Date Presented 04/05/19
Primary Author and Speaker: Lynn Jaffe
Contributing Authors: David Brown, Galen Papkov
PURPOSE: Acute care occupational and physical therapy assessment and recommendations influence the health and well-being clients, to the extent of preventing hospital readmission (Rogers, Bai, Lavin, & Anderson, 2017). The Activity Measure for Post-Acute Care(AM-PAC), a formal assessment used by occupational and physical therapists to determine post-acute discharge outcomes is being used with increasing frequency in healthcare systems due to the quick, yet comprehensive, assessment of patient-related outcome measures (Jette, Haley, Coster, & Ni, 2014). This study explored the usefulness of the AM-PAC in helping to predict appropriate discharge settings by investigating the relationship between the AM-PAC, recommendations of occupational and physical therapists, actual discharge dispositions, and readmission rates. Specifically, this study addressed three objectives: 1) determine if the AM-PAC “6-clicks” Daily Activity or Mobility Score helped occupational and physical therapists predict a discharge setting best suited for the patient; 2) examined the matches between the AM-PAC “6-clicks” Daily Activity or Mobility Score on a patient’s discharge recommendation and the actual discharge location; and 3) identify relationship between actual discharge destination and hospital readmission rates.
DESIGN: Retrospective analysis of de-identified data collected from 3 acute care units of one hospital system between the dates of July 2017 to December 2017.
METHOD: Lee Memorial Hospital System patient admission records utilizing an electronic health records (EHR) system with Mobility AM-PAC evaluation scores by physical therapy and discharge recommendations, Activity AM-PAC scores by occupational therapy and discharge recommendations, patient’s actual discharge disposition, and readmission records of patients within 30 days of initial discharge. A total of 4,549 occupational therapy records and 11,715 physical therapy records were included in the data analysis. A multinomial ordered probit regression model was used to address objectives.
RESULTS: Significant main effects of hospital and AM-PAC scores were found to be important in predicting recommendations made by clinicians. The trend established by the data supports the first objective’s hypothesis that the AM-PAC is useful in predicting a discharge setting best suited for the patient. Findings showed that the lower the AM-PAC score, the higher the level of care recommended. No significant findings were concluded from objective 2. The matches between the Activity or Mobility Score and the actual discharge location varied greatly across all hospitals and discharge settings. For Objective 3, the results indicated a low probability of readmission when using the AM-PAC mobility and activity scores to predict client’s level of function and ensure appropriate discharge location.
CONCLUSION: The data supported our clinical judgement that there would be a correlation between AM-PAC scores, both therapist and physician discharge disposition, as well as readmission rates. Predicted probabilities that clinicians are most likely to recommend a Inpatient/SNF/long term care for patients with mobility or activity scores between 6-17, Home Health for scores ranging from 18-22, and routine discharge for scores above 22. Low scoring individuals were at higher risk to be readmitted. High-scoring individuals were less likely to require readmission. Recommendations for practice and research are discussed. Student research can positively change practice.
References
Rogers, A. T., Bai, G., Lavin, R. A., & Anderson, G. F. (2017). Higher hospital spending on occupational therapy is associated with lower readmission rates. Medical Care Research and Review, 74(6), 668-686. http://dx.doi.org/10.1177/1077558716666981
Jette, A., Haley, S.M., Coster, & W., Ni, P.S. (2007, rev. 2014). AM-PAC short forms for inpatient and outpatient settings: Instruction manual. Boston: Boston University.
Jette, D., Stilphen, M., Ranganathan, V., Passek, S., Frost, F., & Jette, A. (2014). AM-PAC “6-clicks” functional assessment scores predict acute care hospital discharge destination. Physical Therapy 94 (9), 1252-1261.
