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Strauss DH, Davoodi NM, Resnik LJ, Keene S, Serina PT, Goldberg EM. Emergency Department-Based Physical Function Measures for Falls in Older Adults and Outcomes: A Secondary Analysis of GAPcare. J Geriatr Phys Ther 2024:00139143-990000000-00048. [PMID: 38656264 DOI: 10.1519/jpt.0000000000000403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND AND PURPOSE Falls are the leading reason for injury-related emergency department (ED) visits for older adults. The Geriatric Acute and Post-acute Fall Prevention Intervention (GAPcare), an in-ED intervention combining a medication therapy management session delivered by a pharmacist and a fall risk assessment and plan by a physical therapist, reduced ED revisits at 6 months among older adults presenting after a fall. Our objective was to evaluate the relationship between measures of function obtained in the ED and clinical outcomes. METHODS This was a secondary analysis of data from GAPcare, a randomized controlled trial conducted from January 2018 to October 2019 at 2 urban academic EDs. Standardized measures of function (Timed Up and Go [TUG] test, Barthel Activity of Daily Living [ADL], Activity Measure for Post Acute Care [AM-PAC] 6 clicks) were collected at the ED index visit. We performed a descriptive analysis and hypothesis testing (chi square test and analysis of variance) to assess the relationship of functional measures with outcomes (ED disposition, ED revisits for falls, and place of residence at 6 months). Emergency department disposition status refers to discharge location immediately after the ED evaluation is complete (eg, hospital admission, original residence, skilled nursing facility). RESULTS AND DISCUSSION Among 110 participants, 55 were randomized to the GAPcare intervention and 55 received usual care. Of those randomized to the intervention, 46 received physical therapy consultation. Median age was 81 years; participants were predominantly women (67%) and White (94%). Seventy-three (66%) were discharged to their original residence, 14 (13%) were discharged to a skilled nursing facility and 22 (20%) were admitted. There was no difference in ED disposition status by index visit Barthel ADLs (P = .371); however, TUG times were faster (P = .016), and AM-PAC 6 clicks score was higher among participants discharged to their original residence (P ≤ .001). Participants with slower TUG times at the index ED visit were more likely to reside in nursing homes by six months (P = .002), while Barthel ADL and AM-PAC 6 clicks did not differ between those residing at home and other settings. CONCLUSIONS Measures of function collected at the index ED visit, such as the AM-PAC 6 clicks and TUG time, may be helpful at predicting clinical outcomes for older adults presenting for a fall. Based on our study findings, we suggest a novel workflow to guide the use of these clinical measures for ED patients with falls.
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Affiliation(s)
- Daniel H Strauss
- Department of Emergency Medicine, The Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Natalie M Davoodi
- Department of Emergency Medicine, The Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Linda J Resnik
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island
- Research Department, Providence VA Medical Center, Providence, Rhode Island
| | - Sarah Keene
- Department of Emergency Medicine, The Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Peter T Serina
- Department of Emergency Medicine, The Warren Alpert Medical School, Brown University, Providence, Rhode Island
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island
| | - Elizabeth M Goldberg
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado
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Jabal MS, Wahood W, Ibrahim MK, Kobeissi H, Ghozy S, Kallmes DF, Rabinstein AA, Brinjikji W. Machine learning prediction of hospital discharge disposition for inpatients with acute ischemic stroke following mechanical thrombectomy in the United States. J Stroke Cerebrovasc Dis 2024; 33:107489. [PMID: 37980845 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 10/25/2023] [Accepted: 11/13/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND AND PURPOSE Predicting patient recovery and discharge disposition following mechanical thrombectomy remains a challenge in patients with ischemic stroke. Machine learning offers a promising prognostication approach assisting in personalized post-thrombectomy care plans and resource allocation. As a large national database, National Inpatient Sample (NIS), contain valuable insights amenable to data-mining. The study aimed to develop and evaluate ML models predicting hospital discharge disposition with a focus on demographic, socioeconomic and hospital characteristics. MATERIALS AND METHODS The NIS dataset (2006-2019) was used, including 4956 patients diagnosed with ischemic stroke who underwent thrombectomy. Demographics, hospital characteristics, and Elixhauser comorbidity indices were recorded. Feature extraction, processing, and selection were performed using Python, with Maximum Relevance - Minimum Redundancy (MRMR) applied for dimensionality reduction. ML models were developed and benchmarked prior to interpretation of the best model using Shapley Additive exPlanations (SHAP). RESULTS The multilayer perceptron model outperformed others and achieved an AUROC of 0.81, accuracy of 77 %, F1-score of 0.48, precision of 0.64, and recall of 0.54. SHAP analysis identified the most important features for predicting discharge disposition as dysphagia and dysarthria, NIHSS, age, primary payer (Medicare), cerebral edema, fluid and electrolyte disorders, complicated hypertension, primary payer (private insurance), intracranial hemorrhage, and thrombectomy alone. CONCLUSION Machine learning modeling of NIS database shows potential in predicting hospital discharge disposition for inpatients with acute ischemic stroke following mechanical thrombectomy in the NIS database. Insights gained from SHAP interpretation can inform targeted interventions and care plans, ultimately enhancing patient outcomes and resource allocation.
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Affiliation(s)
- Mohamed Sobhi Jabal
- Department of Radiology, Mayo Clinic, Rochester, MN, USA; Department of Computer and Information Science, University of Pennsylvania, Philadelphia, PA, USA
| | - Waseem Wahood
- Dr Kiran C Patel College of Allopathic Medicine, Nova Southeastern University, Davie, FL, USA
| | | | | | - Sherief Ghozy
- Department of Radiology, Mayo Clinic, Rochester, MN, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
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Yedavalli V, Koneru M, Hoseinyazdi M, Copeland K, Xu R, Luna L, Caplan J, Dmytriw A, Guenego A, Heit J, Albers G, Wintermark M, Gonzalez F, Urrutia V, Huang J, Leigh R, Marsh E, Llinas R, Hernandez MG, Hillis A. Excellent Recanalization and Small Core Volumes Are Associated With Favorable AM-PAC Score in Patients With Acute Ischemic Stroke Secondary to Large Vessel Occlusion. Arch Rehabil Res Clin Transl 2023; 5:100306. [PMID: 38163017 PMCID: PMC10757189 DOI: 10.1016/j.arrct.2023.100306] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Objective To assess pretreatment and interventional parameters as predictors of favorable Activity Measure for Post-Acute Care (AM-PAC) scores for optimal discharge planning. Design In this prospectively collected, retrospectively reviewed multicenter study from 9/1/2017 to 9/22/2022, patients were dichotomized into favorable and unfavorable AM-PAC. Multivariate logistic regression and receiver operator characteristics analyses were performed for the identified significant variables. A P value of ≤.05 was significant. Setting Hospitalized care. Participants In total, 229 patients (mean ±SD 70.65 ±15.2 [55.9% women]) met our inclusion criteria. Inclusion criteria were (a) computed tomography (CT) angiography confirmed LVO from 9/1/2017 to 9/22/2022; (b) diagnostic CT perfusion; and (c) available AM-PAC scores. Interventions None. Main Outcome Measures Favorable AM-PAC, defined as a daily activity score ≥19 and basic mobility score of ≥17. Results Patients with favorable AM-PAC were younger (61.3 vs 70.7, P<.001), had lower admission glucose (mean, 124 vs 136, P=.042), lower blood urea nitrogen (mean, 15.59 vs 19.11, P<.001), and lower admission National Institutes of Health Stroke Scale (NIHSS) (mean, 10.58 vs 16.15, P<.001). No differences in sex were noted. Multivariate regression analyses revealed age, admission NIHSS, relative cerebral blood flow (rCBF) <30% volume, and modified thrombolysis in cerebral infarction (mTICI) score to be independent predictors of favorable AM-PAC (P<.047 for all predictors). The combined model revealed an area under the curve (AUC) of 0.83 (IQR 0.75-0.86). Conclusion Excellent recanalization, smaller core volumes, younger age, and lower stroke severity independently predict favorable outcomes as measured by AM-PAC.
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Affiliation(s)
- Vivek Yedavalli
- Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, MD
| | | | - Meisam Hoseinyazdi
- Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, MD
| | | | - Risheng Xu
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Licia Luna
- Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, MD
| | - Justin Caplan
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Adam Dmytriw
- Department of Neuroradiology, Massachusetts General Hospital & Harvard Medical School, Cambridge, MA
| | - Adrien Guenego
- Department of Radiology, Université Libre De Bruxelles Hospital Erasme, Brussels, BE
| | - Jeremy Heit
- Department of Radiology, Stanford University School of Medicine, Palo Alto, CA
| | - Gregory Albers
- Department of Neurology, Stanford University School of Medicine, Baltimore, MD
| | - Max Wintermark
- Department of Radiology, University of Texas MD Anderson Center, Houston, TX
| | - Fernando Gonzalez
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Victor Urrutia
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Judy Huang
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Richard Leigh
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Elisabeth Marsh
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Rafael Llinas
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD
| | | | - Argye Hillis
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD
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Young DL, Johnson JK, Guo N, Tereshchenko LG, Martinez M, Rothberg MB. Association between physical therapy frequency and postacute care for a national cohort of patients hospitalized with pneumonia. J Hosp Med 2023; 18:803-811. [PMID: 37545436 DOI: 10.1002/jhm.13186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Annually more than 300,000 patients hospitalized for pneumonia need postacute care. Patients and systems prefer home discharge, but physical limitations often necessitate postacute care. It is unknown whether frequency of physical therapy in the hospital affects postacute care discharges. OBJECTIVE Examine the relationship between physical therapy visit frequency and disposition among a national sample of patients hospitalized with pneumonia. DESIGNS Observational cohort study. SETTING Acute care hospital. PARTICIPANTS Adult patients with primary diagnosis of pneumonia in the Premier Data Set who received physical therapy in the hospital during a 5-day window, with therapy on at least days 1 and 5. INTERVENTION Physical therapy visit frequency. MAIN OUTCOME AND MEASURES Discharge disposition (home or postacute care). RESULTS We included 18,886 patients from 595 hospitals. Just over half were discharged home (n = 9638; 51.0%) and 558 (2.95%) died. Patients getting more frequent therapy were older, non-Hispanic white, treated in small non-teaching rural hospitals in the West, Midwest, or South, and had fewer severe illness indicators. In adjusted models, patients who received physical therapy on 100% of days were 7% [(95% confidence interval, 4.3-9.7), p < .0001] more likely to go home than patients who received physical therapy on 40% of days. As a falsification test, we found that there was no relationship between physical therapy frequency and all-cause mortality. Physical therapy visit frequency was positively associated with discharge to home. Increasing visit frequency of physical therapy in hospitals might reduce the need for postacute care, but randomized controlled trials are needed to confirm the effect.
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Affiliation(s)
- Daniel L Young
- Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Joshua K Johnson
- Department of Physical Medicine & Rehabilitation, Cleveland Clinic, Cleveland, Ohio, USA
- Rehabilitation and Sports Therapy, Cleveland Clinic, Cleveland, Ohio, USA
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ning Guo
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Maylyn Martinez
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Michael B Rothberg
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
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Fitzhugh N, Rasmussen LR, Simoni AH, Valentin JB. Misuse of multinomial logistic regression in stroke related health research: A systematic review of methodology. Eur J Neurosci 2023; 58:3116-3131. [PMID: 37442794 DOI: 10.1111/ejn.16084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 06/13/2023] [Accepted: 06/17/2023] [Indexed: 07/15/2023]
Abstract
Multinomial logistic regression (MLR) is often used to model the association between a nominal outcome variable and one or more covariates. The results of MLR are interpreted as relative risk ratios (RRR) and warrant a more coherent interpretation than ordinary logistic regression. Some authors compare the results of MLR to ordinal logistic regression (OLR), irrespective of the fact that these estimate different quantities. We aim to investigate the time trends in the use and misuse of MLR in studies including stroke patients, specifically the extent to which (1) the results are denoted as anything other than RRR, (2) comparisons are made of results with results of OLR and (3) results have been interpreted coherently. Secondarily, we examine the use of model validation techniques in studies with predictive aims. We searched EMBASE and PubMed for articles using MLR on populations of stroke patients. Identified studies were screened, and information pertaining to our aims was extracted. A total of 285 articles were identified through a systematic literature search, and 68 of these were included in the review. Of these, 60 articles (88%) did not denote exponentiated coefficients of MLR as relative risk ratios but rather some other measure. Additionally, 63 articles (93%) interpreted the results of MLR in a non-coherent manner. Two articles attempted to compare MLR results with those of OLR. Nine studies attempted to use MLR for predictive means, and three used relevant validation techniques. From these findings, it is clear that the interpretation of MLR is often suboptimal.
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Affiliation(s)
- Nicholas Fitzhugh
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Gistrup, Denmark
- Danish Health Technology Council (Behandlingsrådet), Aalborg, Denmark
| | - Line Ryberg Rasmussen
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Gistrup, Denmark
| | - Amalie Helme Simoni
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Gistrup, Denmark
| | - Jan Brink Valentin
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Gistrup, Denmark
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Gore S, Blackwood J, Emily H, Natalia F. Determinants of acute care discharge in adults with chronic obstructive pulmonary disease. Physiother Theory Pract 2023; 39:39-48. [PMID: 34802385 DOI: 10.1080/09593985.2021.2001883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
CONCLUSIONS In adults with COPD basic mobility scores on the AM-PAC "6-clicks" measure completed at discharge had the best sensitivity and specificity for predicting discharge to home and need for rehab services.
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Affiliation(s)
- Shweta Gore
- Physical Therapy, MGH Institute of Health Professions, Boston, MA, USA
| | - Jennifer Blackwood
- Physical Therapy Department, University of Michigan-Flint, Flint, MI, USA
| | - Houser Emily
- Physical Therapy, Michigan Medicine, Ann Arbor, MI, USA
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Hayes HA, Marcus R, Stoddard GJ, McFadden M, Magel J, Hess R. Is the Activity Measure for Postacute Care "6-Clicks" Tool Associated With Discharge Destination Postacute Stroke? Arch Rehabil Res Clin Transl 2022; 4:100228. [PMID: 36545521 PMCID: PMC9761263 DOI: 10.1016/j.arrct.2022.100228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objective To investigate the association of poststroke physical function, measured within 24 hours prior to discharge from the acute care hospital using Activity Measure for Postacute Care (AM-PAC) Inpatient "6-Clicks" scores and discharge destination (home vs facility and inpatient rehabilitation facility [IRF] vs skilled nursing facility [SNF]). Design Retrospective cross-sectional cohort study. Setting Acute care, University Hospital. Participants Individuals post acute ischemic stroke, N=721, 51.3% male, mean age 63.6±16.4 years. Interventions Not applicable. Main Outcome Measures AM-PAC "6-Clicks" 3 domains: basic mobility, daily activity, and applied cognition. Results AM-PAC basic mobility and daily activity were significant predictors of discharge. Those in the home discharge group had AM-PAC basic mobility mean t scale score of 48.5 compared with a score of 34.8 for individuals sent to a facility and daily activity score of 47.2 compared with 32.7 for individuals sent to a facility. The AM-PAC variables accounted for an additional 24% of the variance in the discharge destination, with basic mobility and daily activity accounting for most of the variance.The AM-PAC scores were not statistically different and were not able to discriminate between placement in an IRF vs SNF. The mean basic mobility t scale score for individuals going to an IRF was 34.9 compared with 34.6 for those going to an SNF. The daily activity score for IRF was 32.8 compared with 32.6 for SNF. The AM-PAC accounted for no additional variance in discharge destination to an IRF or SNF. Conclusions The AM-PAC Inpatient "6-Clicks" 3 domains are able to distinguish individuals with stroke being discharged to home from postacute care (PAC) but not for differentiating between PAC facilities (IRF vs SNF) in this cohort of individuals post stroke.
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Affiliation(s)
- Heather Anne Hayes
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT
| | - Robin Marcus
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT
| | | | - Molly McFadden
- Division of Epidemiology, University of Utah, Salt Lake City, UT
| | - Jake Magel
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT
| | - Rachel Hess
- Division of Health System Innovation and Research, University of Utah, Salt Lake City, UT
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The Predictive Validity of Functional Outcome Measures With Discharge Destination for Hospitalized Medical Patients. Arch Rehabil Res Clin Transl 2022; 4:100231. [PMID: 36545519 PMCID: PMC9761250 DOI: 10.1016/j.arrct.2022.100231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objective To investigate the predictive validity for discharge to home or facility of 4 functional mobility outcome measures. Design Retrospective, observational study. Setting Urban, academic hospital in the United States. Participants Adult patients (N=3999) admitted to medical units between June 1, 2019, and February 29, 2020, with 2 or more recorded scores on each of 4 tools: Activity Measure for Post-Acute Care (AM-PAC) 6-Clicks Basic Mobility and Daily Activity, Henry Ford Mobility Level, and The Johns Hopkins Highest Level of Mobility. Interventions Not applicable. Main Outcome Measures Mobility scores and discharge destination. Results For the 3999 subjects, 51.4% went home at discharge and had higher mean scores on each measure than those not returning home. Both early (I) and later (II) time point for each measure had positive predictability for discharge home. AM-PAC 6-Clicks had the highest confidence intervals for early and later recorded scores. The c-statistic value for Basic Mobility I (cut point=16) was 0.74 and for II (cut point=18) was, 0.79. The value for Daily Activity I (cut point=18) was 0.75 and for Daily Activity II (cut point=18) was 0.80). The Johns Hopkins Highest Level of Mobility and Henry Ford Mobility Level measures were less discriminative at initial score (c-statistic 0.704 and 0.665, respectively) and final score (c-statistic 0.74 and 0.75, respectively). Conclusions Functional outcome measures have good predictive validity for discharge destination. The AM-PAC Basic mobility score appears to have a slightly higher confidence interval than the other tools in this study design.
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Herbold J, Rajaraman D, Taylor S, Agayby K, Babyar S. 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. Arch Rehabil Res Clin Transl 2022; 4:100204. [PMID: 36123982 PMCID: PMC9482026 DOI: 10.1016/j.arrct.2022.100204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A standardized Basic Mobility score of 42.9 predicts home vs institution discharge. Orthopedic diagnoses may have a cutoff score of 41.5 to predict home discharge. Cutoff scores vary by diagnostic group and discharge destination. Cutoff scores vary by time of assessment relative to admission for some diagnoses.
Objectives To establish cutoff scores for the Activity Measure for Post-Acute Care “6-Clicks” standardized Basic Mobility scores (sBMSs) for predicting discharge destination after acute care hospitalization for diagnostic subgroups within an acute care population and to evaluate the need for a second score to improve predictive ability. Design Retrospective, observational design. Setting Major medical center in metropolitan area. Participants Electronic medical records of 1696 adult patients (>18 years) admitted to acute care from January to October 2018. Records were stratified by orthopedic, cardiac, pulmonary, stroke, and other neurological diagnoses (N=1696). Interventions: None Main Outcome Measure Physical therapists scored patients’ sBMSs after referral for physical therapy and prior to discharge. Receiver operating characteristic curves delineated sBMS cutoff scores distinguishing various pairings of home, home with services, inpatient rehabilitation, or skilled nursing facility discharges. First and second sBMSs were compared with percentage change of the area under the curve and inferential statistics. Results Home vs institution cutoff score was 42.88 for combined sample, pulmonary and neurological cases. The cutoff score for orthopedic diagnoses score was 41.46. Cardiac and stroke model quality invalidated cutoff scores. Home without services vs skilled nursing discharges and home with services vs skilled nursing discharges were predicted with varying cutoff scores per diagnosis. sBMS cutoff scores collected closer to discharge were either the same or higher than first cutoffs, with varying effects on predictive ability. Conclusions sBMSs can help decide institution vs home discharge and finer distinctions among discharge settings for some diagnostic groups. A single sBMS may provide sufficient assistance with discharge destination decisions but timing of scoring and diagnostic group may influence cutoff score selection.
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Affiliation(s)
- Janet Herbold
- Post Acute Services, Burke Rehabilitation Hospital, White Plains, NY
| | - Divya Rajaraman
- Department of Physical Therapy, Hunter College, The City University of New York, New York, NY
| | - Sarah Taylor
- Department of Physical Therapy, Hunter College, The City University of New York, New York, NY
| | - Kirollos Agayby
- Department of Physical Therapy, Hunter College, The City University of New York, New York, NY
| | - Suzanne Babyar
- Department of Physical Therapy, Hunter College, The City University of New York, New York, NY
- Corresponding author Suzanne Babyar, PT, PhD, Department of Physical Therapy, Hunter College, The City University of New York, 425 East 25th Street, New York, NY 10010.
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Rehabilitation Course and Management of Intravascular Lymphoma Presenting as Recurrent Strokes: A Case Report. REHABILITATION ONCOLOGY 2022. [DOI: 10.1097/01.reo.0000000000000319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mclaughlin KH, Young D, Friedman LA, Peters J, Vickery G, Hoyer EH. An Interprofessional Examination of the Johns Hopkins Mobility Goal Calculator among Hospitalized Post-Surgical Patients. Nurs Health Sci 2022; 24:735-741. [PMID: 35780301 DOI: 10.1111/nhs.12972] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/29/2022] [Accepted: 06/30/2022] [Indexed: 11/28/2022]
Abstract
Individualized mobility goals created using a goal calculator have been shown to increase patient mobility on medical nursing units, but have not been studied among postoperative populations. This study aimed to examine the feasibility of an automated mobility goal calculator on a postoperative nursing unit. To examine this, we utilized the goal calculator to create goals for patients (N=128) following surgery and mobilized each patient with either a nurse or physical therapist. Each patient's highest level of mobility was recorded and providers completed surveys on the appropriateness of calculated goals. Overall, 94% of patients achieved calculated goals. Patients with more pain achieved goals significantly less often than those with less pain. Those with higher mobility achieved their goals similarly with either provider. Providers reported 47% of goals were appropriate, with goals being set too low as the primary reason for goals being inappropriate. We conclude that the automated goal calculator can be used on postoperative nursing units to set realistic goals for patients after surgery. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Kevin H Mclaughlin
- Johns Hopkins University, School of Medicine, Department of Physical Medicine and Rehabilitation
| | - Daniel Young
- University of Nevada, Las Vegas, Department of Physical Therapy
| | - Lisa A Friedman
- Johns Hopkins University, School of Medicine, Department of Medicine
| | | | | | - Erik H Hoyer
- Johns Hopkins University, School of Medicine, Department of Physical Medicine and Rehabilitation
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Casertano LO, Bassile CC, Pfeffer JS, Morrone TM, Stein J, Willey JZ, Rao AK. Utility of the AM-PAC "6 Clicks" Basic Mobility and Daily Activity Short Forms to Determine Discharge Destination in an Acute Stroke Population. Am J Occup Ther 2022; 76:23318. [PMID: 35771733 DOI: 10.5014/ajot.2022.047381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE The American Heart Association and American Stroke Association recommend early identification of level of rehabilitative care as a priority after stroke. OBJECTIVE To evaluate the utility of the Activity Measure for Post-Acute Care (AM-PAC) "6 Clicks" Daily Activity and Basic Mobility forms to determine the next level of rehabilitation after hospitalization for adults with stroke. DESIGN Retrospective cohort design using medical records from 2015 to 2016. SETTING Major urban hospital. PARTICIPANTS Patients admitted to the stroke service, with a confirmed stroke, who were seen by a physical or occupational therapist; who had a 6 Clicks Basic Mobility or Daily Activity score at initial evaluation; and who were discharged to home, an acute inpatient rehabilitation facility (IRF), or a subacute skilled nursing facility (SNF). OUTCOMES AND MEASURES Length of stay and discharge destination. RESULTS Seven hundred four participants (M age = 68.28 yr; 51.21% female) were included. Analysis of variance and receiver operating characteristic curves were performed. Daily Activity scores were highest for home discharge, lower for IRF discharge, and lowest for SNF discharge; Basic Mobility showed a similar pattern. Cutoff values distinguishing home from further inpatient rehabilitation were 44.50 for Basic Mobility and 39.40 for Daily Activity scores (area under the curve [AUC] = .82 for both forms), with scores of 34.59 (AUC = 0.64) and 31.32 (AUC = 0.67) separating IRF from SNF, respectively. CONCLUSIONS AND RELEVANCE Therapists should incorporate 6 Clicks scores into their discharge planning. What This Article Adds: This research demonstrates the utility of an outcome measure in the acute care setting that assists in planning discharge destination for patients with stroke.
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Affiliation(s)
- Lorenzo O Casertano
- Lorenzo O. Casertano, PT, DPT, NCS, is Advanced Clinician-Acute Care Neurology, Department of Physical Therapy, New York-Presbyterian Hospital, New York, NY;
| | - Clare C Bassile
- Clare C. Bassile, PT, EdD, is Associate Professor, Program in Physical Therapy, Department of Rehabilitation and Regenerative Medicine, Columbia University Medical Center, New York, NY
| | - Jacqueline S Pfeffer
- Jacqueline S. Pfeffer, PT, MPH, is Compliance Coordinator, Department of Physical Therapy, New York-Presbyterian Hospital, New York, NY
| | - Theresa M Morrone
- Theresa M. Morrone, PT, MS, CCS, passed away during the process of resubmission. At the time of the study, Morrone was Director, Department of Physical Therapy, New York-Presbyterian Hospital, New York, NY
| | - Joel Stein
- Joel Stein, MD, is Professor and Chair, Department of Rehabilitation and Regenerative Medicine, Columbia University Vagelos College of Physicians and Surgeons, and Chief, Department of Rehabilitation Medicine, New York-Presbyterian Hospital, New York, NY
| | - Joshua Z Willey
- Joshua Z. Willey, MD, MS, is Assistant Attending and Associate Professor of Neurology, Department of Rehabilitation and Regenerative Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Ashwini K Rao
- Ashwini K. Rao, OTR, EdD, FAOTA, is Professor, Program in Physical Therapy, Department of Rehabilitation and Regenerative Medicine, Columbia University Medical Center, New York, NY
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Johnson JK, Lapin B, Bethoux F, Skolaris A, Katzan I, Stilphen M. Patient Versus Clinician Proxy Reliability of the AM-PAC "6-Clicks" Basic Mobility and Daily Activity Short Forms. Phys Ther 2022; 102:6563497. [PMID: 35385119 DOI: 10.1093/ptj/pzac035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 12/14/2021] [Accepted: 02/08/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The purpose of this study was to test the reliability of the Activity Measure for Post-Acute Care (AM-PAC) "6-Clicks" mobility and activity short forms between patients and therapist proxies. As a secondary aim, reliability was examined when patients completed their self-report before versus after the therapist evaluation. METHODS Patients being seen for an initial physical therapist (N = 70) or occupational therapist (N = 71) evaluation in the acute care hospital completed the "6-Clicks" mobility short form (if a physical therapist evaluation) or activity short form (if an occupational therapist evaluation). Whether patients completed their self-assessment before or after the evaluation was randomized. Patient- and therapist-rated "6-Clicks" raw scores were converted to AM-PAC T-scores for comparison. Reliability was assessed with intraclass correlation coefficients (ICCs) and Bland-Altman plots, and agreement was assessed with weighted kappa values. RESULTS The ICCs for the "6-Clicks" mobility and daily activity short forms were 0.57 (95% CI = 0.42-0.69) and 0.45 (95% CI = 0.28-0.59), respectively. For both short forms, reliability was higher when the patient completed the self-assessment after versus before the therapist evaluation (ICC = 0.67, 95% CI = 0.47-0.80 vs ICC = 0.50, 95% CI = 0.26-0.67 for the mobility short form; and ICC = 0.52, 95% CI = 0.29-0.70 vs ICC = 0.34, 95% CI = 0.06-0.56 for the activity short form). CONCLUSION Reliability of the "6-Clicks" total scores was moderate for both the mobility and activity short forms, though higher for the mobility short form and when patients' self-report occurred after the therapist evaluation. IMPACT Reliability of the AM-PAC "6-Clicks" short forms is moderate when comparing scores from patients with those of therapists responding as proxies. The short forms are useful for measuring participants' function in the acute care hospital; however, it is critical to recognize limitations in reliability between clinician- and patient-reported AM-PAC scores when evaluating longitudinal change and recovery.
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Affiliation(s)
- Joshua K Johnson
- Department of Physical Medicine and Rehabilitation, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Rehabilitation and Sports Therapy, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Center for Value-Based Care Research, Community Care, Cleveland Clinic, Cleveland, Ohio, USA
| | - Brittany Lapin
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Francois Bethoux
- Department of Physical Medicine and Rehabilitation, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Alexis Skolaris
- Department of Physical Medicine and Rehabilitation, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Irene Katzan
- Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mary Stilphen
- Department of Rehabilitation and Sports Therapy, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
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14
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Johnson JK, Rothberg MB, Adams K, Lapin B, Keeney T, Stilphen M, Bethoux F, Freburger J. Association of Physical Therapy Treatment Frequency in the Acute Care Hospital With Improving Functional Status and Discharging Home. Med Care 2022; 60:444-452. [PMID: 35293885 PMCID: PMC9106906 DOI: 10.1097/mlr.0000000000001708] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Physical therapists (PTs) are consulted to address functional deficits during hospitalization, but the effect of PT visit frequency on patients' outcomes is not clear. OBJECTIVE The objective of this study was to examine whether PT visit frequency is independently associated with functional improvement, discharge home, and both outcomes combined. RESEARCH DESIGN This was a retrospective cohort study. SUBJECTS Patients discharged from hospitals in 1 health system between 2017 and 2020, stratified by diagnostic subgroup: cardiothoracic and vascular, general medical/surgical, neurological, oncology, and orthopedic. MEASURES PT visit frequency was categorized as ≤2, >2-4, >4-7, >7 visits/week. Functional improvement was defined as ≥5-point improvement in Activity Measure for Post-Acute Care mobility score. Other outcomes were discharge home and both outcomes combined. RESULTS There were 243,779 patients included. Proportions within frequency categories ranged from 11.0% (>7 visits/wk) to 40.5% (≤2 visits/wk) and varied by subgroup. In the full sample, 36% of patients improved function, 64% were discharged home, and 27% achieved both outcomes. In adjusted analyses, relative to ≤2 visits/week, the adjusted relative risk (aRR) for functional improvement increased incrementally with higher frequency (aRR=1.20, 95% confidence interval: 1.14-1.26 for >2-4 visits to aRR=1.78, 95% confidence interval: 1.55-2.03 for >7 visits). For all patients and within subgroups, the higher frequency was also associated with a greater likelihood of discharging home and achieving both outcomes. CONCLUSIONS More frequent PT visits during hospitalization may facilitate functional improvement and discharge home. Most patients, however, receive infrequent visits. Further research is needed to determine the optimal delivery of PT services to meet individual patient needs.
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Affiliation(s)
- Joshua K. Johnson
- Department of Physical Medicine and Rehabilitation, Neurological Institute, Cleveland Clinic
- Rehabilitation and Sports Therapy, Neurological Institute, Cleveland Clinic
- Center for Value-Based Care Research, Community Care, Cleveland Clinic
| | - Michael B. Rothberg
- Center for Value-Based Care Research, Community Care, Cleveland Clinic
- Department of Geriatric and Internal Medicine, Community Care, Cleveland Clinic
| | - Kellie Adams
- Rehabilitation and Sports Therapy, Neurological Institute, Cleveland Clinic
| | - Brittany Lapin
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic
- Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic
| | - Tamra Keeney
- Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital
| | - Mary Stilphen
- Rehabilitation and Sports Therapy, Neurological Institute, Cleveland Clinic
| | - Francois Bethoux
- Department of Physical Medicine and Rehabilitation, Neurological Institute, Cleveland Clinic
| | - Janet Freburger
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh
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15
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Weiss DJ, Wang C, Suen KY, Basford J, Cheville A. Can Proxy Ratings Supplement Patient Report to Assess Functional Domains Among Hospitalized Patients? Arch Phys Med Rehabil 2021; 103:S34-S42.e4. [PMID: 34678294 PMCID: PMC9018891 DOI: 10.1016/j.apmr.2021.08.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 08/09/2021] [Accepted: 08/17/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To (1) characterize the agreement between patient and proxy responses on a multidimensional computerized adaptive testing (MCAT) measure of function, and to (2) determine whether patient, proxy, or MCAT score characteristics identify when a proxy report can be used as a substitute for patient report in clinical decision making. DESIGN A psychometric study of the Functional Assessment in Acute Care MCAT (FAMCAT) and its three scales (Applied Cognition, Daily Activity, and Basic Mobility). SETTING An Upper Midwestern quaternary academic medical center PARTICIPANTS: A total of 300 pairs of patients [average age 60.9 years (range 19 to 89)] hospitalized on general medical services or readmitted to surgical services for postoperative complications and their proxies [average age 60.5 years (range 20-88]. INTERVENTION Not applicable. MAIN OUTCOME MEASURES There were three outcomes:. 1) Agreement between patient and proxy scores on the FAMCAT domains, as well as age and gender, analyzed with univariate and multivariate analysis of variance (MANOVA); 2) Associations of patient-proxy relationship and FAMCAT score characteristics with patient-proxy score agreement; and 3) Presence of psychometrically significant intra-dyad differences in FAMCAT scores. RESULTS The results of the MANOVA and follow-up ANOVAs indicated that there were no statistically significant differences in FAMCAT scale scores between patient and proxy estimates for either the Daily Activity or Basic Mobility scales. There were significant differences for the Applied Cognition scale (p < .005) between mean patient and proxy scores, with proxies rating patients as functioning at a higher level (mean = 0.42) than patients did themselves (mean = 0.00). However, psychometrically significant intra-dyadic Applied Cognition score differences occurred in only 14% of dyads, compared to 25% in the other two scales. Gender and age were associated with patient-proxy agreement, but the patterns were not sufficiently consistent to permit generalizations regarding the likely validity of a proxy's scores. CONCLUSIONS Patient and proxy FAMCAT Daily Activity and Basic Mobility scores did not differ significantly, and proxy reporting offers a credible surrogate for patient report on these domains. Low rates of psychometrically significant intra-dyadic score differences suggest that proxy report may serve as a low resolution screen for functional deficits in all FAMCAT domains. Approximately half the proxies provided multi-domain profile ratings on the three scales that did not differ significantly from these of the associated patients, but more research is needed to identify situations in which proxy profiles could be used in place of those provided by patients.
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Affiliation(s)
| | - Chun Wang
- University of Washington, Seattle, WA
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16
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Weiss DJ, Wang C, Basford JR, Suen KY, Alvarado IM, Cheville A. Does the Mode of PROM Administration Affect the Responses of Hospitalized Patients? Arch Phys Med Rehabil 2021; 103:S59-S66.e3. [PMID: 34606758 PMCID: PMC8971138 DOI: 10.1016/j.apmr.2021.07.813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/29/2021] [Accepted: 07/21/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine whether a multidimensional computerized adaptive test, the Functional Assessment in Acute Care Multidimensional Computerized Adaptive Test (FAMCAT), could be administered to hospitalized patients via a tablet computer rather than being orally administered by an interviewer. DESIGN A randomized comparison of the responses of hospitalized patients to interviewer vs. tablet delivery of the FAMCAT and its assessment of Applied Cognition, Daily Activity, and Basic Mobility. SETTING Two quaternary teaching hospitals in the Upper Midwest. PARTICIPANTS A total of 300 patients (127 men, 165 females ), average age 61.2 (range 18 to 97)) hospitalized on medical, or re-hospitalized on surgical, services were randomly assigned to either a tablet (150) or an interview (150) group. INTERVENTION Electronic tablet versus interview. MAIN OUTCOME MEASURES Item response theory (IRT) point estimates of the FAMCAT latent scales, their psychometric standard errors, number of items administered per domain, the determinant (an indicator of overall precision of the latent trait vector), as well as the time that patients required to complete their FAMCAT sessions. RESULTS Of the 300 patients, 292 completed their assessments. (The assessments of 4 individuals in each group were interrupted by clinical care and were not included in the analyses.) A significant (p = .009) mode effect (i.e., interview vs. tablet) was identified when all outcome variables were considered simultaneously. However, the only outcome that was affected by the administration mode was test duration: tablet administration reduced the roughly 6-minute test time required by both approaches by only 20 seconds which, while statistically significant, was clinically insignificant. CONCLUSIONS The results of a FAMCAT assessment, at least for this cohort of hospitalized patients, are independent of administration via tablet computer or interview.
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Affiliation(s)
- David J Weiss
- Department of Psychology, University of Minnesota, Minneapolis, MN.
| | - Chun Wang
- College of Education, University of Washington, Seattle, WA
| | - Jeffrey R Basford
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
| | - King Yiu Suen
- Department of Psychology, University of Minnesota, Minneapolis, MN
| | - Isabella M Alvarado
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
| | - Andrea Cheville
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
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Cheville AL, Wang C, Yost KJ, Teresi JA, Ramirez M, Ocepek-Welikson K, Ni P, Marfeo E, Keeney T, Basford JR, Weiss DJ. Improving the Delivery of Function-Directed Care During Acute Hospitalizations: Methods to Develop and Validate the Functional Assessment in Acute Care Multidimensional Computerized Adaptive Test (FAMCAT). Arch Rehabil Res Clin Transl 2021; 3:100112. [PMID: 34179750 PMCID: PMC8212002 DOI: 10.1016/j.arrct.2021.100112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To (1) develop a patient-reported, multidomain functional assessment tool focused on medically ill patients in acute care settings; (2) characterize the measure's psychometric performance; and (3) establish clinically actionable score strata that link to easily implemented mobility preservation plans. DESIGN This article describes the approach that our team pursued to develop and characterize this tool, the Functional Assessment in Acute Care Multidimensional Computer Adaptive Test (FAMCAT). Development involved a multistep process that included (1) expanding and refining existing item banks to optimize their salience for hospitalized patients; (2) administering candidate items to a calibration cohort; (3) estimating multidimensional item response theory models; (4) calibrating the item banks; (5) evaluating potential multidimensional computerized adaptive testing (MCAT) enhancements; (6) parameterizing the MCAT; (7) administering it to patients in a validation cohort; and (8) estimating its predictive and psychometric characteristics. SETTING A large (2000-bed) Midwestern Medical Center. PARTICIPANTS The overall sample included 4495 adults (2341 in a calibration cohort, 2154 in a validation cohort) who were admitted either to medical services with at least 1 chronic condition or to surgical/medical services if they required readmission after a hospitalization for surgery (N=4495). INTERVENTION Not applicable. MAIN OUTCOME MEASURES Not applicable. RESULTS The FAMCAT is an instrument designed to permit the efficient, precise, low-burden, multidomain functional assessment of hospitalized patients. We tried to optimize the FAMCAT's efficiency and precision, as well as its ability to perform multiple assessments during a hospital stay, by applying cutting edge methods such as the adaptive measure of change (AMC), differential item functioning computerized adaptive testing, and integration of collateral test-taking information, particularly item response times. Evaluation of these candidate methods suggested that all may enhance MCAT performance, but none were integrated into initial MCAT parameterization. CONCLUSIONS The FAMCAT has the potential to address a longstanding need for structured, frequent, and accurate functional assessment among patients hospitalized with medical diagnoses and complications of surgery.
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Key Words
- AM-PAC, Activity Measure of Post-Acute Care
- AMC, Adaptive Measurement of Change
- Activities of daily living
- CAT, computerized adaptive testing
- Cognition
- DIF, differential item functioning
- EHR, electronic health record
- FAM, Functional Assessment for Acute Care Multidimensional
- FAMCAT, Functional Assessment in Acute Care Multidimensional Computer Adaptive Test
- HIPAA, Health Insurance Portability and Accountability Act of 1996
- IRT, item response theory
- MCAT, multidimensional computerized adaptive testing
- MGRM, multidimensional graded response model
- MIRT, multidimensional item response theory
- PAC, postacute care
- PH, physical function
- PROM, patient-reported outcome measure
- PROMIS, Patient-Reported Outcomes Measurement Information System
- Rehabilitation
- SF, short form
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Affiliation(s)
- Andrea L. Cheville
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota
| | - Chun Wang
- College of Education, University of Washington, Seattle, Washington
| | - Kathleen J. Yost
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Jeanne A. Teresi
- Research Division, Hebrew Home at Riverdale, Riverdale, New York
- Columbia University Stroud Center at New York State Psychiatric Institute, New York, New York
| | - Mildred Ramirez
- Research Division, Hebrew Home at Riverdale, Riverdale, New York
| | | | - Pengsheng Ni
- School of Public Health, Boston University, Boston, Massachusetts
| | - Elizabeth Marfeo
- Tufts University, Department of Occupational Therapy, Medford, Massachusetts
| | - Tamra Keeney
- Division of Palliative Care and Geriatric Medicine, Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, Massachusetts
| | - Jeffrey R. Basford
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota
| | - David J. Weiss
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota
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Warren M, Knecht J, Verheijde J, Tompkins J. Association of AM-PAC "6-Clicks" Basic Mobility and Daily Activity Scores With Discharge Destination. Phys Ther 2021; 101:6124779. [PMID: 33517463 DOI: 10.1093/ptj/pzab043] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/25/2020] [Accepted: 11/29/2020] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The objective was to use the Activity Measure for Post-Acute Care "6-Clicks" scores at initial physical therapist and/or occupational therapist evaluation to assess (1) predictive ability for community versus institutional discharge, and (2) association with discharge destination (home/self-care [HOME], home health [HHA], skilled nursing facility [SNF], and inpatient rehabilitation facility [IRF]). METHODS In this retrospective cohort study, initial "6-Clicks" Basic Mobility and/or Daily Activity t scores and discharge destination were obtained from electronic health records of 17,546 inpatient admissions receiving physical therapy/occupational therapy at an academic hospital between October 1, 2015 and August 31, 2018. For objective (1), postacute discharge destination was dichotomized to community (HOME and HHA) and institution (SNF and IRF). Receiver operator characteristic curves determined the most predictive Basic Mobility and Daily Activity scores for discharge destination. For objective (2), adjusted odds ratios (OR) from multinomial logistic regression assessed association between discharge destination (HOME, HHA, SNF, IRF) and cut-point scores for Basic Mobility (≤40.78 vs >40.78) and Daily Activity (≤40.22 vs >40.22), accounting for patient and clinical characteristics. RESULTS Area under the curve for Basic Mobility was 0.80 (95% CI = 0.80-0.81) and Daily Activity was 0.81 (95% CI = 0.80-0.82). The best cut-point for Basic Mobility was 40.78 (raw score = 16; sensitivity = 0.71 and specificity = 0.74) and for Daily Activity was 40.22 (raw score = 19; sensitivity = 0.68 and specificity = 0.79). Basic Mobility and Daily Activity were significantly associated with discharge destination, with those above the cut-point resulting in increased odds of discharge HOME. The Basic Mobility scores ≤40.78 had higher odds of discharge to HHA (OR = 1.7 [95% CI = 1.5-1.9]), SNF (OR = 7.8 [95% CI = 6.8-8.9]), and IRF (OR = 7.5 [95% CI = 6.3-9.1]), and the Daily Activity scores ≤40.22 had higher odds of discharge to HHA (OR = 1.8 [95% CI = 1.7-2.0]), SNF (OR = 8.9 [95% CI = 7.9-10.0]), and IRF (OR = 11.4 [95% CI = 9.7-13.5]). CONCLUSION 6-Clicks at physical therapist/occupational therapist initial evaluation demonstrated good prediction for discharge decisions. Higher scores were associated with discharge to HOME; lower scores reflected discharge to settings with increased support levels. IMPACT Initial Basic Mobility and Daily Activity scores are valuable clinical tools in the determination of discharge destination.
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Affiliation(s)
- Meghan Warren
- Patient Centered Outcomes Research Institute, Washington, DC, USA.,Department of Physical Medicine and Rehabilitation, Mayo Clinic, Phoenix, Arizona, USA
| | - Jeff Knecht
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Phoenix, Arizona, USA
| | - Joseph Verheijde
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Phoenix, Arizona, USA
| | - James Tompkins
- Department of Rehabilitation Services, Bayhealth, Dover, Delaware, USA
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Harry M, Woehrle T, Renier C, Furcht M, Enockson M. 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. BMJ Open 2021; 11:e044278. [PMID: 33478966 PMCID: PMC7825271 DOI: 10.1136/bmjopen-2020-044278] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To 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. DESIGN Retrospective, observational cohort study of electronic health record data. SETTING Five hospitals in a multistate, integrated healthcare system serving a large, rural US population. PARTICIPANTS The 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. INTERVENTION Occupational and physical therapist use of 6-Clicks daily activity and basic mobility short forms in the post-6-Clicks cohort. PRIMARY AND SECONDARY OUTCOMES Discharge disposition (home, including to assisted living, or skilled nursing facility, including swing beds) and 30-day inpatient readmissions. RESULTS Areas 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. CONCLUSIONS 6-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.
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Affiliation(s)
- Melissa Harry
- Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota, USA
| | - Theo Woehrle
- Telehealth, Essentia Health, Duluth, Minnesota, USA
| | - Colleen Renier
- Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota, USA
| | - Margaret Furcht
- Hospitalist Services, Essentia Health, Duluth, Minnesota, USA
| | - Michelle Enockson
- Rehab Administration, Essentia Health West Region, Fargo, North Dakota, USA
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