An Early and Routinely Collected Applied Cognitive Assessment Is Associated with Post-Acute Care Facility Discharge from the Hospital

Abstract

Objective: Although patient cognition can have an impact on health services needs once discharged from the hospital, it is typically not evaluated as part of routine care. We aimed to investigate how routinely collected Activity Measure for Post-Acute Care Applied Cognitive Inpatient Short Form (AM-PAC ACISF) scores, a measure of applied cognition, are associated with discharge disposition. Methods: A retrospective analysis was conducted on 5,236 electronic medical records of adult patients admitted in Johns Hopkins Hospital (JHH) between July 1, 2020 to November 2, 2021. Data was evaluated on whether patients who have been admitted across hospital services required post-acute care based on their AM-PAC ACISF scores. A cut-off raw score of 21 or less was considered as having cognitive impairment. Results: The applied cognitive t-scale scores assessed near time of admission were 9.3 points lower in patients discharged to PAC compared to discharge home. Adjusted regression models showed the odds of PAC needs for patients with AM-PAC ACISF t-scale scores in the lowest tertile were 3.4 times greater than patients in the highest tertile (95% CI 2.8,4.0; p <0.001). Patients with scores in the middle tertile have 1.9 times greater odds for PAC needs than those in the highest tertile (95% CI 1.6,2.2; p<0.001). Bivariate and multivariate logistic regression models showed AM-PAC ACISF, living alone, male gender, prior residence outside of home, admission due to general surgery, neurology, or orthopedics services versus medicine service all increased the odds of discharge to PAC (OR 1.2–4.4, p=<0.001). Conclusions: This study provides empirical evidence that a routinely collected cognitive assessment could be a care coordination strategy to help identify patients who are more likely to require PAC after discharge.