Activities of Daily Living Assessment Early in Hospitalization Is Associated With Key Outcomes

Abstract

Abstract Importance: Assessing patients’ activities of daily living (ADLs) function early in hospitalization may help identify patients at risk for poor outcomes. Objective: To investigate the association between patients’ ADL function at hospital admission and length of stay, inpatient falls, hospital-acquired pressure injuries, and discharge disposition. Design: Retrospective cohort study using scores collected on the Activity Measure for Post-Acute Care Inpatient Activity Short Form (AM-PAC IASF) in routine care at admission. Setting: Two inpatient units at the Johns Hopkins Hospital. Participants: Hospitalized patients with various diagnoses, including neurosurgical, stroke, and general neurology (N = 1,899). Results: People with lower AM-PAC scores (every 10-point difference) had increased odds (odds ratio [OR] = 1.6; 95% confidence interval [CI] = 1.4–1.8) of being in the highest length-of-stay quartile (≥8 days), having an injurious fall (OR = 1.7; 95% CI = 1.3–2.2), acquiring a pressure injury (OR = 2.7; 95% CI = 1.5–5.3), and being discharged to a postacute care facility (OR = 3.02; 95% CI = 2.1–2.7). Conclusions and Relevance: Greater functional impairments in ADLs, measured with the AM-PACS IASF, were significantly associated with worse outcomes. AM-PAC IASF scores may be useful in identifying patients with ADL deficits and targeting occupational therapy services for patients who are at higher risk for negative outcomes. What This Article Adds: Early assessment of ADL function in routine care of hospitalized patients may aid in treatment and care plan decisions, particularly for inpatients who may be at higher risk for adverse outcomes.