The business case for hospital mobility programs in the veterans health care system: Results from multi-hospital implementation of the STRIDE program

Brystana G Kaufman; S Nicole Hastings; Cassie Meyer; Karen M Stechuchak; Ashley Choate; Kasey Decosimo; Caitlin Sullivan; Virginia Wang; Kelli D Allen; Courtney H Van Houtven

doi:10.1111/1475-6773.14307

The business case for hospital mobility programs in the veterans health care system: Results from multi-hospital implementation of the STRIDE program

Health Serv Res. 2024 Apr 17. doi: 10.1111/1475-6773.14307. Online ahead of print.

Authors

Brystana G Kaufman^{1

2

3}, S Nicole Hastings^{1

2

4}, Cassie Meyer¹, Karen M Stechuchak¹, Ashley Choate¹, Kasey Decosimo¹, Caitlin Sullivan¹, Virginia Wang^{1

2

3

4}, Kelli D Allen^{1

5}, Courtney H Van Houtven^{1

2

3}

Affiliations

¹ Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, North Carolina, USA.
² Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA.
³ Duke Margolis Institute for Health Policy, Duke University, Durham, North Carolina, USA.
⁴ Department of Medicine, Duke University, Durham, North Carolina, USA.
⁵ Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA.

PMID: 38632179
DOI: 10.1111/1475-6773.14307

Abstract

Objective: To conduct a business case analysis for Department of Veterans Affairs (VA) program STRIDE (ASsisTed EaRly MobIlization for hospitalizeD older VEterans), which was designed to address immobility for hospitalized older adults.

Data sources and study setting: This was a secondary analysis of primary data from a VA 8-hospital implementation trial conducted by the Function and Independence Quality Enhancement Research Initiative (QUERI). In partnership with VA operational partners, we estimated resources needed for program delivery in and out of the VA as well as national implementation facilitation in the VA. A scenario analysis using wage data from the Bureau of Labor Statistics informs implementation decisions outside the VA.

Study design: This budget impact analysis compared delivery and implementation costs for two implementation strategies (Replicating Effective Programs [REP]+CONNECT and REP-only). To simulate national budget scenarios for implementation, we estimated the number of eligible hospitalizations nationally and varied key parameters (e.g., enrollment rates) to evaluate the impact of uncertainty.

Data collection: Personnel time and implementation outcomes were collected from hospitals (2017-2019). Hospital average daily census and wage data were estimated as of 2022 to improve relevance to future implementation.

Principal findings: Average implementation costs were $9450 for REP+CONNECT and $5622 for REP-only; average program delivery costs were less than $30 per participant in both VA and non-VA hospital settings. Number of walks had the most impact on delivery costs and ranged from 1 to 5 walks per participant. In sensitivity analyses, cost increased to $35 per participant if a physical therapist assistant conducts the walks. Among study hospitals, mean enrollment rates were higher among the REP+CONNECT hospitals (12%) than the REP-only hospitals (4%) and VA implementation costs ranged from $66 to $100 per enrolled.

Conclusions: STRIDE is a low-cost intervention, and program participation has the biggest impact on the resources needed for delivering STRIDE.

Trial registration: ClinicalsTrials.gov NCT03300336. Prospectively registered on 3 October 2017.

Keywords: cost of care; geriatrics; implementation science; veterans.

Published 2024. This article is a U.S. Government work and is in the public domain in the USA.

Associated data

ClinicalTrials.gov/NCT03300336

Abstract

Associated data

Grants and funding