Implementing 3-Steps Workout for Life to Support Patient Functional Outcomes in Home Health: Facilitators, Barriers, and Preliminary Findings 4363

Objectives

To investigate how to adapt the 3-Step Workout for Life, a task-oriented resistance exercise program, to be used by home health therapy practitioners.

Design

A mixed-methods action research design consisting of a single-site, pragmatic, quasi-experimental trial.

Setting

Home health care agency.

Participants

A rehabilitation therapy team (1 director, 3 occupational therapy practitioners, 5 physical therapy practitioners) and 10 home health patients (mean age, 77y; women, 5; White, 5) from a local home health agency participated in the study. Patients were excluded if they had a neurological condition or major surgical procedure.

Interventions

Individual interviews were conducted with administrators and therapy practitioners before and after the implementation of the modified 3-Step Workout for Life, which consisted of structured resistance exercise and principle-based activity exercise. Implementation barriers and facilitators were identified based on the interview results using directed qualitative content analysis, which was guided by the Consolidated Framework for Implementation Research. Different delivery models were developed to accommodate the type of therapy services provided to each patient. The modified 3-Step Workout for Life was implemented in eligible patients by the home health therapy team during in-person visits.

Main Outcome Measures

Patient outcomes were assessed with Activity Measure for Post-Acute Care and EQ-5D-5L, and were analyzed using the Wilcoxon singed-rank test. Patient satisfaction was measured using an exit survey.

Results

External policy changes (ie, the new Medicare payment model) were identified as a potential implementation barrier due to concerns about limited therapy visits. However, multiple implementation facilitators were identified regarding perceived positive strength and quality of the intervention, strong inner agency networks and communication, positive office culture, good compatibility of the intervention, great knowledge and belief about the intervention, and self-efficacy in delivering the intervention. Patients pre-post tests showed improved mobility (Z=−2.52, P=.01), daily activities (Z=−2.37, P=.02), and quality of life (Z=−1.87, P=.07).

Conclusions

Although identifying potential barriers before implementation was helpful in modifying the intervention program, additional barriers were raised during the implementation process, such as patients being discharged before program completion or changes in referrals of eligible patients due to the new Medicare payment model. Although home health patients may benefit from the 3-Step Workout for Life program, addressing existing practice habits and understanding the new Medicare payment model are crucial to support its implementation.

Disclosures

none.