AM-PAC“六连击”功能评估得分可预测急性护理医院的出院去向。

AM-PAC "6-Clicks" functional assessment scores predict acute care hospital discharge destination.

机构信息

D.U. Jette, PT, DSc, FAPTA, Department of Rehabilitation and Movement Sciences, University of Vermont, Rowell Bldg 305, 106 Carrigan Dr, Burlington, VT 05405 (USA).

M. Stilphen, PT, DPT, Rehabilitation and Sports Therapy, Cleveland Clinic, Cleveland, Ohio.

出版信息

Phys Ther. 2014 Sep;94(9):1252-61. doi: 10.2522/ptj.20130359. Epub 2014 Apr 24.

DOI:10.2522/ptj.20130359

PMID:24764073

Abstract

BACKGROUND

Physical therapists and occupational therapists practicing in acute care hospitals play a crucial role in discharge planning. A standardized assessment of patients' function could be useful for discharge recommendations.

OBJECTIVES

The study objective was to determine the accuracy of "6-Clicks" basic mobility and daily activity measures for predicting discharge from an acute care hospital to a home or institutional setting.

DESIGN

The study was retrospective and observational.

METHODS

"6-Clicks" scores obtained at initial visits by physical therapists or occupational therapists and patients' discharge destinations were used to develop and validate receiver operating characteristic curves for predicting discharge destination. Positive predictive values (PPV), negative predictive values (NPV), and likelihood ratios were calculated.

RESULTS

Areas under the receiver operating characteristic curves for basic mobility scores were 0.857 (95% confidence interval [CI]=0.852, 0.862) and 0.855 (95% CI=0.850, 0.860) in development and validation samples, respectively. Areas under the curves for daily activity scores were 0.846 (95% CI=0.841, 0.851) and 0.845 (95% CI=0.840, 0.850) in development and validation samples, respectively. Cutoff scores providing the best accuracy for determining discharge destination were 42.9 for basic mobility and 39.4 for daily activity. For basic mobility, the PPV was 0.748 and the NPV was 0.801 in both development and validation samples. For daily activity, the PPVs were 0.787 and 0.784 and the NPVs were 0.748 and 0.746 in development and validation samples, respectively.

LIMITATIONS

Limitations included lack of information on the rater reliability of "6-Clicks" instruments, use of surrogate data for some discharge designations, and use of a clinical database for research purposes.

CONCLUSIONS

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

摘要

背景

在急性护理医院中工作的物理治疗师和作业治疗师在出院计划中发挥着至关重要的作用。对患者功能进行标准化评估有助于为出院建议提供参考。

目的

本研究旨在确定“6 点击”基本活动能力和日常活动测量在预测从急性护理医院出院到家庭或机构环境中的准确性。

设计

本研究为回顾性和观察性研究。

方法

采用物理治疗师或作业治疗师在初始就诊时获得的“6 点击”评分以及患者的出院去向，建立并验证预测出院去向的受试者工作特征曲线。计算阳性预测值（PPV）、阴性预测值（NPV）和似然比。

结果

基本活动能力评分的受试者工作特征曲线下面积分别为 0.857（95%置信区间[CI]=0.852，0.862）和 0.855（95%CI=0.850，0.860），在开发和验证样本中；日常活动评分的曲线下面积分别为 0.846（95%CI=0.841，0.851）和 0.845（95%CI=0.840，0.850）。用于确定出院去向的最佳准确性的截断值分别为基本活动能力 42.9 分和日常活动 39.4 分。在基本活动能力方面，开发和验证样本的 PPV 分别为 0.748 和 0.801，NPV 分别为 0.801 和 0.801。在日常活动方面，开发和验证样本的 PPV 分别为 0.787 和 0.784，NPV 分别为 0.748 和 0.746。