Session Information
Session Title: Research Hub - Live Theater Research Spotlight: Practice Management, Leadership, and Quality Improvement
Session Time: None. Available on demand.
Disclosures: Erik Hoyer: No financial relationships or conflicts of interest
Background and/or Objectives: To detail an approach to help identify low- and high-value therapy consultation utilizing nursing assessments of basic mobility and daily activity.
Design: Retrospective analysis of electronic health records from December 2016 to September 2019, including 47 units. The Activity Measure for Post-Acute Care (AM-PAC) was used to assess patient basic mobility and daily activity. Patients with >=1 AM-PAC score from a therapist and nurse on the same day were used to evaluate agreement between providers. Among patients with length of stay of 7 or more days, we examined the association between nursing assessments and number of therapy sessions. Patients with “high-value” therapy were those who received more than one therapy session.
Setting: Academic hospital
Participants: 47,455 patients
Interventions: NA
Main Outcome Measures: Number of physical and occupational therapy visits received compared to nursing AM-PAC score.
Results: A total of 19,932 patients (42%) were seen by PT and/or OT for a total of 88,509 visits. For reliability of nursing and therapist assessments, the intraclass correlation coefficient of mobility AM-PAC scores was 0.87 (95% confidence interval [CI]: 0.83-0.90; n=14,490) and for daily activity was 0.86 (95% CI: 0.85-0.86; n=9,500). The area under the ROC curve for predicting “high-value” consults (>1 session) was 0.81 (95% CI: 0.80-0.81; n=17,298) for mobility and 0.83 (95% CI: 0.83-0.84; n=17,290) for activity. Nursing AM-PAC raw scores ≥23 had a sensitivity of 96% and 99% for mobility and daily activity, respectively, for identifying low-value therapy consults.
Conclusions: We found that nurses and therapists have good agreement when assessing function (i.e., basic mobility and daily activities). Those assessments can then be used to help target rehabilitations services for hospitalized patients where patients with lower levels of function will receive rehabilitation consults and consults for patients with higher level of function will be avoided; hence, providing care that is timely, efficient, and of high value.
Level of Evidence: Level III
To cite this abstract in AMA style:
Hoyer E, McLaughlin K, Young D. Choosing Wisely in the Hospital Setting: A Multidisciplinary Approach to Targeting Rehabilitation Services [abstract]. PM R. 2022; 14(S1)(suppl 1). https://pmrjabstracts.org/abstract/choosing-wisely-in-the-hospital-setting-a-multidisciplinary-approach-to-targeting-rehabilitation-services/. Accessed May 17, 2025.« Back to AAPM&R Annual Assembly 2022
PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/choosing-wisely-in-the-hospital-setting-a-multidisciplinary-approach-to-targeting-rehabilitation-services/