Use of a functional mobility measure to predict discharge destinations for patients admitted to an older adult rehabilitation ward: A feasibility study

Tillson, Trish; Rohan, Maheswaran; Larmer, Peter

doi:10.1111/ajag.12491

Cited by 6 publications

(9 citation statements)

References 18 publications

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“…Previous studies have examined many factors that predict discharge destination. Predictors of discharge destination in general medical and rehabilitation populations have included, but are not limited to, severity of illness, 24 functional status, [25][26][27][28] mobility, [28][29][30] cognitive status, 25 length of stay, 29 depression, 25 and sociodemographic factors such as age, 27,28 ethnicity, 25 number of coresident household numbers, 27 and marital status. 25,31 In an age-and Elixhauser comorbidityematched sample cohort with COVID-19, 88.2% had physical health deficits, 72.5% had mental health deficits, and 17.6% experienced sensory deficits.…”

Section: Discussionmentioning

confidence: 99%

Identification of Functional Limitations and Discharge Destination in Patients With COVID-19

Roberts

Wertheimer

Park³

et al. 2021

Archives of Physical Medicine and Rehabilitation

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Objective The objectives of this study were to identify functional limitations in COVID-19 patients admitted to acute care hospitals, to evaluate functional limitations by demographic, medical and encounter characteristics, and to examine functional limitations in relation to discharge destination. Design and Setting This is a cross sectional, retrospective study of adult patients with COVID-19 who were discharged from two different types of hospitals (academic medical center and a community hospital) within one healthcare system between January 1 and April 30, 2020. Participants Patients were identified from the Cedars-Sinai COVID-19 data registry who had a new onset positive test for SARS-CoV-2. A total of 273 cases were identified, which included 230 cases that were discharged alive and 43 patients who expired and were excluded from the study sample. Interventions Not applicable Main Outcome Measures Functional limitations in COVID-19 patients in acute care hospitals and the predictors for discharge disposition. Results A total of 230 records were analyzed including demographic, encounter, medical, and functional variables. In a propensity-score matched cohort based on age and comorbidity, 88.2% had functional physical health deficits, 72.5% had functional mental health deficits, and 17.6% experienced sensory deficits. In the matched cohort, individuals discharged to an institution experienced greater physical (62.7% vs. 25.5%, p<.001) and mental health (49.0% vs. 23.5%, p=.006) deficits than patients discharged home. Marital status (OR 3.17, p=.011) and physical function deficits (OR 3.63, p=0.025) were associated with an increase odds ratio of discharge to an institution. Conclusions This research highlights that functional status is a strong predictor for discharge destination to an institution for COVID-19 patients. Patients who were older, in the acute care hospital longer, and with comorbidities were more likely to be discharged to an institution. Rehabilitation is a significant aspect of the healthcare system for these vulnerable patients. The challenges of adjusting the role of rehabilitation providers and systems during the pandemic needs further exploration. Moreover, additional research is needed to look more closely at the many facets and timing of functional status needs, to shed light in utilization of interdisciplinary rehabilitation services, and to guide providers and healthcare systems in facilitating optimal recovery and patient outcomes.

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Section: Discussionmentioning

confidence: 99%

Identification of Functional Limitations and Discharge Destination in Patients With COVID-19

Roberts

Wertheimer

Park³

et al. 2021

Archives of Physical Medicine and Rehabilitation

View full text Add to dashboard Cite

show abstract

“…The probability of hospital readmission was 2.89 times greater when the PT’s recommendations for post-acute care services were not implemented (OR, 2.89, 95% CI, 1.57-5.30) [ 25 ]. Additionally, the timing of the onset of discharge planning during a patient’s hospital stay has been shown to impact readmissions, with earlier strategies associated with reduced readmissions, lower mortality, and improved quality of life [ 28 ]. Initial AM-PAC “6-Clicks” scores alone have been shown to accurately predict hospital discharge destination and may allow discharge planners additional data to initiate post-acute care transition planning earlier in the index admission [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Can AM-PAC “6-Clicks” Inpatient Functional Assessment Scores Strengthen Hospital 30-Day Readmission Prevention Strategies?

Arnold

Naessens

McVeigh

et al. 2021

Cureus

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BackgroundPrevention of unplanned hospital readmissions remains a priority in the US healthcare sector. Patient functional status has evolved as an important factor in identifying patients at risk for unplanned readmissions and poor predischarge functional performance has been shown to be predictive of increased readmission risk. Yet, patient functional status appears to be underutilized in readmission prediction models. MethodsTo examine the impact of inpatient functional status (mobility and activity performance) on unplanned 30day hospital readmissions at two tertiary care hospitals, retrospective cohort analysis was performed on electronic health record data from adult inpatients (N = 26,298) having undergone completed functional assessments during their index hospitalization. Primary outcomes were functional assessment scores and unplanned all-cause patient readmission within 30 days following hospital discharge. Secondary analysis stratified the assessment by discharge destination. Functional assessment scores from the Activity Measure for Post-Acute Care (AM-PAC) "6-Clicks" Basic Mobility Short Form or Daily Activity Short Form were extracted along with patient demographics, admission diagnoses, comorbid conditions, and hospital readmission risk score. ResultsAdjusting for age, sex, and comorbidity, lower AM-PAC "6-Clicks" Basic Mobility and Daily Activity scores resulted in higher readmission rates when each score was considered separately. When both scores were considered, only Daily Activity scores were significant. ConclusionPatients with lower Basic Mobility and Daily Activity scores are at a higher risk for readmission. The relative importance of AM-PAC "6-Click" scores on short-term readmission depends on discharge destination. Timely identification of patient mobility and activity performance may lead to earlier intervention strategies to reduce readmissions.

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“…This can be of considerable value to the management because a (too) long LOS could probably be avoided. 13 This study has some limitations. First, the outcome 'successful rehabilitation' was determined as returning to community living 'yes'/'no'.…”

Section: Discussionmentioning

confidence: 91%

“…Early discharge planning will provide the ability to make arrangements, if necessary, and to inform the patient and his caregiver well before discharge. 6,13 However, it is unknown what the patients' long-term functioning is after home discharge. Nevertheless, this is another area of interest.…”

Section: Discussionmentioning

confidence: 99%

“…Early planning of discharge has been shown to reduce hospital readmissions and mortality and improve the patients' QoL. 7,13 Early discharge planning could lead to a more custom-made rehabilitation trajectory, rehabilitation goals and preparation for discharge. 6 However, due to the frailty and multimorbidity of the patients admitted to GR, predicting discharge destination at admission is difficult.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Factors associated with successful rehabilitation in older adults: A systematic review and best evidence synthesis

et al. 2021

View full text Add to dashboard Cite

Use of a functional mobility measure to predict discharge destinations for patients admitted to an older adult rehabilitation ward: A feasibility study

Cited by 6 publications

References 18 publications

Identification of Functional Limitations and Discharge Destination in Patients With COVID-19

Identification of Functional Limitations and Discharge Destination in Patients With COVID-19

Can AM-PAC “6-Clicks” Inpatient Functional Assessment Scores Strengthen Hospital 30-Day Readmission Prevention Strategies?

Factors associated with successful rehabilitation in older adults: A systematic review and best evidence synthesis

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