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Ability of the Functional Assessment in Acute Care Multidimensional Computerized Adaptive Test (FAMCAT) to Predict Discharge to Institutional Postacute Care

Published:October 17, 2021DOI:https://doi.org/10.1016/j.apmr.2021.04.028

      Abstract

      Objective

      To characterize the ability of the patient-reported Functional Assessment in Acute Care Multidimensional Computerized Adaptive Test (FAMCAT) domains to predict discharge disposition when administered during acute care stays.

      Design

      Cohort study. Logistic regression models were estimated to identify the ability of FAMCAT domains to predict discharge to an institution for postacute care (PAC).

      Setting

      Academic medical center.

      Participants

      Patients admitted to general medicine services from June 2016 to June 2019 (n = 4240).

      Interventions

      Not applicable.

      Main Outcome Measure(s)

      Discharge to an institution.

      Results

      In this sample, 10.5% of patients were discharged to an institution for rehabilitation versus home. FAMCAT domain scores were highly predictive of discharge to institutional PAC. Daily Activity and Basic Mobility domains had excellent discriminative ability for discharge to an institution (c-statistic, 0.83 and 0.87, respectively). In best fit models accounting for additional characteristics, discrimination was outstanding for Daily Activity (c-statistic, 0.91; 95% confidence interval, 0.89-0.94) and Basic Mobility (c-statistic 0.92; 95% confidence interval, 0.89-0.94).

      Conclusions

      The FAMCAT Daily Activity and Basic Mobility domains demonstrated excellent discrimination for identifying patients who discharged to an institutional setting for rehabilitation and outstanding discrimination when adjusted for salient patient factors associated with discharge disposition. Estimates obtained in this investigation are comparable to the best discrimination achieved with clinician-rated measures to identify patients who would require institutional PAC.

      Keywords

      List of abbreviations:

      CI (confidence interval), EHR (electronic health record), FAMCAT (Functional Assessment in Acute Care Multidimensional Computerized Adaptive Test), PAC (postacute care), PROM (patient-reported outcomes measure), RN (registered nurse), SNF (skilled nursing facility)
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