Exploring the Effectiveness of the Allen Cognitive Level Screen in Predicting the Readmission of Patients With Psychiatric Diagnoses

PURPOSE: When patients are frequently rehospitalized at mental health hospitals, their participation in day-to-day roles and routines is jeopardized, or at the very least interrupted. Occupational therapy literature shows that insufficient roles, routines, and meaningful activities negatively impact health and quality of life (Bejerholm & Eklund, 2007). As hospital readmission rates rise, there is an increasing concern for patients as well as the hospital. Studies have found a number of variables associated with high readmission rates, including but not limited to psychotic symptoms, no utilization of community mental health services, unemployment, and low level of functioning (Odes et al., 2011). Startup, Jackson, & Startup (2010) examined the relationship between level of insight, social functioning and readmission rates. Their study recommends further research focusing on interventions designed to help improve function and relapse prevention.

Occupational therapy practitioners have a unique approach to addressing the whole person, which contributes to improved patient quality of life and ability to live a meaningful life. In this time of health care reform, occupational therapists need to assert their role in identifying functional deficits that prevent safe transition from hospital to community settings. Without the ability to understand a person’s capacity to engage in new learning and solve problems, appropriate discharge planning is challenged. The Allen Cognitive Level Screen (ACLS) is a standardized assessment of learning potential; global cognitive processing capacities, including insight; and performance abilities (Allen et al., 2007). The aim of the study was to determine if there was a relationship between ACLS scores on discharge from the hospital and readmission rates. Our belief was that we could identify a relationship between level of function and successful transition to the community. Further, we believed we could define a role for community-based occupational therapy treatment that would provide necessary support and opportunity to build skills.

DESIGN: The study involved evaluating patients’ level of cognitive function at discharge and then monitoring readmission rates. Data on readmission rates were gathered 30, 60, and 180 days after discharge. Data analysis involved descriptive statistics and bivariate and multiple regression analysis to determine if lower scores on the ACLS correlated with higher inpatient readmission rates at 30, 60, and 180 days.

METHOD: Participants were patients in an inpatient mental health setting between February 2013 and August 2015 who consented to participate in the study and were administered the ACLS within 24 hr of discharge. Readmission rates to this hospital were identified through review of the electronic medical record.

RESULTS: The population consisted of 87 patients diagnosed with psychotic disorders who were primarily White (77%), male (55%), and single (85%). Average length of stay was 10.7 days. The rate of readmissions at 30 days was 23% and at 60 days was 31%; by 180 days, it increased to 46%. This increase in readmission rates appeared related to lower ACLS scores. However, due to lack of power in the study, statistical significance was not reached.

CONCLUSION: Although the data analyzed lack the power to determine conclusively a link between ACLS scores and readmission rates, the data appear to show a clinical difference in readmission rates between patients who scored ACLS scores 3 and 4. Next steps will involve a larger sample size to further evaluate the clinical trends noted between ACLS scores 3 and 4 and readmissions. Study outcomes provide potential for occupational therapists to take a direct role in discharge planning.

References

Allen, C. K., Austin, S. L., David, S. K., Earhart, C. A., McCraith, D. B., & Riska-Williams, L. (2007). Manual for the Allen Cognitive Level Screen–5 (ACLS–5) and Large Allen Cognitive Level Screen–5 (LACLS–5). Camarillo, CA: ACLS and LACLS Committee.

Bejerholm, U., & Eklund, M. (2007). Occupational engagement in persons with schizophrenia: Relationships to self-related variables, psychopathology, and quality of life. American Journal of Occupational Therapy, 61, 21–32. https://doi.org/10.5014/ajot.61.1.21

Metzler, C., Hartmann, K., & Lowenthal, L. (2012). Defining primary care: Envisioning the roles of occupational therapy. American Journal of Occupational Therapy, 66, 266–270. https://doi.org/10.5014/ajot.2010.663001

Odes, H., Katz, N., Noter, E., Shamir, Y., Weizman, A., & Valevski, A. (2011). Level of function at discharge as a predictor of readmission among inpatients with schizophrenia. American Journal of Occupational Therapy, 65, 314–319. https://doi.org/10.5014/ajot.2011.001362