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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: June 02, 2016
Footnotes
Supported in part by the National Institutes of Health (grant nos. R01 AG031178, P30 AG024832, R01 HD069443, R24 HD065702, and K12 HD055929) and the National Institute on Disability, Independent Living and Rehabilitation Research (grant no. 90IF0071).
Publication of this article was supported by the American Congress of Rehabilitation Medicine.
Disclosures: none.
Identification
Copyright
© 2016 by the American Congress of Rehabilitation Medicine
