Department of Rehabilitation Therapy, Emory University Hospital, Atlanta, Georgia, USA.
School of Interactive Computing, College of Computing, Georgia Institute of Technology, Atlanta, Georgia, USA.
Phys Ther. 2022 Jan 1;102(1). doi: 10.1093/ptj/pzab252.
The objective of this study was to determine the ability of the Activity Measure for Post-Acute Care "6-Clicks" Basic Mobility Short Form to predict patient discharge destination (home vs postacute care [PAC] facility) from the cardiac intensive care unit (ICU), including patients from the cardiothoracic surgical ICU and coronary care unit.
This retrospective cohort study utilized electronic medical records of patients in cardiac ICU (n = 359) in an academic teaching hospital in the southeastern region of United States from September 1, 2017, through August 31, 2018.
The median interquartile range age of the sample was 68 years (75-60), 55% were men, the median interquartile range 6-Clicks score was 16 (20-12) at the physical therapist evaluation, and 79% of the patients were discharged to home. Higher score on 6-Clicks indicates improved function. A prediction model was constructed based on a machine learning approach using a classification tree. The classification tree was constructed and evaluated by dividing the sample into a train-test split using the Leave-One-Out cross-validation approach. The classification tree split the data into 4 distinct groups along with their predicted outcomes. Patients with a 6-Clicks score >15.5 and a score between 11.5 and 15.5 with primary insurance other than Medicare were discharged to home. Patients with a 6-Clicks score between 11.5 and 15.5 with Medicare insurance and those with a score ≤11.5 were discharged to a PAC facility.
Patients with lower 6-Clicks scores were more likely to be discharged to a PAC facility. Patients without Medicare insurance had to be significantly lower functioning, as indicated by lower 6-Clicks scores for PAC facility placement than those with Medicare insurance.
The ability of 6-Clicks along with primary insurance to determine discharge destination allows for early discharge planning from cardiac ICUs.
本研究旨在确定“6 点击活动测量法”基本活动能力简式对心脏重症监护病房（ICU）患者出院去向（居家或康复机构）的预测能力，包括心胸外科 ICU 和冠心病监护病房的患者。
本回顾性队列研究使用了美国东南部一所学术教学医院心脏 ICU（n=359）的电子病历，时间为 2017 年 9 月 1 日至 2018 年 8 月 31 日。
样本的中位数（四分位距）年龄为 68 岁（75-60），55%为男性，物理治疗师评估时 6 点击简式的中位数（四分位距）评分为 16（20-12），79%的患者出院回家。6 点击简式评分越高表示功能越好。使用分类树的机器学习方法构建预测模型。通过使用留一法交叉验证方法将样本分为训练-测试部分来构建和评估分类树。分类树根据 6 点击简式评分将数据分为 4 个不同组及其预测结果。6 点击简式评分>15.5 分且主要保险不是医疗保险的患者出院回家；6 点击简式评分 11.5-15.5 分且主要保险不是医疗保险的患者出院回家；6 点击简式评分 11.5-15.5 分且医疗保险的患者和评分≤11.5 分的患者出院到康复机构。
6 点击简式评分较低的患者更有可能出院到康复机构。没有医疗保险的患者功能显著下降，6 点击简式评分较低，需要安置到康复机构，而不是医疗保险患者。
6 点击简式评分结合主要保险能够确定出院去向，有助于提前规划心脏 ICU 患者的出院计划。
