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Combining the AM-PAC “6-Clicks” and the Morse Fall Scale to Predict Individuals at Risk for Falls in an Inpatient Rehabilitation Hospital

Published:August 15, 2021DOI:https://doi.org/10.1016/j.apmr.2021.07.800

      Abstract

      Objective

      To determine the effect of adding the Activity Measure for Post-Acute Care (AM-PAC) Inpatient ‘6-Clicks’ Short Forms to the Morse Fall Scale (MFS) to assess fall risk. Falls that occur in a rehabilitation hospital result in increased morbidity and mortality, increased cost, and negatively affect reimbursement. Identifying individuals at high risk for falls would enable targeted fall prevention strategies and facilitate appropriate resource allocation to address this critical patient safety issue.

      Design

      We used a retrospective observational design and repeated k-fold cross-validation (10 repeats and 10 folds) of logistic regression models with falls regressed onto: MFS alone, AM-PAC basic mobility and applied cognitive scales alone, and MFS and AM-PAC combined.

      Setting

      Inpatient rehabilitation hospital.

      Participants

      After exclusions, 2007 patients from an inpatient setting (N=2007; 131 experienced a fall). Primary diagnoses included 602 individuals with stroke (30%), 502 with brain injury (25%), 321 with spinal cord injury (16%), and 582 with other diagnoses (29%).

      Interventions

      Not applicable.

      Main Outcome Measures

      Experience of a fall during inpatient stay.

      Results

      The MFS at admission was associated with falls (area under the curve [AUC], 0.64). Above and beyond the MFS, AM-PAC applied cognitive and basic mobility at admission were also significantly associated with falls (combined model AUC, 0.70). Although MFS and applied cognition showed linear associations, there was evidence for a nonlinear association with AM-PAC basic mobility.

      Conclusions

      The AM-PAC basic mobility and AM-PAC applied cognitive scales showed associations with falls above and beyond the MFS. More work is needed to validate model predictions in an independent sample with truly longitudinal data; prediction accuracy would also need to be substantially improved. However, the current data do suggest that the AM-PAC has the potential to reduce the burden of fall management by focusing resources on a smaller cohort of patients identified as having a high fall risk.

      Keywords

      List of abbreviations:

      AM-PAC (Activity Measure for Post-Acute Care), AUC (area under the curve), LOS (length of stay), MFS (Morse Fall Scale), MS-DRG (Medicare Severity Diagnostic Related Group)
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