Post-acute Care Hospitals Research Articles

Risk assessment model used to predict discharge care after total hip and total knee arthroplasty: A population-based study

BackgroundTransfer to a post-acute care facility or hospital readmission after total joint arthroplasty represent additional costs and increased surgical and health care resource utilization. Accurate prediction of post-acute care factors could help providers to plan the patient's discharge destination and have a positive impact on postoperative outcomes and readmission rates. ObjectiveTo develop a risk assessment model to predict discharge care after total hip arthroplasty (THA) and total knee arthroplasty (TKA). DesignA retrospective longitudinal observational study. Settingsand participants: This study included 209 patients who underwent primary unilateral THA or TKA at a major academic medical center in Switzerland from January 2018 to December 2019. MethodsA collection of computerized- and paper-recorded data identified the discharge destination, socio-demographic factors, comorbidities, and other factors related to the patient. Univariate and multivariate analyses were performed to describe the predictors of post-surgical discharge destinations. ResultsThe characteristics associated with post-acute care after primary unilateral THA or TKA were the absence of a caregiver, advanced age, female gender, presence of walking aids, high ASA score, and comorbidity severity. A prediction model demonstrated that these six characteristics were associated 52 % with discharge to a post-acute care destination. ConclusionsThis study allowed us to identify predictors of discharge to a post-surgical destination. Predictive models can be efficiently used to better predict which patients are predisposed to post-acute care after hospital discharge. Further studies are needed to determine the optimal criteria for different destinations.

Characteristics Associated with Long-Term Outcomes in Severe COVID-19 Patients after a Post-Acute Care Hospitalization: A Prospective Cohort Study

ObjectivesTo describe characteristics associated with long-term outcomes in severe COVID-19 patients admitted to a post-acute care facility (PACF). DesignProspective cohort. Setting and ParticipantsConsecutive severe COVID-19 admitted to a PACF from April 2020 to August 2021. MethodsPatients were followed for 180 days after discharge. Functional outcomes were measured by the modified Barthel index and further stratified into good outcome (for those independent, mildly dependent, or moderately dependent) and into bad outcome (for those severely dependent, completely dependent, or dead). Multivariate binary logistic regression was performed to evaluate between patients’ characteristics and long-term outcomes. ResultsA total of 186 patients admitted from 17 different acute hospitals were included. Median age was 67 years, 88% of patients were previously independent, 95% were admitted to the ICU, and 85% were mechanically ventilated during the acute hospitalization. Median (interquartile range) Barthel indexes at admission, discharge, and 180-day follow-up were 9 (1-23), 81 (45-92), and 100 (98-100) (P < .001), respectively. In addition, 180-day mortality was 17.2%. Baseline functional status, comorbidities, and functional status at admission to the PACF were associated with bad outcome at 180-day follow-up, after multivariate binary logistic regression. Conclusions and ImplicationsPatients with severe COVID-19 admitted to a PACF had substantial functional improvements at PACF discharge and during 180-day follow-up. These findings may help prognosticate and manage post-acute severe COVID-19 patients.

Post-acute day and night non-invasive respiratory intervention use and outcome: A brief report.

This study aimed to describe daytime and nighttime use and outcome of non-invasive respiratory intervention (NIRI) for infants born prematurely and for children with medical complexity (CMC) during a post-acute care hospital (PACH) admission. Thirty-eight initial PACH admissions (October 2018 through September 2020) for premature infants (< 1 year; n = 19) and CMC (> 1 year; n = 19) requiring NIRI during the day and/or at night were retrospectively examined. Measures included: 1) daytime and nighttime NIRI use by type (supplemental oxygen therapy via low-flow nasal cannula or positive airway pressure [PAP] via high-flow nasal cannula, continuous positive airway pressure, or biphasic positive airway pressure at admission and discharge) and 2) daytime and nighttime NIRI outcome-reduction, increase, or no change from admission to discharge. For the total sample (n = 38), daytime vs nighttime NIRI use was significantly different (p < 0.001). At both admission and discharge, supplemental oxygen was the most common NIRI during the day, while PAP was most common at night. From admission to discharge, seven (18%) infants and children had a positive change (reduced NIRI) during the day, while nine (24%) had a positive change at night. At discharge, 11/38 (29%) infants and children required no daytime NIRI, while 4/38 (11%) required no day or night NIRI. NIRI use differs between day and night at PACH admission and discharge for CMC. Reductions in NIRI were achieved during the day and at night from PACH admission to discharge for both infants born prematurely and for children with varied congenital, neurological, or cardiac diagnoses.

Protocol of a mixed method research design to study medical respite programs for persons experiencing homelessness.

Medical Respite Programs (MRPs) characterize a care model that has been developed to address the health care and social needs of persons experiencing homelessness by providing post-acute hospital care in a safe environment. Although this model has been shown to reduce hospitalizations, improve health outcomes and increase access to health services, prior studies of MRP programs and outcomes have been limited to individual sites and may not generalize to the population of individuals receiving MRP care. This study protocol describes a mixed method design to collect organizational, provider, and patient-level data from a sample of MRPs.

Active surveillance for carbapenem-resistant Acinetobacter baumannii (CRAB) carriage.

Carbapenem-resistant Acinetobacter baumannii (CRAB) poses a significant threat in healthcare settings, necessitating robust infection control measures. To identify the most effective sampling method for CRAB carriage detection, we conducted a comparative analysis between skin sampling using a pre-moistened sponge, rectal swabs, and respiratory specimens. Our study encompassed both acute care and post-acute care hospitals. The results revealed that the skin sponge method, when plated on selective chromogenic media, demonstrated the highest sensitivity, exceeding 90% in both settings. Conversely, the commonly employed methods of rectal swabs and respiratory samples combined to exhibit sensitivity levels below 40%. Based on these findings, we recommend implementing the skin sponge method as the preferred approach for CRAB screening in healthcare facilities. This recommendation aims to optimize infection control strategies and mitigate the spread of CRAB in healthcare settings.IMPORTANCEOur study's results provide promising evidence for the incorporation of a high-sensitivity carbapenem-resistant Acinetobacter baumannii (CRAB) screening method in healthcare settings. Such an approach could prove beneficial in enhancing infection prevention and control measures, leading to improved patient outcomes and potentially alleviating the burden of CRAB in healthcare systems.

Does informal care delay nursing home entry? Evidence from Dutch linked survey and administrative data

We assess whether informal care receipt affects the probability of transitioning to a nursing home. Available evidence derives from the US, where nursing home stays are often temporary. Exploiting linked survey and administrative data from the Netherlands, we use the gender mix of children to retrieve exogenous variation in informal care receipt. We find that informal care increases the chance of an admission within a three-year period for individuals with severe functional limitations, and increases the costs incurred on formal home care. For individuals with mild limitations, informal care substantially decreases total care costs, whereas its effect on nursing home admission is unclear. Further, informal care results in lower post-acute care use and hospital care costs, and does not increase mortality. Promoting informal care cannot be expected to systematically result in lower institutionalization rate and care costs, but it may nonetheless induce health benefits for its recipients.

Time-motion observations to characterize the developmental environment in a paediatric post-acute care hospital.

Chronically hospitalized children are at risk for neurodevelopmental delay, compounded by restricted social interactions, movement and environmental stimulation. We measured patients' movements and interactions to characterize developmentally relevant aspects of our inpatient environment and identify opportunities for developmental enrichment. As part of a quality improvement initiative to inform neurodevelopmental programming for children with medical complexity at our paediatric post-acute care specialty hospital, we conducted >232 hours of time-motion observations. Trained observers followed 0- to 5-year-old inpatients from 7am to 7pm on weekdays, categorizing observations within five domains: Where, With, Position, State and Environment. Observations were collected continuously utilizing REDCap on iPads. A change in any domain initiated a new observation. Patients were median 1year and 8months of age (range 2months to 3years 9months) with a median length of hospitalization of 514 days (range 66-1298). In total, 2636 unique observations (or median 134 observations per patient-day [range 95-210]) were collected. Patients left their rooms up to 4 times per day for median 1h and 34 min (range 41 min to 4h:30 min). Patients spent 4h:6min (2h:57 min to 6h:30 min) interacting with someone and 3h:51 min (57 min to 6h:36 min) out of bed each day. Patients were simultaneously out of their beds, interacting with someone and awake for 2h:21 min (51 min to 4h:19 min) each day. Despite a care model prioritizing time out of bed and social interaction, time-motion observations indicate patients spent many of their waking hours in bed and alone. Quantifying our inpatients developmental opportunities will inform neurodevelopmental programming initiatives.

Comparing prevalence and types of potentially inappropriate medications among patient groups in a post-acute and secondary care hospital

Reducing potentially inappropriate medications (PIMs) is a challenge in post-acute care hospitals. Some PIMs may be associated with patient characteristics and it may be useful to focus on frequent PIMs. This study aimed to identify characteristic features of PIMs by grouping patients as in everyday clinical practice. A retrospective review of medical records was conducted for 541 patients aged 75 years or older in a Japanese post-acute and secondary care hospital. PIMs on admission were identified using the Screening Tool for Older Person’s Appropriate Prescriptions for Japanese. The patients were divided into four groups based on their primary disease and reason for hospitalization: post-acute orthopedics, post-acute neurological disorders, post-acute others, and subacute. Approximately 60.8% of the patients were taking PIMs, with no significant difference among the four patient groups in terms of prevalence of PIMs (p = 0.08). However, characteristic features of PIM types were observed in each patient group. Hypnotics and nonsteroidal anti-inflammatory drugs were common in the post-acute orthopedics group, multiple antithrombotic agents in the post-acute neurological disorders group, diuretics in the post-acute others group, and hypnotics and diuretics in the subacute group. Grouping patients in clinical practice revealed characteristic features of PIM types in each group.

Healthcare Utilization After Thermal Injury: An Analysis Using a Commercial Claims Database

Abstract Burn injuries affect more than 500,000 people per year in the United States but no previous studies have looked at the impact on the healthcare system. Several prior studies have shown decreased unplanned healthcare utilization after acute care discharge and increased healthcare costs for patients who have undergone burn injury grafting. This study describes postacute care hospitalization healthcare use in burn patients. A retrospective commercial claims database review was performed utilizing Truven MarketScan (MS) database. In a 10-year MS sample, 23,262 patients with burn injuries were identified and matched to a control population in a 1:1 ratio based on age, sex, and total time in the MS database. Pre- and postburn utilization of therapy, emergency department, nutritional support, psychiatry/psychology, home health, skilled nursing facility, inpatient, and outpatient visits were recorded. For controls, pre- and postburn periods were defined using the burn event date of the matched case adjusted by the pair’s relative difference in enrollment into the MS database. A series of negative binomial regressions were completed to evaluate the data. For every outcome, except skilled nursing facility, healthcare utilization was greater in the preinjury burn group relative to controls. Healthcare utilization for the burn cohort postinjury was greater for every outcome compared to controls and remained higher for at least 25-month postinjury and did not return to preinjury levels during this time frame. Relatively higher healthcare utilization prior to injury in burn patients may indicate an important difference in baseline health, and an opportunity for injury prevention.

Hospital partnership and patient outcomes among postacute patients with stroke.

Postacute care (PAC) heavily relies on effective connection between acute and postacute providers. However, little is known about whether and to what extent providers' patient-sharing relationships influence patient outcomes. This study aimed to examine whether patients with stroke who were discharged to PAC hospitals with which the originating hospital had a strong patient-sharing relationship have a lower rate of rehospitalization and lower mortality risk. This population-based retrospective cohort study used the Taiwan National Health Insurance Research Database. A total of 1988 patients initially hospitalized for stroke between July 1, 2017, and June 30, 2018, who were newly discharged to 193 PAC hospitals from 175 originating hospitals were included. We described the partnership between originating acute hospitals and PAC hospitals using tie strength and referral concentration. The main outcome included unplanned readmission and mortality. Hierarchical logistic regression analysis and Cox proportional hazards models were applied. A dose-response relationship was clearly observed between tie strength and patient outcomes. Patients with stroke who were discharged to a PAC hospital that had the strongest tie strength with the originating hospital were least likely to be readmitted and had the lowest mortality risk. Moreover, patients who received care from hospital pairs with highly or moderately concentrated referrals also had lower readmission and mortality risk. A greater number of shared patients and a more concentrated referral linkage between acute and PAC providers may reduce potential adverse outcomes in PAC patients. Instead of attaining more partners, PAC policies should encourage providers to strengthen their patient-sharing relationship with their existing PAC partners.

Impact of energy intake on the activities of daily living in patients with cervical spinal cord injury undergoing post-acute rehabilitation

Objective: To investigate the association between sufficient energy intake and improvement in activities of daily living (ADL) after hospitalization in patients with cervical spinal cord injury (CSCI) undergoing post-acute rehabilitation. Design: Retrospective cohort study. Setting: Post-acute care hospital from September 2013 to December 2020. Participants: Patients with CSCI admitted to a post-acute care hospital for rehabilitation. Intervention: Not applicable. Outcome measure(s): Multiple regression analysis was performed to investigate the relationship of sufficient energy intake to Motor Functional Independence Measure (mFIM) gain, mFIM score at discharge, and body weight change during hospitalization. Results: In total, 116 patients (104 men and 12 women), median age: 55 (interquartile range [IQR] 41−65) years were included in the analysis. Then, 68 (58.6%) were in the energy-sufficient group, and 48 (41.4%) patients were classified under the energy-deficient group. The two groups did not significantly differ in terms of mFIM gain and mFIM score at discharge. The energy-sufficient group maintained body weight change during hospitalization than the energy-deficient group (0.6 [−2.0−2.0] vs. −1.9 [−4.0−−0.3], P < 0.001). Multiple regression analysis showed no association between sufficient energy intake and outcomes. Conclusion: Sufficient energy intake within the first 3 days of admission did not affect ADL improvement during hospitalization in patients with a post-cute CSCI undergoing rehabilitation.

Point-of-Care Ultrasound in Children With Medical Complexity

Children with medical complexity (CMC) have significant chronic health conditions that involve congenital or acquired multisystem disease associated with medical fragility, functional limitations, dependence on technology, and high health care utilization. The objective of this study was to describe the indications, applications, and point-of-care ultrasound (POCUS) findings in this population. A descriptive study of POCUS scans performed for clinical purposes in CMC admitted to a single pediatric postacute care hospital. All children for whom a POCUS was requested by a medical team provider were eligible for inclusion. One hundred and four POCUS evaluations were performed for 33 patients. Diagnostic groups for the 33 patients included multiple congenital anomalies (41%), neurologic or neuromuscular (31%), prematurity (25%) and cardiac (3%). Lung, cardiac, and diaphragmatic ultrasound accounted for 57% of POCUS requested. POCUS was abnormal in 82% of diaphragmatic, 73% of lung, and 11% of cardiac ultrasounds. Twenty-three percent of POCUS studies were requested to answer a specific clinical question, 56% for follow-up information, and 21% for baseline evaluation. Lung, diaphragmatic, and cardiac ultrasound were the most prevalent POCUS studies requested in a postacute care hospital. POCUS may offer an expanded role in such patients and settings by answering clinical questions and by providing baseline and follow-up information.

Delayed neurologic improvement and long-term survival of patients with poor neurologic status after out-of-hospital cardiac arrest: A retrospective cohort study in Japan

AimTo assess survival duration and frequency of delayed neurologic improvement in patients with poor neurologic status at discharge from emergency hospitals after out-of-hospital cardiac arrest (OHCA). MethodsThis retrospective cohort study included OHCA patients admitted to two tertiary emergency hospitals in Japan between January 2014 and December 2020. Pre-hospital, tertiary emergency hospital, and post-acute care hospital data, were retrospectively collected by reviewing medical records. Neurologic improvements were defined as an improvement of Cerebral Performance Category (CPC) scores from 3 or 4 at hospital discharge to 1 or 2. The primary outcome was neurologic improvement after discharge, while the secondary outcome was survival time after cardiac arrest. ResultsOf all patients (n = 1,012) admitted to tertiary emergency hospitals after OHCA during the observation period, 239 with CPC 3 or 4 at discharge were included, and all were Japanese. Median age was 75 years, 64% were male, and 31% had initially shockable rhythms. Neurologic improvements were observed in nine patients (3.6%), higher in CPC 3 (31%) than CPC 4 (1.3%) patients, but not after 6 months from cardiac arrest. The median survival time after cardiac arrest was 386 days (95% confidence interval: 303–469). ConclusionSurvival probability in patients with CPC 3 or 4 was 50% at 1-year and 20% at 3-year. Neurologic improvements were observed in 3.6% patients, higher in CPC 3 than in CPC 4 patients. During the first 6 months after OHCA, the neurologic status may improve in patients with CPC 3 or 4.

Musculoskeletal Ultrasound Shows Muscle Mass Changes during Post-Acute Care Hospitalization in Older Men: A Prospective Cohort Study.

This study aimed to prospectively assess changes in muscle thickness (MT) and the cross-sectional area (CSA) of the rectus femoris (RF) muscle in a cohort of older adults, using musculoskeletal ultrasound at admission and at a 2-week follow-up during hospitalization in a post-acute care unit. Differences in frailty status and correlations of MT-RF and CSA-RF with current sarcopenia diagnostic criteria were also studied. Forty adults aged 79.5 (SD 9.5) years (57.5% women) participated, including 14 with frailty and 26 with pre-frailty. In the first week follow-up, men had a significant increase in MT (0.9 mm [95%CI 0.3 to 1.4], p = 0.003) and CSA (0.4 cm2 [95%CI 0.1 to 0.6], p = 0.007). During the second week, men continued to have a significant increase in MT (0.7 mm [95%CI 0.0 to 1.4], p = 0.036) and CSA (0.6 cm2 [95%CI 0.01 to 1.2], p = 0.048). Patients with frailty had lower values of MT-RF and CSA-RF at admission and during the hospitalization period. A moderate-to-good correlation of MT-RF and CSA with handgrip strength, fat-free mass and gait speed was observed. Musculoskeletal ultrasound was able to detect MT-RF and CSA-RF changes in older adults admitted to a post-acute care unit.

Caregiver Engagement During Pediatric Post-Acute Care Hospitalization.

Caregiver engagement during acute inpatient hospitalizations has been demonstrated to provide developmental and behavioral benefits for children, decrease readmissions and length of stay, and improve caregiver confidence. Caregiver engagement has been examined in acute care settings; however, there is a gap in information regarding caregiver engagement in a pediatric post-acute care hospital (pPACH). The objective of this study was to explore caregiver engagement in a pPACH. All patients, birth to 23 years of age, in the medical service of an independent pPACH in the Northeastern United States, January 1, 2013, through December 31, 2017, were identified. Retrospective review of electronic health records for patient demographics and caregiver engagement, identified as visit(s) and telephone call(s), was conducted. Descriptive statistics and logistic regression were used to distinguish differences and measure associations of caregiver visits and calls between demographic groups. The primary mode of caregiver engagement for pPACH patients (n = 614) was by visits, whereas caregiver calls were less frequent. Multivariable logistic regression analysis identified significantly greater odds of caregiver visits among patients ages 1 to 17 years, with private payer, and having a single admission, whereas lower odds of visits were identified among those <1 year or ≥18 years, with ≥2 pPACH admissions, public insurance, Child Protective Services (CPS) involvement, and African American/Black, other, and unknown race/ethnicities. Patients who were infants, had ≥2 admissions, had CPS involvement, and were covered under public payer experienced lower caregiver visit rates. Strategies are needed to further identify and address barriers to caregiver engagement.

Association between BIA-derived Phase Angle and Sarcopenia and Improvement in Activities of Daily Living and Dysphagia in Patients undergoing Post-Stroke Rehabilitation.

To investigate the predictive value of the BIA-derived phase angle with respect to the functional prognosis and baseline sarcopenia in patients undergoing post-stroke rehabilitation. Retrospective cohort study. Overall, 577 Japanese patients admitted to a post-acute care hospital from 2016 to 2020 were recruited. Body composition analysis, which included BIA-derived phase angle and skeletal muscle mass, was performed using bioelectrical impedance analysis (BIA). Study outcomes included physical function assessed using the Functional Independence Measure (FIM-motor) and the level of dysphagia assessed using the Food Intake LEVEL Scale (FILS). Sarcopenia was defined as the loss of skeletal muscle mass and decreased muscle strength. Receiver operating characteristic curves were used to calculate the optimal cutoff value of BIA-derived phase angle to diagnose sarcopenia. Multivariate analyses were used to determine whether the BIA-derived phase angle at admission was associated with outcomes at discharge and baseline sarcopenia. After enrollment, 499 patients (mean age: 74.0 ± 13.1 years; 52.0% men) were examined. The median FIM-motor and FILS scores at admission were 47 (20-69) and 8 (7-10), respectively. Sarcopenia was observed in 43.2% of patients. After adjusting for potential confounders, BIA-derived phase angle was positively associated with FIM-motor scores at discharge (β = 0.134, P < 0.001), FIM-motor score gain (β = 2.504, P < 0.001), and FILS scores at discharge (β = 0.120, P = 0.039). BIA-derived phase angle was negatively associated with the sarcopenia diagnosis at baseline (odds ratio = -0.409, P < 0.001); its cutoff value was 4.76° (sensitivity 0.800, specificity 0.790, P < 0.001) for sarcopenia diagnosis in men and 4.11° (sensitivity 0.735, specificity 0.829, P < 0.001) in women. BIA-derived phase angle was positively associated with the recovery of physical function and dysphagia level and negatively associated with baseline sarcopenia in patients undergoing post-stroke rehabilitation. The BIA-derived phase angle cutoff for sarcopenia diagnosis was 4.76° for men and 4.11° for women.

T1 Healthcare Utilization After Thermal Injury: An Analysis Using a Commercial Claims Database

IntroductionBurn Injuries directly affect more than 500,000 people per year in the United States but no previous studies have looked at the impact on the healthcare system. Several prior studies have shown decrease in unplanned healthcare utilization after acute care discharge following burn injury and increased healthcare costs in patients who have undergone grafting for burn injury. The goal of this study is to describe post-acute care hospitalization healthcare use in burn patients.MethodsA retrospective commercial claims database review was performed of the Truven MarketScan (MS) database. In a 10 year MS sample, 23,262 patients with burn injuries were identified and were matched to a control population in a 1:1 ratio based on age, sex, and total time in the MS database. For the burn patient population in the study, pre-burn and post-burn utilization of therapy, emergency department, nutritional support, psychiatry/psychology, home health, skilled nursing facility, inpatient, and outpatient visits were recorded. For controls, we defined their pre-burn and post-burn periods using the burn event date of the matched case adjusted by the pair’s relative difference in initial enrollment into the MS database, and then recorded the same utilization metrics. A series of negative binomial regressions were completed to evaluate the data.ResultsAt the conclusion of the study, for every outcome, except skilled nursing facility, healthcare utilization was greater in the pre-injury burn group relative to controls. Healthcare utilization for the burn cohort post-injury was greater for every outcome compared to controls. Relative to controls, healthcare utilization remains higher for at least 25 months post-injury in the burn patients and does not return to pre-injury levels during this time frame.ConclusionsIn a commercial claims database study, the healthcare utilization of the burn patients is higher both before and after burn injury than matched controls. Utilization does not return to preburn levels in the 25-month follow-up period. Additionally, burn patients have higher healthcare utilization prior to injury compared to matched controls, which may indicate an important difference in baseline health of these patients, and an opportunity for injury prevention.

A Machine Learning-Based Screening Test for Sarcopenic Dysphagia Using Image Recognition.

Background: Sarcopenic dysphagia, a swallowing disorder caused by sarcopenia, is prevalent in older patients and can cause malnutrition and aspiration pneumonia. This study aimed to develop a simple screening test using image recognition with a low risk of droplet transmission for sarcopenic dysphagia. Methods: Older patients admitted to a post-acute care hospital were enrolled in this cross-sectional study. As a main variable for the development of a screening test, we photographed the anterior neck to analyze the image features of sarcopenic dysphagia. The studied image features included the pixel values and the number of feature points. We constructed screening models using the image features, age, sex, and body mass index. The prediction performance of each model was investigated. Results: A total of 308 patients participated, including 175 (56.82%) patients without dysphagia and 133 (43.18%) with sarcopenic dysphagia. The area under the receiver operating characteristic curve (ROC-AUC), sensitivity, specificity, positive predictive value, negative predictive value, and area under the precision-recall curve (PR-AUC) values of the best model were 0.877, 87.50%, 76.67%, 66.67%, 92.00%, and 0.838, respectively. The model with image features alone showed an ROC-AUC of 0.814 and PR-AUC of 0.726. Conclusions: The screening test for sarcopenic dysphagia using image recognition of neck appearance had high prediction performance.

Expedited Cross-Training: An Approach to Help Mitigate Nurse Staffing Shortages.

Cross-training of nurses is an approach used by hospitals to mitigate anticipated nurse staffing shortages. This article provides professional practice nurse educators guidance on how to plan, implement, and evaluate expedited cross-training that integrate the principles of just-in-time training. Sixty-one nurses in a postacute care hospital setting were cross-trained over the course of 8 weeks using a six-step method.

Performance of the EWGSOP2 Cut-Points of Low Grip Strength for Identifying Sarcopenia and Frailty Phenotype: A Cross-Sectional Study in Older Inpatients

Background: The European Working Group on Sarcopenia has recently proposed revised cut-off values for the definition of low grip strength (EWGSOP2). We therefore compared performance of the EWGSOP2 cut-off definition of low grip strength with other internationally used cut-off points in a sample of older patients. Methods: We analyzed geriatric assessment data in a cross-sectional sample of 98 older patients admitted to a post-acute care hospital. First, we compared prevalence of sarcopenia and frailty phenotype in our sample using low grip strength cut-points from the EWGSOP2 and seven other internationally used consensus statements. Second, we calculated correlations between low grip strength and two independent surrogate outcomes (i.e., gait speed, and the clinical frailty scale) for the EWGSOP2 and the other seven cut-point definitions. Results: Prevalence of sarcopenia based on the EWGSOP2 grip strength cut-off values was significantly lower (10.2%) than five of the seven other cut-point definitions (e.g., 19.4% based on Sarcopenia Definitions and Outcomes Consortium (SDOC) criteria). Similarly, frailty phenotype prevalence was significantly lower based on EWGSOP2 cut-points (57.1%) as compared to SDOC (70.4%). The correlation coefficient of gait speed with low grip strength based on EWGSOP2 cut-points was lower (0.145) as compared to other criteria (e.g., SDOC 0.240). Conclusions: Sarcopenia and frailty phenotype were identified considerably less using the EWGSOP2 cut-points for low grip strength, potentially underestimating prevalence of sarcopenia and frailty phenotype in post-acute hospital patients.