Activity Measure for Post-Acute Care "6-Clicks" Basic Mobility Scores Predict Discharge Destination After Acute Care Hospitalization in Select Patient Groups: A Retrospective, Observational Study

Janet Herbold; Divya Rajaraman; Sarah Taylor; Kirollos Agayby; Suzanne Babyar

doi:10.1016/j.arrct.2022.100204

Activity Measure for Post-Acute Care "6-Clicks" Basic Mobility Scores Predict Discharge Destination After Acute Care Hospitalization in Select Patient Groups: A Retrospective, Observational Study

Arch Rehabil Res Clin Transl. 2022 Jul 16;4(3):100204. doi: 10.1016/j.arrct.2022.100204. eCollection 2022 Sep.

Authors

Janet Herbold¹, Divya Rajaraman², Sarah Taylor², Kirollos Agayby², Suzanne Babyar²

Affiliations

¹ Post Acute Services, Burke Rehabilitation Hospital, White Plains, NY.
² Department of Physical Therapy, Hunter College, The City University of New York, New York, NY.

Abstract

Objectives: To establish cutoff scores for the Activity Measure for Post-Acute Care "6-Clicks" standardized Basic Mobility scores (sBMSs) for predicting discharge destination after acute care hospitalization for diagnostic subgroups within an acute care population and to evaluate the need for a second score to improve predictive ability.

Design: Retrospective, observational design.

Setting: Major medical center in metropolitan area.

Participants: Electronic medical records of 1696 adult patients (>18 years) admitted to acute care from January to October 2018. Records were stratified by orthopedic, cardiac, pulmonary, stroke, and other neurological diagnoses (N=1696). Interventions: None.

Main outcome measure: Physical therapists scored patients' sBMSs after referral for physical therapy and prior to discharge. Receiver operating characteristic curves delineated sBMS cutoff scores distinguishing various pairings of home, home with services, inpatient rehabilitation, or skilled nursing facility discharges. First and second sBMSs were compared with percentage change of the area under the curve and inferential statistics.

Results: Home vs institution cutoff score was 42.88 for combined sample, pulmonary and neurological cases. The cutoff score for orthopedic diagnoses score was 41.46. Cardiac and stroke model quality invalidated cutoff scores. Home without services vs skilled nursing discharges and home with services vs skilled nursing discharges were predicted with varying cutoff scores per diagnosis. sBMS cutoff scores collected closer to discharge were either the same or higher than first cutoffs, with varying effects on predictive ability.

Conclusions: sBMSs can help decide institution vs home discharge and finer distinctions among discharge settings for some diagnostic groups. A single sBMS may provide sufficient assistance with discharge destination decisions but timing of scoring and diagnostic group may influence cutoff score selection.

Keywords: AM-PAC, Activity Measure for Post-Acute Care; AUC, area under curve; Continuity of patient care; Hospitalization; IRF, inpatient rehabilitation facility; Outcome assessment, health care 2; Patient discharge; Patient transfer; ROC, receiver operating characteristic; Rehabilitation; SNF, skilled nursing facility; sBMS, AM-PAC “6-Clicks” standardized Basic Mobility scores.