Ability of the Functional Assessment in Acute Care Multidimensional Computerized Adaptive Test (FAMCAT) to Predict Discharge to Institutional Post-Acute Care

Association between physical therapy frequency and postacute care for a national cohort of patients hospitalized with pneumonia

BACKGROUND

Annually more than 300,000 patients hospitalized for pneumonia need postacute care. Patients and systems prefer home discharge, but physical limitations often necessitate postacute care. It is unknown whether frequency of physical therapy in the hospital affects postacute care discharges.

OBJECTIVE

Examine the relationship between physical therapy visit frequency and disposition among a national sample of patients hospitalized with pneumonia.

DESIGNS

Observational cohort study.

SETTING

Acute care hospital.

PARTICIPANTS

Adult patients with primary diagnosis of pneumonia in the Premier Data Set who received physical therapy in the hospital during a 5-day window, with therapy on at least days 1 and 5.

INTERVENTION

Physical therapy visit frequency.

MAIN OUTCOME AND MEASURES

Discharge disposition (home or postacute care).

RESULTS

We included 18,886 patients from 595 hospitals. Just over half were discharged home (n = 9638; 51.0%) and 558 (2.95%) died. Patients getting more frequent therapy were older, non-Hispanic white, treated in small non-teaching rural hospitals in the West, Midwest, or South, and had fewer severe illness indicators. In adjusted models, patients who received physical therapy on 100% of days were 7% [(95% confidence interval, 4.3-9.7), p < .0001] more likely to go home than patients who received physical therapy on 40% of days. As a falsification test, we found that there was no relationship between physical therapy frequency and all-cause mortality. Physical therapy visit frequency was positively associated with discharge to home. Increasing visit frequency of physical therapy in hospitals might reduce the need for postacute care, but randomized controlled trials are needed to confirm the effect.

Patient-Reported Outcome Measures: An Exploration of Their Utility in Functional Assessment and Rehabilitation

Patient reported outcome measures (PROMs) have had a place in medicine for many years. However, their importance has grown rapidly in recent years due to a number of factors-not the least of which is an increased recognition of importance of the patient’ assessment of their care and outcomes. Despite their growing use, few of us have a good understanding of when they should be favored over alternative measures, how they are developed, the benefits of computerized administration, or how to leverage their incorporation into the electronic health record (EHR) and clinical decision making. This supplement is not intended to cover all aspects of the use of PROMs in clinical and rehabilitation care. Rather it’s goal is to provide an overview of their use and development, as well as the clinical relevance of their increasingly electronic, computerized, and EHR-based administration. It’s papers also highlight how advances in computing capabilities have permitted the use of newer modeling capabilities, such as multidimensional item response theory, to radically expand the capabilities of computerized PROMs.

The supplement emphasizes functional PROMs, however the described methods are easily applicable to other domains. More specially, its papers range from an introduction in the form of a historical overview of PROMs in rehabilitation medicine to the details of novel computerized approaches to improve their efficiency and capacity for individualized, clinically actionable assessments. In summary, we do hope that, whether you are a clinician, administrator, or psychometrician that you will find something of interest in this intriguing and increasingly important, aspect of medicine and rehabilitation.