE
MLA
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Kappler, C. B., Coffman, C. J., Stechuchak, K. M., Choate, A., Meyer, C., Zullig, L. L., … Hastings, S. N. (2024). Evaluation of strategies to support implementation of a hospital walking program: protocol for a type III effectiveness-implementation hybrid trial. Implement Sci Commun, 5(1), 8. https://doi.org/10.1186/s43058-024-00544-5
Kappler, Caitlin B., Cynthia J. Coffman, Karen M. Stechuchak, Ashley Choate, Cassie Meyer, Leah L. Zullig, Jaime M. Hughes, et al. “Evaluation of strategies to support implementation of a hospital walking program: protocol for a type III effectiveness-implementation hybrid trial.Implement Sci Commun 5, no. 1 (January 12, 2024): 8. https://doi.org/10.1186/s43058-024-00544-5.
Kappler CB, Coffman CJ, Stechuchak KM, Choate A, Meyer C, Zullig LL, et al. Evaluation of strategies to support implementation of a hospital walking program: protocol for a type III effectiveness-implementation hybrid trial. Implement Sci Commun. 2024 Jan 12;5(1):8.
Kappler, Caitlin B., et al. “Evaluation of strategies to support implementation of a hospital walking program: protocol for a type III effectiveness-implementation hybrid trial.Implement Sci Commun, vol. 5, no. 1, Jan. 2024, p. 8. Pubmed, doi:10.1186/s43058-024-00544-5.
Kappler CB, Coffman CJ, Stechuchak KM, Choate A, Meyer C, Zullig LL, Hughes JM, Drake C, Sperber NR, Kaufman BG, Van Houtven CH, Allen KD, Hastings SN. Evaluation of strategies to support implementation of a hospital walking program: protocol for a type III effectiveness-implementation hybrid trial. Implement Sci Commun. 2024 Jan 12;5(1):8.

Published In

Implement Sci Commun

DOI

EISSN

2662-2211

Publication Date

January 12, 2024

Volume

5

Issue

1

Start / End Page

8

Location

England

Related Subject Headings

  • 4206 Public health
  • 4203 Health services and systems