Patient Centered Outcomes Research Institute, Washington, DC, USA.
Department of Physical Medicine and Rehabilitation, Mayo Clinic, Phoenix, Arizona, USA.
Phys Ther. 2021 Apr 4;101(4). doi: 10.1093/ptj/pzab043.
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]).
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.
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]).
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.
Initial Basic Mobility and Daily Activity scores are valuable clinical tools in the determination of discharge destination.
利用康复治疗初始评估时的“6 点击”活动测量评分，评估（1）对社区与机构出院的预测能力，以及（2）与出院去向（家庭/自我护理[HOME]、家庭健康[HHA]、熟练护理设施[SNF]和住院康复设施[IRF]）的关联。
本回顾性队列研究从 2015 年 10 月 1 日至 2018 年 8 月 31 日在学术医院接受物理治疗/职业治疗的 17546 例住院患者的电子健康记录中获取了初始“6 点击”基本活动能力和/或日常活动 t 评分和出院去向。为了实现目标 1，将急性后出院去向分为社区（HOME 和 HHA）和机构（SNF 和 IRF）。接收者操作特征曲线确定了对出院去向最具预测性的基本活动能力和日常活动能力评分。为了实现目标 2，从多变量逻辑回归中调整优势比（OR），评估出院去向（HOME、HHA、SNF、IRF）与基本活动能力（≤40.78 与>40.78）和日常活动能力（≤40.22 与>40.22）的截断值评分之间的关联，同时考虑患者和临床特征。
基本活动能力的曲线下面积为 0.80（95%CI=0.80-0.81），日常活动能力为 0.81（95%CI=0.80-0.82）。基本活动能力的最佳截断值为 40.78（原始分数=16；敏感性=0.71，特异性=0.74），日常活动能力的最佳截断值为 40.22（原始分数=19；敏感性=0.68，特异性=0.79）。基本活动能力和日常活动能力与出院去向显著相关，得分高于截断值者更有可能出院到 HOME。基本活动能力评分≤40.78 与出院到 HHA（OR=1.7[95%CI=1.5-1.9]）、SNF（OR=7.8[95%CI=6.8-8.9]）和 IRF（OR=7.5[95%CI=6.3-9.1]）的相关性更高，日常活动能力评分≤40.22 与出院到 HHA（OR=1.8[95%CI=1.7-2.0]）、SNF（OR=8.9[95%CI=7.9-10.0]）和 IRF（OR=11.4[95%CI=9.7-13.5]）的相关性更高。
康复治疗师/职业治疗师初始评估时的“6 点击”基本活动能力和日常活动能力评分对出院决策具有良好的预测能力。较高的分数与出院到 HOME 相关；较低的分数反映了需要更多支持水平的出院去向。
基本活动能力和日常活动能力的初始评分是确定出院去向的有价值的临床工具。
