Using the Replicating Effective Programs Framework to Adapt an Outpatient Rehabilitation Program for the Post-Acute Nursing Home Setting

Research Objectives To adapt a successful outpatient rehabilitation program targeting the prevention of mobility decline among older adults for the post-acute nursing home setting within the Veterans Health Administration (VHA) using the Replicating Effective Programs (REP) Framework. Design Program development. Setting Community Living Center (CLC), the post-acute nursing home setting within VHA. Participants Veterans receiving post-acute CLC rehabilitative care. Interventions We used the REP framework to guide adaptation of the Live Long Walk Strong (LLWS) program for the CLC setting. The original LLWS program treats physiologic impairments associated with mobility decline, promotes behavior change, and links patients to physical activity programs to foster long-term maintenance of health and function. LLWS produces large clinically meaningful improvements in mobility when implemented as an outpatient program for community-dwelling older adults. We adapted the program for the CLC by working through the phases of the REP framework. In the Pre-conditions phase, we identified local champions, developed an understanding of CLC processes, and identified existing resources. In the Pre-implementation phase, we engaged a broader group of stakeholders (CLC providers, CLC administrators, home health agencies), addressed electronic health record logistics, and trained staff. In the Implementation phase, we completed Plan-Do-Study-Act (PDSA) cycles and refined the protocol. Main Outcome Measures Preliminary feasibility. Results The adapted version of LLWS includes novel elements and bridges the inpatient CLC stay and subsequent three months post-discharge. The inpatient component focuses on maximizing functional recovery and includes activities focused on timing and coordination of gait, lower extremity strength and power, and trunk muscle endurance. The care transition and virtual (i.e., telehealth) post-discharge components focus on case management and engagement in physical activity programs. Coaching and behavior change are a consistent focus throughout the program. The adapted program is being rolled out as a clinical demonstration project and demonstrates preliminary feasibility. Conclusions The REP framework provides a useful guide for adapting rehabilitative programs to meet the needs of new populations. Author(s) Disclosures No conflicts of interest to report.