Elizabeth R Pfoh1, Aaron Hamilton2, Bo Hu3, Mary Stilphen4, Michael B Rothberg1. 1. Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland, Ohio. 2. Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: HAMILTA3@ccf.org. 3. Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio. 4. Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, Ohio.
Abstract
OBJECTIVE: To assess the predictive capabilities of 2 measures of functional mobility, the 6-clicks score and the Braden scale mobility score. We also identified the additional predictive value of adding electronic health record data (demographics, laboratory data, and vital signs) to each model. DESIGN: Cohort study. SETTING: A large integrated health system. PARTICIPANTS: Patients ≥18 years of age (N=17,022) admitted to the inpatient medical service of one of 8 hospitals. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Predictive measures were patient demographics, laboratory values, vital signs, and functional mobility as measured by the 6-clicks score within the first 48 hours of hospital admission. Our outcome was discharge destination (home vs other). RESULTS: Our final sample included 19,963 records. Patients were discharged alive from 19,698 admissions. The majority were women (n=11,729, 59%) with a mean age of 73 (standard deviation, 15.3) years. Patients' initial 6-clicks score had moderate discrimination for discharge destination (c-statistic of 0.78) and outperformed the Braden score (c-statistic of 0.68). Electronic health record data alone had poor discrimination (c-statistic of 0.66) and added little to the model of 6-clicks alone (adjusted c-statistic increased from 0.78 to 0.80). CONCLUSION: Functional mobility measured via 6-clicks within 48 hours of admission can help identify patients who are likely to go home, facilitating early discharge planning.
OBJECTIVE: To assess the predictive capabilities of 2 measures of functional mobility, the 6-clicks score and the Braden scale mobility score. We also identified the additional predictive value of adding electronic health record data (demographics, laboratory data, and vital signs) to each model. DESIGN: Cohort study. SETTING: A large integrated health system. PARTICIPANTS: Patients ≥18 years of age (N=17,022) admitted to the inpatient medical service of one of 8 hospitals. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Predictive measures were patient demographics, laboratory values, vital signs, and functional mobility as measured by the 6-clicks score within the first 48 hours of hospital admission. Our outcome was discharge destination (home vs other). RESULTS: Our final sample included 19,963 records. Patients were discharged alive from 19,698 admissions. The majority were women (n=11,729, 59%) with a mean age of 73 (standard deviation, 15.3) years. Patients' initial 6-clicks score had moderate discrimination for discharge destination (c-statistic of 0.78) and outperformed the Braden score (c-statistic of 0.68). Electronic health record data alone had poor discrimination (c-statistic of 0.66) and added little to the model of 6-clicks alone (adjusted c-statistic increased from 0.78 to 0.80). CONCLUSION: Functional mobility measured via 6-clicks within 48 hours of admission can help identify patients who are likely to go home, facilitating early discharge planning.
Authors: Joshua K Johnson; Michael B Rothberg; Kellie Adams; Brittany Lapin; Tamra Keeney; Mary Stilphen; Francois Bethoux; Janet K Freburger Journal: Med Care Date: 2022-03-16 Impact factor: 3.178