E. Klooster1,2, L. Marcellis3, N. Koenders3, P.J. van der Wees1,3, T.J. Hoogeboom1
1Radboud University Medical Center, IQ Healthcare, Radboud Institute for Health Sciences, Nijmegen, Netherlands, 2Deventer Hospital, Department of Rehabilitation, Deventer, Netherlands, 3Radboud University Medical Center, Department of Rehabilitation, Radboud Institute for Health Sciences, Nijmegen, Netherlands
Background: Low physical activity of patients during hospitalization is a global healthcare issue with well-known adverse effects such as decreased strength and functional decline. A longlist of 23 quality indicators (QIs) has previously been developed for hospital care regarding physical activity of patients during hospitalization, also called movement care. These QIs can improve the evaluation and implementation of movement care. The current longlist does not yet satisfy methodological requirements such as clarity, necessity and feasibility for use in daily practice.
Purpose: To compile a core set of clear and necessary QIs; and to test the feasibility in daily practice using the previously developed longlist for movement care among adults of all ages at risk for low physical activity during hospitalization.
Methods: A RAND/UCLA Appropriateness Method modified Delphi study was conducted to rate the QIs on clarity and necessity. The process consisted of four rating rounds. A panel of hospital-based professionals, hospital managers, patient representatives and third-party stakeholders participated in all rounds. Clarity was determined by voting yes or no, a 75% yes-vote was decisive for inclusion. Necessity was scored on a nine-point Likert scale, QIs with scores median ≥8 and ≥70% in the highest tertile were included.
A cross-sectional observational study was conducted at 55 hospital wards in 11 different hospitals to evaluate the feasibility of the QIs. Feasibility was covered using seven criteria for indicator assessment and data collection: applicability, availability, retrievability, complexity, relevance, reliability, and acceptance. The hospital wards were determined through purposeful sampling, meaning that the hospital wards were selected using pre-defined criteria: type of hospital, presence of hospital wards and type of electronic patient record system. Local (quality) managers, researchers and quality employees were asked to evaluate the feasibility using an online questionnaire. Descriptive analysis were used to analyze the results.
A cross-sectional observational study was conducted at 55 hospital wards in 11 different hospitals to evaluate the feasibility of the QIs. Feasibility was covered using seven criteria for indicator assessment and data collection: applicability, availability, retrievability, complexity, relevance, reliability, and acceptance. The hospital wards were determined through purposeful sampling, meaning that the hospital wards were selected using pre-defined criteria: type of hospital, presence of hospital wards and type of electronic patient record system. Local (quality) managers, researchers and quality employees were asked to evaluate the feasibility using an online questionnaire. Descriptive analysis were used to analyze the results.
Results: The study started with the original 23 QIs. Seven QIs were excluded since they were voted unclear and nine QIs were excluded since they were rated unnecessary. The expert panel finally agreed on seven QIs to evaluate 1) the presence of active policy related to movement care (2 QIs), 2) the encouragement of independent functioning of patients (1 QI), 3) informing patients on the importance of physical activity (1 QI), and 4) the use and follow-up of a physical activity plan (3 QIs).
The seven QIs were evaluated on feasibility in eleven hospitals (three academic hospitals, six large general hospitals, two community hospitals) at 55 hospital wards. A total of 17 different wards were included in the study. Results are delayed due to COVID-19 and are expected October 2020.
The seven QIs were evaluated on feasibility in eleven hospitals (three academic hospitals, six large general hospitals, two community hospitals) at 55 hospital wards. A total of 17 different wards were included in the study. Results are delayed due to COVID-19 and are expected October 2020.
Conclusion(s): This core set of seven clear and necessary QIs can be used to quantify, monitor and improve the evaluation and implementation of movement care, tailored to the local hospital context.
Implications: Low physical activity among adults during hospitalization can be quantified using the QIs. Hospital-based physical therapists can utilize the QIs to emphasize the importance of implementing movement care as usual hospital care. Movement care can be monitored and improved using the QIs.
Funding, acknowledgements: The authors received funding from the Dutch Association for Hospital-Based Physical therapists (NVZF).
Keywords: Healthcare quality indicators, Hospitalized patients, Physical activity
Topic: Health promotion & wellbeing/healthy ageing/physical activity
Did this work require ethics approval? No
Institution: Radboud University Medical Center (Nijmegen, the Netherlands)
Committee: Radboud University Medical Center
Reason: Ethical approval is waived, no patient-involved research, no behavioral changes asked from participants, no personal questions in questionnaire
All authors, affiliations and abstracts have been published as submitted.
