In Cheol Jeong1, Ryan Healy2, Benjamin Bao3, William Xie4, Tim Madeira2, Marc Sussman5, Glenn Whitman5, Jennifer Schrack6, Nicole Zahradka1, Erik Hoyer7, Charles Brown2, Peter C Searson1,3,7,8. 1. inHealth, Johns Hopkins Individualized Health Initiative, Johns Hopkins University School of Medicine, Baltimore, Maryland. 2. Department of Critical Care and Anesthesiology, Johns Hopkins University School of Medicine, Baltimore, Maryland. 3. Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland. 4. Department of Computer Science, Johns Hopkins University School of Medicine, Baltimore, Maryland. 5. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland. 6. Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland. 7. Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland. 8. Department of Materials Science and Engineering, Johns Hopkins University, Baltimore, Maryland.
Abstract
Importance: Promoting patient mobility during hospitalization is associated with improved outcomes and reduced risk of hospitalization-associated functional decline. Therefore, accurate measurement of mobility with high-information content data may be key to improved risk prediction models, identification of at-risk patients, and the development of interventions to improve outcomes. Remote monitoring enables measurement of multiple ambulation metrics incorporating both distance and speed. Objective: To evaluate novel ambulation metrics in predicting 30-day readmission rates, discharge location, and length of stay using a real-time location system to continuously monitor the voluntary ambulations of postoperative cardiac surgery patients. Design, Setting, and Participants: This prognostic cohort study of the mobility of 100 patients after cardiac surgery in a progressive care unit at Johns Hopkins Hospital was performed using a real-time location system. Enrollment occurred between August 29, 2016, and April 4, 2018. Data analysis was performed from June 2018 to December 2019. Main Outcomes and Measures: Outcome measures included 30-day readmission, discharge location, and length of stay. Digital records of all voluntary ambulations were created where each ambulation consisted of multiple segments defined by distance and speed. Ambulation profiles consisted of 19 parameters derived from the digital ambulation records. Results: A total of 100 patients (81 men [81%]; mean [SD] age, 63.1 [11.6] years) were evaluated. Distance and speed were recorded for more than 14 000 segments in 840 voluntary ambulations, corresponding to a total of 127.8 km (79.4 miles) using a real-time location system. Patient ambulation profiles were predictive of 30-day readmission (sensitivity, 86.7%; specificity, 88.2%; C statistic, 0.925 [95% CI, 0.836-1.000]), discharge to acute rehabilitation (sensitivity, 84.6%; specificity, 86.4%; C statistic, 0.930 [95% CI, 0.855-1.000]), and length of stay (correlation coefficient, 0.927). Conclusions and Relevance: Remote monitoring provides a high-information content description of mobility, incorporating elements of step count (ambulation distance and related parameters), gait speed (ambulation speed and related parameters), frequency of ambulation, and changes in parameters on successive ambulations. Ambulation profiles incorporating multiple aspects of mobility enables accurate prediction of clinically relevant outcomes.
Importance: Promoting patient mobility during hospitalization is associated with improved outcomes and reduced risk of hospitalization-associated functional decline. Therefore, accurate measurement of mobility with high-information content data may be key to improved risk prediction models, identification of at-risk patients, and the development of interventions to improve outcomes. Remote monitoring enables measurement of multiple ambulation metrics incorporating both distance and speed. Objective: To evaluate novel ambulation metrics in predicting 30-day readmission rates, discharge location, and length of stay using a real-time location system to continuously monitor the voluntary ambulations of postoperative cardiac surgery patients. Design, Setting, and Participants: This prognostic cohort study of the mobility of 100 patients after cardiac surgery in a progressive care unit at Johns Hopkins Hospital was performed using a real-time location system. Enrollment occurred between August 29, 2016, and April 4, 2018. Data analysis was performed from June 2018 to December 2019. Main Outcomes and Measures: Outcome measures included 30-day readmission, discharge location, and length of stay. Digital records of all voluntary ambulations were created where each ambulation consisted of multiple segments defined by distance and speed. Ambulation profiles consisted of 19 parameters derived from the digital ambulation records. Results: A total of 100 patients (81 men [81%]; mean [SD] age, 63.1 [11.6] years) were evaluated. Distance and speed were recorded for more than 14 000 segments in 840 voluntary ambulations, corresponding to a total of 127.8 km (79.4 miles) using a real-time location system. Patient ambulation profiles were predictive of 30-day readmission (sensitivity, 86.7%; specificity, 88.2%; C statistic, 0.925 [95% CI, 0.836-1.000]), discharge to acute rehabilitation (sensitivity, 84.6%; specificity, 86.4%; C statistic, 0.930 [95% CI, 0.855-1.000]), and length of stay (correlation coefficient, 0.927). Conclusions and Relevance: Remote monitoring provides a high-information content description of mobility, incorporating elements of step count (ambulation distance and related parameters), gait speed (ambulation speed and related parameters), frequency of ambulation, and changes in parameters on successive ambulations. Ambulation profiles incorporating multiple aspects of mobility enables accurate prediction of clinically relevant outcomes.
Authors: Brian J Douthit; Rachel L Walden; Kenrick Cato; Cynthia P Coviak; Christopher Cruz; Fabio D'Agostino; Thompson Forbes; Grace Gao; Theresa A Kapetanovic; Mikyoung A Lee; Lisiane Pruinelli; Mary A Schultz; Ann Wieben; Alvin D Jeffery Journal: Appl Clin Inform Date: 2022-02-09 Impact factor: 2.342
Authors: Charles H Brown; Lisa Yanek; Ryan Healy; Tiffany Tsay; Junrui Di; Lee Goeddel; Daniel Young; Vadim Zipunnikov; Jennifer Schrack Journal: JTCVS Open Date: 2022-05-31