Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama; Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
Arch Phys Med Rehabil. 2023 Sep;104(9):1402-1408. doi: 10.1016/j.apmr.2023.03.018. Epub 2023 Apr 5.
To identify nursing assessments of mobility and activity associated with lower-value rehabilitation services.
Retrospective cohort analysis of admissions from December 2016 to September 2019 SETTING: Medicine, neurology, and surgery units (n=47) at a tertiary hospital.
We included patients with a length of stay ≥7 days on units that routinely assessed patient function (n=18,065 patients).
Not applicable.
We examined the utility of nursing assessments of function to identify patients who received lower-value rehabilitation consults, defined as those who received ≤1 therapy visit.
Patient function was assessed using 2 Activity Measure for Post-Acute Care (AM-PAC or "6 clicks") inpatient short forms: (1) basic mobility (eg, bed mobility, walking) and (2) daily activity (eg, grooming, toileting).
Using an AM-PAC cutoff value of ≥23 correctly identified 92.5% and 98.7% of lower-value physical therapy and occupational therapy visits, respectively. In our cohort, using a cutoff value of ≥23 on the AM-PAC would have eliminated 3482 (36%) of lower-value physical therapy consults and 4076 (34%) of lower-value occupational therapy consults.
Nursing assessment, using AM-PAC scores, can be used to help identify lower-value rehabilitation consults, which can then be reallocated to patients with greater rehabilitation needs. Based on our results, an AM-PAC cutoff value of ≥23 can be used as a guide to help prioritize patients with greater rehabilitation needs.
确定与低价值康复服务相关的护理评估的活动和移动能力。
2016 年 12 月至 2019 年 9 月入院的回顾性队列分析，地点为一家三级医院的内科、神经科和外科病房。
我们纳入了在常规评估患者功能的病房中，住院时间≥7 天的患者（n=18065 例）。
不适用。
我们检查了护理评估功能的效用，以确定接受低价值康复咨询的患者，这些咨询定义为接受≤1 次治疗就诊的患者。
使用 2 种用于急性后护理的活动测量量表（AM-PAC 或“6 点击”）住院短期表单评估患者功能：（1）基本活动能力（如床上移动、行走）和（2）日常活动（如梳妆、上厕所）。
使用 AM-PAC 截断值≥23，正确识别了 92.5%和 98.7%的低价值物理治疗和职业治疗就诊，分别。在我们的队列中，使用 AM-PAC 的截断值≥23 将消除 3482 次（36%）的低价值物理治疗咨询和 4076 次（34%）的低价值职业治疗咨询。
护理评估，使用 AM-PAC 评分，可以用于帮助识别低价值的康复咨询，然后可以将其重新分配给需要更大康复需求的患者。根据我们的结果，AM-PAC 截断值≥23 可以用作指导，帮助确定需要更大康复需求的患者。
