Abstract
BackgroundPrevention of unplanned hospital readmissions remains a priority in the US healthcare sector. Patient functional status has evolved as an important factor in identifying patients at risk for unplanned readmissions and poor predischarge functional performance has been shown to be predictive of increased readmission risk. Yet, patient functional status appears to be underutilized in readmission prediction models.MethodsTo examine the impact of inpatient functional status (mobility and activity performance) on unplanned 30-day hospital readmissions at two tertiary care hospitals, retrospective cohort analysis was performed on electronic health record data from adult inpatients (N = 26,298) having undergone completed functional assessments during their index hospitalization. Primary outcomes were functional assessment scores and unplanned all-cause patient readmission within 30 days following hospital discharge. Secondary analysis stratified the assessment by discharge destination. Functional assessment scores from the Activity Measure for Post-Acute Care (AM-PAC) “6-Clicks” Basic Mobility Short Form or Daily Activity Short Form were extracted along with patient demographics, admission diagnoses, comorbid conditions, and hospital readmission risk score. ResultsAdjusting for age, sex, and comorbidity, lower AM-PAC “6-Clicks” Basic Mobility and Daily Activity scores resulted in higher readmission rates when each score was considered separately. When both scores were considered, only Daily Activity scores were significant. ConclusionPatients with lower Basic Mobility and Daily Activity scores are at a higher risk for readmission. The relative importance of AM-PAC “6-Click” scores on short-term readmission depends on discharge destination. Timely identification of patient mobility and activity performance may lead to earlier intervention strategies to reduce readmissions.
Highlights
With 27% of acute care hospital readmissions estimated to be potentially preventable [1], the focus on minimizing unplanned patient rehospitalization remains a key priority in the US healthcare sector
We examined the association of Activity Measure for Post-Acute Care (AM-PAC) “6-Clicks” scores with readmission using t tests and χ 2 tests for unadjusted scores, identifying the threshold cut point on each score that maximized the odds ratio (OR) for readmission, and multivariate logistic regression models adjusted for patient age, sex, emergency department admission, surgical status, and number of comorbidities
When looking at adjusted models including both scores for specific discharge destinations, lower Daily Activity was associated with more readmissions among patients going home without additional services, lower Basic Mobility was associated with more readmissions for patients going to SNF, and higher Basic Mobility was associated with more readmissions for patients going home with home healthcare services
Summary
With 27% of acute care hospital readmissions estimated to be potentially preventable [1], the focus on minimizing unplanned patient rehospitalization remains a key priority in the US healthcare sector. Growing evidence points to patient functional status as an important determinant of unplanned hospital readmission [5,6]. Several authors have demonstrated poor predischarge performance in functional mobility and self-care abilities to be predictive of increased acute care hospital readmissions [5,6,7,8]. Prevention of unplanned hospital readmissions remains a priority in the US healthcare sector. Patient functional status has evolved as an important factor in identifying patients at risk for unplanned readmissions and poor predischarge functional performance has been shown to be predictive of increased readmission risk. Patient functional status appears to be underutilized in readmission prediction models
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