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Inpatient Walking Activity to Predict Readmission in Older Adults

      Abstract

      Objective

      To compare the 30-day readmission predictive power of in-hospital walking activity and in-hospital activities of daily living (ADLs) in older acutely ill patients. In addition, we sought to identify preliminary walking thresholds that could support the targeting of interventions aimed at minimizing rehospitalizations.

      Design

      Prospective, observational clinical cohort study. Step counts during hospitalization were assessed via accelerometry. ADL function was assessed within 48 hours of admission.

      Setting

      Acute care hospital.

      Participants

      One hundred sixty-four ambulatory persons aged 65 years and older admitted to the hospital from the community with an acute medical illness.

      Interventions

      Not applicable.

      Main Outcome Measures

      Readmission back to the index hospital (yes vs no) within 30 days of discharge.

      Results

      Twenty-six patients (15.8%) were readmitted within 30 days of discharge. Walking activity during hospitalization was more strongly and significantly associated with 30-day readmission (odds ratio=0.90; 95% confidence interval, 0.82–0.98) than ADL function (odds ratio=0.45; 95% confidence interval, 0.14–1.45) after adjusting for relevant readmission risk factors. The predictive accuracy (area under the curve) was highest for models that included walking activity and changed little with the addition of ADLs. A walking threshold of 275 steps or more per day identified patients at reduced 30-day readmission risk.

      Conclusions

      Walking activity was a stronger predictor of readmission than ADLs. Monitoring patient activity during hospitalization may provide clinicians with valuable information on early readmission risk not captured by measures of ADLs. Further study is needed to replicate these findings and monitor walking activity posthospitalization to further advance our understanding of readmission risk.

      Keywords

      List of abbreviations:

      ADL (activities of daily living), AUC (area under the curve), CI (confidence interval), EHR (electronic health record), OR (odds ratio), ROC (receiver operating characteristic)
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