Date Presented 4/22/2018
The Activity Measure for Post Acute Care (AM-PAC) “Clicks” tools are used to assess function of patients in acute care settings. This study tested the association between the stages of the AM-PAC activity and cognitive scores and discharge to home. Results show that higher scores were associated with discharge to home.
Primary Author and Speaker: Adam Porter
Contributing Authors: Joshua Johnson, Christopher Noren, Lori Richards
PURPOSE: Functional stages have been derived from score intervals using both the activity and cognitive subscales of the Activity Measure for Post Acute Care (AM-PAC; Tao et al., 2008). The AM-PAC “6-Clicks” short forms have been validated for assessment of function in acute care (Jette et al., 2014a) and are each scored on a scale of 6 to 24 with lower scores indicating lower levels of function. Scores from the “6-Clicks” activity subscale were shown to predict patients’ discharge to home in one hospital system (Jette et al., 2014b), but functional stages have not been explored as predictors of acute care discharge disposition. The purpose of this study was to test the association between acute care discharge to home and stages of activity-based or cognitive-based function determined by the “6-Clicks” activity and cognitive scores recorded in a single academic medical center.
METHOD: This was a retrospective cohort study with patients admitted to the University of Utah Medical Center in 2015 and 2016 who were discharged from a general medicine unit. Patients were retained for analysis if they had at least one score recorded for the “6-Clicks” activity or cognitive subscales and did not die during their admission.
In separate analyses, cut scores for the “6-Clicks” activity and cognitive subscales were applied to patients’ final recorded score to group patients into three function-based categories: low, moderate, and high. For the activity subscale, patients with low function scored 6–18, those with moderate function scored 19–23, and those with high function scored 24. Patients with cognitive scores of 6–20 were categorized as having low cognitive function, those who scored 21 or 22 as having moderate cognitive function, and those who scored 23 or 24 as having high cognitive function.
Adjusted odds ratios (aORs) were estimated from multivariable logistic regression using functional category as the primary predictor variable and discharge to home as the outcome variable. Backward variable selection was used to determine the covariates included in each regression model (Budtz-Jorgensen et al., 2007).
RESULTS: A total of 4,290 patients were included in the analysis of “6-Clicks” activity scores and 1,450 patients in the analysis of “6-Clicks” cognitive scores. Using the “6-Clicks” activity subscale, patients with moderate function (aOR = 5.14, 95% confidence interval [CI] [4.38, 6.03]) and high function (aOR = 13.50, 95% CI [10.41, 17.50]) demonstrated increased odds for acute care discharge to home compared with patients with low function. Using the “6-Clicks” cognitive subscale, patients with moderate (aOR = 2.37, 95% CI [1.33, 4.24]) or high (aOR = 4.54, 95% CI [3.53, 5.84]) cognitive function had greater odds for discharge to home compared with patients with low cognitive function.
CONCLUSION: Higher final scores on the “6-Clicks” activity and cognitive subscales were associated with increased odds of being discharged to home from a general medicine acute care unit. Because both assessments can be completed by an occupational therapy practitioner in <1 min and could guide recommendations for the timing and disposition of patient discharge, this knowledge could enhance the role of occupational therapy practitioners in multidisciplinary discharge planning. The utility of these scores for this purpose should be examined in additional patient populations in future research.
References
Budtz-Jorgensen, E., Keiding, N., Grandjean, P., & Weihe, P. (2007). Confounder selection in environmental epidemiology: Assessment of health effects of prenatal mercury exposure. Annals of Epidemiology, 17, 27–35. https://doi.org/10.1016/j.annepidem.2006.05.007
Jette, D. U., Stilphen, M., Ranganathan, V. K., Passek, S. D., Frost, F. S., & Jette, A. M. (2014a). Validity of the AM-PAC “6-Clicks” inpatient daily activity and basic mobility short forms. Physical Therapy, 94, 379–391. https://doi.org/10.2522/ptj.20130199
Jette, D. U., Stilphen, M., Ranganathan, V. K., Passek, S. D., Frost, F. S., & Jette, A. M. (2014b). AM-PAC “6-Clicks” functional assessment scores predict acute care hospital discharge destination. Physical Therapy, 94, 1252–1261. https://doi.org/10.2522/ptj.20130359
Tao, W., Haley, S. M., Coster, W. J., Ni, P., & Jette, A. M. (2008). An exploratory analysis of functional staging using an item response theory approach. Archives of Physical Medicine and Rehabilitation, 89, 1046–1053. https://doi.org/10.1016/j.apmr.2007.11.036
