Walking All over COVID-19: The Rapid Development of , an Innovative Approach to Enhance a Hospital-Based Walking Program during the Pandemic.

Hospitalization is common among older adults. Prolonged time in bed during hospitalization can lead to deconditioning and functional impairments. Our team is currently working with Department of Veterans Affairs (VA) medical centers across the United States to implement STRIDE (assiSTed eaRly mobIlity for hospitalizeD older vEterans), a hospital-based walking program designed to mitigate the risks of immobility during hospitalization.

Psychological distress among medically complex veterans with a recent emergency department visit.

Medical complexity and psychological distress are associated with frequent emergency department (ED) use. Despite this known association, our understanding is limited about which patients are at risk for persistent psychological distress and what patterns of distress emerge over time. A secondary data analysis was used to examine self-reported psychological distress (defined as ≥14 unhealthy days due to poor mental health in the past month) at 30 and 180 days following enrollment in a randomized control trial of 513 medically complex Veterans after a nonpsychiatric ED visit.

Implementation of a stepped wedge cluster randomized trial to evaluate a hospital mobility program.

Background: Stepped wedge cluster randomized trials (SW-CRT) are increasingly used to evaluate new clinical programs, yet there is limited guidance on practical aspects of applying this design. We report our early experiences conducting a SW-CRT to examine an inpatient mobility program (STRIDE) in the Veterans Health Administration (VHA). We provide recommendations for future research using this design to evaluate clinical programs.

Video-Enhanced Care Management for Medically Complex Older Adults with Cognitive Impairment.

Objective: This pilot study assessed feasibility of video-enhanced care management for complex older veterans with suspected mild cognitive impairment (CI) and their care partners, compared with telephone delivery.

Design: Pilot randomized controlled trial.

Setting: Durham Veterans Affairs Health Care System.

Implementation of a group physical therapy program for Veterans with knee osteoarthritis.

Background: A previous randomized clinical trial found that a Group Physical Therapy (PT) program for knee osteoarthritis yielded similar improvements in pain and function compared with traditional individual PT. Based on these findings the Group PT program was implemented in a Department of Veterans Affairs Health Care System. The objective of this study was to evaluate implementation metrics and changes in patient-level measures following implementation of the Group PT program.

Adaptation and Implementation of a Family Caregiver Skills Training Program: From Single Site RCT to Multisite Pragmatic Intervention.

Purpose: We describe an approach to rapidly adapt and implement an education and skills improvement intervention to address the needs of family caregivers of functionally impaired veterans-Helping Invested Families Improve Veterans' Experience Study (HI-FIVES).

Design: Prior to implementation in eight sites, a multidisciplinary study team made systematic adaptations to the curriculum content and delivery process using input from the original randomized controlled trial (RCT); a stakeholder advisory board comprised of national experts in caregiver education, nursing, and implementation; and a veteran/caregiver engagement panel. To address site-specific implementation barriers in diverse settings, we applied the Replicating Effective Programs implementation framework.

Discharge Information and Support for Patients Discharged from the Emergency Department: Results from a Randomized Controlled Trial.

Background: Little research has been done on primary care-based models to improve health care use after an emergency department (ED) visit.

Objective: To examine the effectiveness of a primary care-based, nurse telephone support intervention for Veterans treated and released from the ED.

Design: Randomized controlled trial with 1:1 assignment to telephone support intervention or usual care arms (ClinicalTrials.

Early Mobility in the Hospital: Lessons Learned from the STRIDE Program.

Immobility during hospitalization is widely recognized as a contributor to deconditioning, functional loss, and increased need for institutional post-acute care. Several studies have demonstrated that inpatient walking programs can mitigate some of these negative outcomes, yet hospital mobility programs are not widely available in U.S.

Supporting teams to optimize function and independence in Veterans: a multi-study program and mixed methods protocol.

Background: Successful implementation of new clinical programs depends on effectively establishing, reorganizing, or enhancing team structures and processes to coordinate the work of individuals who are interdependent in their tasks, manage relationships, and share responsibility for outcomes. However, a one-size-fits-all approach is rarely effective. In partnership with VA national clinical leaders and local clinical champions, the Optimizing Function and Independence VA Quality Enhancement Research Initiative program (Function QUERI) will evaluate efforts to implement team-based clinical programs for Veterans at risk for functional decline and disability.

Internet Use and Technology-Related Attitudes of Veterans and Informal Caregivers of Veterans.

Background: Healthcare systems are interested in technology-enhanced interventions to improve patient access and outcomes. However, there is uncertainty about feasibility and acceptability for groups who may benefit but are at risk for disparities in technology use. Thus, we sought to describe characteristics of Internet use and technology-related attitudes for two such groups: (1) Veterans with multi-morbidity and high acute care utilization and (2) informal caregivers of Veterans with substantial care needs at home.

Genomics and public health practice: a survey of nurses in local health departments in North Carolina.

In order to examine the extent to which current public health practices incorporate information about genetic susceptibilities potentially obtained by a comprehensive family history, public health nurses in North Carolina were surveyed to assess the extent to which this information is routinely collected. In addition, we measured nurses' awareness of the Centers for Disease Control and Prevention's Genomic Competencies and assessed training needs related to genomics. A self-administered survey was distributed to all public health nurse supervisors, directors, consultants as well as Breast and Cervical Cancer Coordination Program managers in North Carolina.