Disposition and Success of Patients Following Discharge in the Acute Setting

Abstract

Abstract: Background & Purpose: Many patients are seen in the hospital by physical therapists who also help decide where the patient will go after discharge (e.g., home, rehab hospital, skilled nursing facility) with the goal being the safest and best quality of life. Therapists may use different tests and measures along with their own professional judgment to help make a recommendation for a discharge location. The purpose of this study was to examine how PT’s recommendation for discharge location, POMA score, “6-clicks” score, age, diagnosis, and gender determine patient’s fall/readmission status after being discharged by hospital. Subjects: There were 113 patients in this study. The inclusion criteria for the patients were that they had to have been seen by a physical therapist in the acute care hospital, were given a physical therapist discharge recommendation, and were over the age of 18. Methods: Data was collected from a single community hospital in the Pacific Northwest. The following data were collected: reason for patient admission to the hospital, POMA score, “6-clicks” score, the therapist’s discharge recommendation, patient age, patient gender, and the actual discharge location of the patient. Approximately 30 days following discharge, the patients were contacted via telephone to determine where they went after discharge, if they were readmitted to the hospital within 30 days, or if they experienced a fall since leaving the hospital. Data were analyzed using independent t-tests, chi-square analysis, and receiver operating characteristic (ROC) curves. Results: There were no significant differences between patients’ “6-clicks” scores (p=0.667), POMA scores (p=0.890), or age (p=0.940) when comparing those who experienced a post-discharge fall and those that did not have a fall. No differences in “6-clicks” scores (p=0.815), POMA scores (p=0.753), and age (p=0.735) were found between patients’ who were readmitted and those not readmitted within 30 days of discharge. No associations were found with mismatch-when the actual discharge location was not the same as the physical therapist’s recommendation for discharge (fall p=0.090, readmission p=0.087), medical diagnosis (fall p=0.989, readmission p=0.002*) or gender (fall p=0.737, readmission p=0.250) with patients’ outcomes (reported falls or no falls and readmitted or not readmitted after 30 days from discharge). Areas under the ROC curves with “6-clicks” for fall status (patients who had either fallen or not fallen post discharge 30 days) was 0.463 (95% confidence interval (CI)=0.288, 0.637) and for readmission status (patients who had either readmitted or did not 30 days after discharge) was 0.477 (95% CI=0.351, 0.604). Areas under the curves with POMA scores for fall status was 0.505 (95% CI=0.331, 0.678) and for readmission status was 0.497 (95% CI=0.376, 0.617). Discussion: The POMA, “6-clicks,” and the physical therapist recommendations were not associated with patient falls or readmissions. Because other studies have shown a relationship between…