Predictive utility of the Activity Measure for Post-Acute Care ‘6-Clicks’ short forms on discharge disposition and effect on readmissions: a retrospective observational cohort study

Abstract

ObjectivesTo evaluate the predictive utility of the Activity Measure for Post-Acute Care ‘6-Clicks’ daily activity and basic mobility functional assessment short forms on inpatient discharge to home compared with skilled nursing facilities, including by diagnostic group (trauma injury, major lower joint replacement/reattachment, spinal fusion excluding cervical), as well as assess the effect of the short forms on 30-day inpatient readmissions.DesignRetrospective, observational cohort study of electronic health record data.SettingFive hospitals in a multistate, integrated healthcare system serving a large, rural US population.ParticipantsThe population-based adult (age ≥18) sample of acute care hospitalised patients receiving rehabilitation services included 10 316 patients with 12 314 hospital admissions from the year prior to 6-Clicks implementation (1 June 2015–31 May 2016) (pre-6-Clicks cohort) and 10 931 patients with 13 241 admissions from the year after 6-Clicks implementation (1 January 2017–31 December 2017) (post-6-Clicks cohort). Patients were admitted for major lower joint replacement/reattachment, spinal fusion excluding cervical, trauma injury or another reason.InterventionOccupational and physical therapist use of 6-Clicks daily activity and basic mobility short forms in the post-6-Clicks cohort.Primary and secondary outcomesDischarge disposition (home, including to assisted living, or skilled nursing facility, including swing beds) and 30-day inpatient readmissions.ResultsAreas under the receiver operating characteristic curve were 0.82–0.92 (daily activity) and 0.87–0.94 (basic mobility) for discharge to home or skilled nursing facilities, with trauma and spinal fusion patients having the highest values. Daily activity and basic mobility standardised positive and negative predictive values were highest for the three diagnostic groups compared with the full study sample. Few significant differences in 30-day readmissions were seen between pre- and post-6-Clicks cohorts.Conclusions6-Clicks performed well when distinguishing between discharge home or skilled nursing facilities, especially by diagnostic group, supporting use by occupational and physical therapists in discharge planning. Future research could assess where additional intervention or training may reduce 30-day readmissions.

Activity Measure for Post-Acute Care “6-Clicks” Basic Mobility Scores Predict Discharge Destination After Acute Care Hospitalization in Select Patient Groups: A Retrospective, Observational Study

“…This procedure yielded contingency tables of predicted and actual frequencies, which were used to calculate sensitivity and specificity and their respective 95% confidence intervals. 10 , 16 , 19 Positive and negative predictive values (PPVs and NPVs, respectively) were also generated from the contingency table values. Hosmer and Lemeshow tests with P >.05 indicated goodness of fit of the logistic regression model.…”

“…These tools document degree of difficulty or assistance needed for functional tasks 3 with strong validity, 3 , 4 interrater reliability, 4 , 5 , 6 , 7 and sensitivity to change over time. 8 , 9 Recent research confirmed that the “6-Clicks” tools may play an important role in predicting discharge destination in acute care 6 , 10 , 11 , 12 , 13 , 14 , 15 , 16 and other inpatient 17 , 18 , 19 and outpatient settings. 20 , 21 , 22 , 23 Clinicians may use Basic Mobility and/or the Daily Activities “6-Clicks” scores along with factors such as patients’ personal circumstances in deciding whether discharge to home, with or without services, or an institution (skilled nursing facility [SNF] or inpatient rehabilitation facility [IRF]) best meets patients’ needs.…”

“…Standardized cutoff scores for basic mobility predicted home vs institution discharge after acute care, with higher scores indicating return to home. 10 Though home vs institution cutoff scores are well established, 10 , 12 , 14 , 15 , 19 , 26 few researchers 15 , 16 , 19 have examined finer distinctions in placement, such as home vs home with services or SNF vs IRF. Using a sample from a tertiary care academic hospital that treats complicated diagnoses, Warren et al 19 determined that standardized Basic Mobility scores (sBMSs) can help predict finer distinctions among discharge settings.…”

“…Some studies examined specific segments of acute care populations to determine whether unique cutoff scores existed for diagnostic groups. 11 , 13 , 15 , 26 , 27 , 28 Harry et al 16 found that discharge from acute care to home or to an SNF could be predicted with sBMSs of patients with trauma, elective joint replacement or reattachment, and spinal fusion (excluding cervical). They used the sBMS cutoff score of 42.9 suggested by Jette et al 10 but found that a higher Basic Mobility score of 44.5 improved sensitivity with slight reduction in specificity of the prediction model.…”

“…They used the sBMS cutoff score of 42.9 suggested by Jette et al 10 but found that a higher Basic Mobility score of 44.5 improved sensitivity with slight reduction in specificity of the prediction model. 16 A cutoff score of 33.99 helped predict discharge to inpatient rehabilitation for patients with stroke. 13 Older adults with cardiovascular disease showed a greater referral to further inpatient care if sBMS was 44.5 using a discharge score.…”