Award Date

5-17-2020

Degree Type

Dissertation

Degree Name

Doctor of Physical Therapy (DPT)

Department

Physical Therapy

Advisor 1

Daniel Young

First Committee Member

Merrill Landers

Second Committee Member

Daniel Young

Number of Pages

23

Abstract

Background: Illness and inactivity in the hospital frequently leads to disability that can reduce quality of life and increase costs. Early identification of people with limitations in activities of daily living (ADL) who are at risk for poor outcomes such as increased length of stay (LOS), hospital acquired conditions (i.e., falls and pressure injuries (PIs)), and discharge away from home can facilitate appropriate intervention. The Activity Measure for Post-Acute Care Inpatient Activity Short Form (AM-PAC IASF), a reliable and valid tool to measure ADL limitations, is scored at admission for all patients in our hospital. The purpose of this study was to determine the relationship between admission AM-PAC IASF and LOS, hospital acquired conditions (i.e., falls and PIs), and discharge disposition. Design: Retrospective cohort study of 1899 consecutive patients. Setting: Large academic hospital. Materials/Methods: In this retrospective cohort study, we gathered data from the electronic medical records of patients at The John Hopkins Hospital. The AM-PAC IASF scale score (higher is better), scored within 48 hours of hospital admission, was the independent variable in multivariate regression models for each of the four dependent variables: LOS, hospital acquired conditions (i.e., falls and PIs), and discharge to facility. Models were also adjusted by patient demographic variables including gender, race, and payor. Results: Our sample included 1039 males and 860 females with a mean age of 54 years (range of 16-95 years). The odds of a patient being in the highest quartile (≥ 8 days) for LOS was 1.91 (p<0.001) times higher for every 10-point decrease in AM-PAC IASF. For every 10-point decrease in AM-PAC IASF the odds of having an injurious fall was 1.66 (p<0.001) times higher. The odds of acquiring a PI during hospitalization were 2.72 (p<0.001) times higher for every 10-point decrease in AM-PAC IASF. Finally, for every 10-point decrease in AM-PAC IASF the odds were 3.02 (p<0.001) times higher for patients to be discharged to a facility instead of home. Conclusions: Lower ability in ADL’s at hospital admission was significantly associated with poor outcomes. Clinical Relevance: Early AM-PAC IASF scores could be used by providers to identify at risk patients and design treatment plans to mitigate those risks including early planning for discharge. This study supports using the AM-PAC IASF to aid the health care team in making evidence-based decisions about patient’s care.

Keywords

Patient Outcome Assessment; Acute Care; Rehabilitation; Activity Measure For Post-Acute Care Inpatient Activity Short Form; 6-Clicks; AM-PAC; Functional Activity; Hospital; Falls; Pressure Injuries; Hospital Acquired Conditions; Discharge Disposition; Length Of Stay; Sub-Acute Care; Activities Of Daily Living; Physical Therapy; Occupational Therapy

Disciplines

Medicine and Health Sciences | Physical Therapy | Rehabilitation and Therapy

File Format

pdf

File Size

263 KB

Degree Grantor

University of Nevada, Las Vegas

Language

English

Rights

IN COPYRIGHT. For more information about this rights statement, please visit http://rightsstatements.org/vocab/InC/1.0/

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