Myszenski Adele L, Divine George, Gibson Jessica, Samuel Preethy, Diffley Michael, Wang Anqi, Siddiqui Aamir
Rehabilitation, Henry Ford Health System, Detroit, USA.
Public Health Sciences, Henry Ford Health System, Detroit, USA.
Cureus. 2024 Sep 18;16(9):e69670. doi: 10.7759/cureus.69670. eCollection 2024 Sep.
Early discharge planning is important for safe, cost-effective, and timely hospital discharges. Patients with deconditioning are at risk for prolonged lengths of stay related to discharge needs. Functional mobility outcome measures are associated with discharge disposition. The purpose of this study is to examine the clinical usefulness of risk categories based on the Activity Measure for Post-Acute Care (AM-PAC) "6-clicks" Basic Mobility (6cBM) scores on predicting discharge destination.
A retrospective cohort study of 3739 adults admitted to general medical units at an urban, academic hospital between January 1, 2018 and February 29, 2020 who received at least two physical therapy visits and had an AM-PAC 6cBM recorded within 48 hours of admission and before discharge. The outcome variable was discharge destination dichotomized to post-acute care facilities (PACF); inpatient rehabilitation, skilled nursing facility, or subacute rehabilitation) or home (with or without home care services). The predictor variables were 6cBM near admission and discharge. Logistic regression was used to estimate the odds of being discharged to PACF compared to home, based on the Three-level risk categorization system: (a) low (6cBM score > 20), (b) moderate (6cBM score 15-19), or (c) high (6cBM score < 14) risk.
Analysis indicated important differences between the three risk categories in both time periods. Based on 6cBM at admission, patients in the high-risk category were nine times more likely to be discharged to PACF than those in the low-risk category. At discharge, those in the high-risk category were 29 times more likely to go to PACF than those in the low-risk category. Other characteristics differentiating patients who went to PACF were sex (males), age (older) and longer hospitalization.
Predicting risk for discharge to a PACF using risk categories based on AM-PAC 6cBM can be useful for early discharge planning.
早期出院计划对于安全、经济高效且及时的医院出院至关重要。身体机能衰退的患者因出院需求而面临住院时间延长的风险。功能活动能力结局指标与出院处置相关。本研究的目的是检验基于急性后期护理活动测量（AM-PAC）“6点击”基本活动能力（6cBM）评分的风险类别在预测出院目的地方面的临床实用性。
一项回顾性队列研究，研究对象为2018年1月1日至2020年2月29日期间入住一家城市学术医院普通内科病房的3739名成年人，这些患者至少接受了两次物理治疗，且在入院后48小时内及出院前记录了AM-PAC 6cBM。结局变量是出院目的地，分为急性后期护理机构（PACF，包括住院康复、专业护理机构或亚急性康复机构）或家庭（有或没有家庭护理服务）。预测变量是入院时和出院时的6cBM。基于三级风险分类系统，使用逻辑回归来估计与出院回家相比，出院到PACF的几率：（a）低风险（6cBM评分>20），（b）中度风险（6cBM评分15-19），或（c）高风险（6cBM评分<14）。
分析表明，在两个时间段内，三个风险类别之间存在重要差异。根据入院时的6cBM，高风险类别患者出院到PACF的可能性是低风险类别患者的九倍。出院时，高风险类别患者前往PACF的可能性是低风险类别患者的29倍。其他区分前往PACF患者的特征包括性别（男性）、年龄（较大）和住院时间较长。
使用基于AM-PAC 6cBM的风险类别预测出院到PACF的风险，对于早期出院计划可能是有用的。
