Activity Measure for Post-Acute Care "6-Clicks" for the Prediction of Short-term Clinical Outcomes in Individuals Hospitalized With COVID-19: A Retrospective Cohort Study.

OBJECTIVE: To determine the ability of the Activity Measure for Post-Acute Care (AM-PAC) "6-Clicks" assessments of mobility and activity to predict key clinical outcomes in patients hospitalized with coronavirus disease 2019 (COVID-19). DESIGN: Retrospective cohort study. SETTING: An academic health system in the United States consisting of 5 inpatient hospitals. PARTICIPANTS: Adult patients (N=1486) urgently or emergently admitted who tested positive for COVID-19 and had at least 1 AM-PAC assessment. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Discharge destination, hospital length of stay, in-hospital mortality, and readmission. RESULTS: A total of 1486 admission records were included in the analysis. After controlling for covariates, initial and final mobility (odds ratio, 0.867 and 0.833, respectively) and activity scores (odds ratio, 0.892 and 0.862, respectively) were both independent predictors of discharge destination with a high accuracy of prediction (area under the curve [AUC]=0.819-0.847). Using a threshold score of 17.5, sensitivity ranged from 0.72-0.79, whereas specificity ranged from 0.74-0.83. Both initial AM-PAC mobility and activity scores were independent predictors of mortality (odds ratio, 0.885 and 0.877, respectively). Initial mobility, but not activity, scores were predictive of prolonged length of stay (odds ratio, 0.957 and 0.980, respectively). However, the accuracy of prediction for both outcomes was weak (AUC=0.659-0.679). AM-PAC scores did not predict rehospitalization. CONCLUSIONS: Functional status as measured by the AM-PAC "6-Clicks" mobility and activity scores are independent predictors of key clinical outcomes individual hospitalized with COVID-19.

"6-clicks" Predicts Discharge Destination for Patients Hospitalized with COVID-19

To investigate the ability of the initial Activity Measure for Post-Acute Care (AM-PAC) "6-clicks" mobility and activity scores to predict discharge disposition for patients hospitalized with COVID-19. Retrospective cohort using data from a COVID-19 registry. Five inpatient hospitals in a single academic Health System within the United States. Adults (> 17 years) who were urgently or emergently admitted to one of the five acute hospitals between March 1st and July 31st, 2020, tested positive for COVID-19 during their hospitalization, and had at least 1 AM-PAC "6-clicks" score in their medical record. N/A. Discharge destination, dichotomized as home vs. facility. Of the 2565 records in the registry, 1486 included AM-PAC "6-clicks" mobility scores and 1200 included activity scores. Median age was 64 years (IQR=26), COVID-19 was primary or admitting diagnosis for 47% (n = 700), and 61.6% (n = 915) were discharged home. Initial AM-PAC was assessed 1 (IQR=3) days after admission, and the median for both mobility and activity scores was 18 (IQR=14). Multivariate logistic regression analyses revealed that, after controlling for the influence of covariates, initial mobility and activity scores were both independent predictors of discharge destination. Each point decrease in initial AM-PAC score increased the odds of discharge to a faculty by 1.15 (95 CI% 1.12 - 1.19;p < 0.001) and 1.16 (95 CI% 1.11 - 1.22;p < 0.001) fold for mobility and activity scores, respectively. Receiver operating characteristic (ROC) curve analysis revealed that initial AM-PAC scores were strong predictors of discharge destination, with area under the curve (AUC) of 0.806 (95 CI% 0.781 - 0.831;p < 0.001) and 0.796 (95% CI 0.767 - 0.826;p < 0.001) for mobility and activity scores, respectively. A score of 17.5 predicted discharge with a sensitivity of.687 and specificity of 0.81 for mobility and 0.724 and 0.770 for activity. Initial AM-PAC "6-clicks" activity and mobility scores were both predictive of discharge destination in individuals hospitalized with COVID-19. Dr. Adler is a paid consultant for MedBridge Education.