Machine learning prediction of hospital patient need for post-acute care using an admission mobility measure is robust across patient diagnoses

Young, Daniel L.; Engels, Rebecca; Colantuoni, Elizabeth; Friedman, Lisa Aronson; Hoyer, Erik H.

doi:10.1016/j.hlpt.2023.100754

Cited by 2 publications

(1 citation statement)

References 35 publications

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“…Reductions in LOS are facilitated by postsurgical pathways consisting of a multidisciplinary perioperative approach [6,12] and by determining a patient's appropriate discharge location as early as possible [20]. Objective measures such as the RAPT and AM-PAC scores can help guide the discharge planning process [14,19,24,26]. However, few studies examine the correlation of preoperative RAPT scores with postoperative AM-PAC scores [14].…”

Section: Discussionmentioning

confidence: 99%

RAPT and AM-PAC “6-Clicks”: Do They Correlate on Predicting Discharge Destination After Total Joint Arthroplasty?

Tuohy,

Schwartz-Dillard,

McInerney

et al. 2023

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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Background: The Risk Assessment and Prediction Tool (RAPT) and the Activity Measure for Post-Acute Care “6-Clicks” Mobility Score (AM-PAC) are validated discharge planning tools for patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA). Planning for discharge with these tools considers very different factors and it is important to determine if they relate. Purpose: We sought to determine whether the preoperative RAPT score would correlate with postoperative AM-PAC score for predicting discharge destination for THA and TKA populations. Secondarily, we sought to examine whether the AM-PAC and RAPT scores would remain statistically significant predictors of discharge destination despite covariates. Methods: A retrospective cohort study was performed for patients who underwent THA or TKA from January 2020 to December 2022 at a specialty orthopedic hospital. Primary variables included the RAPT score, the AM-PAC score, and discharge disposition. Correlation between AM-PAC and RAPT scores was tested using Pearson’s correlation coefficient, and association between both scores and discharge destination was tested using chi-square tests and multivariable logistic regression. Results: Our comparison of AM-PAC scores and RAPT scores found a statistically significant, positive correlation in both THA and TKA patients. Regression analysis found that increased RAPT and AM-PAC scores resulted in higher odds of being discharged home for both populations, after adjusting for all other variables. In both cohorts, patients discharged to a facility were more likely to be female, be over the age of 70 years, have Medicare/Medicaid insurance, and have a higher number of preoperative social work visits or any incidence of an intraoperative or hospital complication. Conclusions: This retrospective study found that RAPT score correlated with AM-PAC score for predicting discharge destination for elective THA and TKA populations, suggesting that these scores may be predictors of home discharge destination even when accounting for covariates. Further study is recommended.

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Section: Discussionmentioning

confidence: 99%

RAPT and AM-PAC “6-Clicks”: Do They Correlate on Predicting Discharge Destination After Total Joint Arthroplasty?

Tuohy,

Schwartz-Dillard,

McInerney

et al. 2023

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

View full text Add to dashboard Cite

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Effect of Acute Care Discharge Delays on Inpatient Rehabilitation Effect of Acute Care Discharge Delays on Inpatient Rehabilitation Facility (IRF) Utilization Facility (IRF) Utilization

Garrard

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Discharge delays present hospitals with challenges in managing costs for Medicare admissions. Meanwhile, Inpatient Rehabilitation Facilities (IRF) are subject to strict pre-admission requirements that can complicate efficient transitions of care for patients with intensive rehabilitation needs. The purpose of this retrospective quantitative correlational study was to examine any relationship between acute care discharge delays and IRF utilization. This study investigated whether length of stay (LOS) and Medicare Advantage prior authorization requirements impact IRF referrals by reviewing 3,747 medical records of acute stroke patients aged 65 years and older at a regionally integrated healthcare system over a 3-year period (2020- 2022). Referral to IRF was strongly correlated with LOS, and Medicare financial class (fee-for-service vs. Medicare Advantage) was a significant moderator of that relationship. Patient age at admission and whether the referring hospital operated an IRF were also significantly related to IRF referral. Further, distinct differences in post-acute care pathways were noted for stroke patients between FFS and MA plans despite very similar clinical profiles.

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Machine learning prediction of hospital patient need for post-acute care using an admission mobility measure is robust across patient diagnoses

Cited by 2 publications

References 35 publications

RAPT and AM-PAC “6-Clicks”: Do They Correlate on Predicting Discharge Destination After Total Joint Arthroplasty?

RAPT and AM-PAC “6-Clicks”: Do They Correlate on Predicting Discharge Destination After Total Joint Arthroplasty?

Effect of Acute Care Discharge Delays on Inpatient Rehabilitation Effect of Acute Care Discharge Delays on Inpatient Rehabilitation Facility (IRF) Utilization Facility (IRF) Utilization

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