AM-PAC “6-Clicks” Functional Assessment Scores Predict Acute Care Hospital Discharge Destination

Jette, Diane U.; Stilphen, Mary; Ranganathan, Vinoth K.; Passek, Sandra; Frost, Frederick; Jette, Alan M.

doi:10.2522/ptj.20130359

Cited by 150 publications

(128 citation statements)

References 24 publications

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“…Conversely, some participants felt completely engaged in the process and felt like the decision was their own. No patient mentioned the use of evidence-based tools such as the simplified Trauma Rehabilitation and Prediction Tool (sTRaPT) 33 or the Activity Measure for Post Acute Care (AM-PAC) '6-Clicks' functional assessment tool 34 in decision-making. Previous literature has shown that non-injury-related considerations, such as funding arrangements and compensation status, are significant factors relating to patient discharge to in-patient rehabilitation after an acute hospital stay, 4,35 but patients in this cohort seemed unaware of the significance of their funding arrangements in terms of discharge choices.…”

Section: Discussionmentioning

confidence: 99%

Discharge from the acute hospital: trauma patients’ perceptions of care

Kimmel

Holland

Hart

et al. 2016

Aust. Health Review

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Objective. The involvement of orthopaedic trauma patients in the decision-making regarding discharge destination from the acute hospital and their perceptions of the care following discharge are poorly understood. The aim of the present study was to investigate orthopaedic trauma patient experiences of discharge from the acute hospital and transition back into the community.Methods. The present qualitative study performed in-depth interviews, between October 2012 and November 2013, with patients aged 18-64 years with lower limb trauma. Thematic analysis was used to derive important themes.Results. Ninety-four patients were interviewed, including 35 discharged to in-patient rehabilitation. Key themes that emerged include variable involvement in decision-making regarding discharge, lack of information and follow-up care on discharge and varying opinions regarding in-patient rehabilitation. Readiness for discharge from in-patient rehabilitation also differed widely among patients, with patients often reporting being ready for discharge before the planned discharge date and feeling frustration at the need to stay in in-patient care. There was also a difference in patients' perception of the factors leading to recovery, with patients discharged to rehabilitation more commonly reporting external factors, such as rehabilitation providers and physiotherapy.Conclusion. The insights provided by the participants in the present study will help us improve our discharge practice, especially the need to address the concerns of inadequate information provision regarding discharge and the role of inpatient rehabilitation.What is known about the topic? There is no current literature describing trauma patient involvement in decision-making regarding discharge from the acute hospital and the perception of how this decision (and destination choice; e.g. home or in-patient rehabilitation) affects their outcome. HEALTH SERVICE RESEARCH What does this paper add?The present large qualitative study provides information on patients' opinion of discharge from the acute hospital following trauma and how this could be improved from their perception. Patients are especially concerned with the lack of information provided to them on discharge, their lack of involvement and understanding of the choices made with regard to their discharge and describe concerns regarding their follow-up care. There is also a feeling from the patients that they are ready to leave rehabilitation before their actual planned discharge date, a concept that needs further investigation. What are the implications for practitioners? The patient insights gained by the present study will lead to a change in discharge practice, including increased involvement of the patient in the decision-making in terms of discharge from both the acute and rehabilitation hospitals and a raised awareness of the need to provide written information and follow-up telephone calls to patients following discharge. Further research into many aspects of patient discharge from the acute hosp...

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Section: Discussionmentioning

confidence: 99%

Discharge from the acute hospital: trauma patients’ perceptions of care

Kimmel

Holland

Hart

et al. 2016

Aust. Health Review

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“…We first evaluated differences between participants according to whether they lived alone at the time of admission using chi‐square tests for categorical variables and t‐tests for continuous variables. We then used a multivariable logistic regression model examining the association between living alone and discharge to a SNF, controlling for a set of confounders defined a priori based on clinical experience and the prior published literature that included age, sex, race, insurance status, comorbidities, length of stay, and ADLs (including impaired mobility) . Drawing from findings of prior studies, we examined the interaction between living alone and previously identified variables associated with discharge to a SNF (age, length of stay, insurance status, impaired mobility) to determine whether there were different effects of living alone on discharge to SNF.…”

Section: Methodsmentioning

confidence: 99%

Living Alone and Discharge to Skilled Nursing Facility Care after Hospitalization in Older Adults

Lage

Jernigan

Chang

et al. 2017

J American Geriatrics Society

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Background/Objectives Community‐based older adults are increasingly living alone. When they become ill, they might need greater support from the healthcare system than would those who live with others. There also has been a growing concern about the high use of postacute care such as skilled nursing facility (SNF) care and the level of variation in this use between hospitals and regions. Our objective was to examine whether living alone contributed to the risk of being discharged to a SNF. Design Retrospective cohort study. Setting Massachusetts General Hospital. Participants Community‐dwelling individuals aged 50 and older admitted to the medical service and discharged alive between July 2014 and August 2015 (N = 7,029). Measurements We extracted demographic, clinical, and functional data from the electronic medical record and used multivariable logistic regression to determine whether living alone at the time of hospitalization was associated with subsequent discharge to a SNF. Results Of eligible individuals, 24.8% reported living alone before admission. Those living alone were more likely to be female, older, and more independent before admission than those living with others. Of all participants, 10.9% were discharged to a SNF. After adjustment, participants living alone had more than twice the odds of being discharged to a SNF (odds ratio = 2.23, 95% confidence interval = 1.85–2.69, P < .001). Discussion People living alone are more likely to be discharged to SNFs, even when compared to other individuals with similar levels of clinical complexity and functional status. To the extent that this variation is due to a lack of home support, it could be possible to reduce SNF use through additional home services after hospital discharge.

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“…12 Hence, improving the efficiency of care, reducing LOS, unplanned hospital readmissions and providing sufficient supports to patients and their caregivers are priorities in acute care discharge planning. [13][14][15] However, discharge planning becomes a challenging issue for acute care providers from the first few days of trauma admission. 14 16 At the time of discharge, a wide range of discharge ► To the best of our knowledge, this study will be the first systematic review on predictors of discharge destination from acute care in patients with traumatic brain injury.…”

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confidence: 99%

Predictors of Discharge Destination From Acute Care in Patients With Traumatic Brain Injury: A Systematic Review

Zarshenas

Colantonio

Alavinia

et al. 2019

Journal of Head Trauma Rehabilitation

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Objective: To systematically review studies on clinical and nonclinical predictors of discharge destination from acute care in patients with traumatic brain injury. Methods: The search was conducted using 7 databases up to December 2016. A systematic review and in-depth quality synthesis were conducted on eligible articles that met the inclusion criteria. Results: The search yielded 8503 articles of which 18 studies met the inclusion criteria. This study demonstrated that a larger proportion of patients with traumatic brain injury were discharged home. The main predictors of discharge to a setting with rehabilitation services versus home included increasing age, white and non-Hispanic race/ethnicity, having insurance coverage, greater severity of the injury, and longer acute care length of stay. Age was the only consistent factor that was negatively associated with discharge to inpatient rehabilitation facilities versus other institutions. Conclusion: Results of this study support healthcare providers in providing consultation to patients about the expected next level of cares while considering barriers that may helpful in effective discharge planning, decreasing length of stay and saving resources. These findings also suggest the need for further studies with a stronger methodology on the contribution of patients and families/caregivers to distinguish the predictors of discharge to dedicated rehabilitation facilities.

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AM-PAC “6-Clicks” Functional Assessment Scores Predict Acute Care Hospital Discharge Destination

Abstract: This study provides evidence of the accuracy of "6-Clicks" scores for predicting destination after discharge from an acute care hospital.

Cited by 150 publications

References 24 publications

Discharge from the acute hospital: trauma patients’ perceptions of care

Discharge from the acute hospital: trauma patients’ perceptions of care

Living Alone and Discharge to Skilled Nursing Facility Care after Hospitalization in Older Adults

Predictors of Discharge Destination From Acute Care in Patients With Traumatic Brain Injury: A Systematic Review

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