Ability of the Functional Assessment in Acute Care Multidimensional Computerized Adaptive Test (FAMCAT) to Predict Discharge to Institutional Postacute Care.
Tamra Keeney, David J Weiss, Pengsheng Ni and 2 others
PMID 34670134WHAT IT FOUND
Patient-reported mobility and daily activity scores strongly predicted discharge to institutional post-acute care.
Basic Mobility alone had excellent discrimination, with scores averaging 12.2 points lower for those needing facility placement compared to those going home.
Key findings
01Patients discharged to institutional post-acute care scored an average of 12.2 points lower on Basic Mobility, 10.9 points lower on Daily Activity, and 6.2 points lower on Applied Cognition compared to those discharged home.
02The FAMCAT Basic Mobility domain demonstrated excellent discrimination for predicting institutional discharge with a c-statistic of 0.87, while Daily Activity showed a c-statistic of 0.83.
03Adding FAMCAT Daily Activity and Basic Mobility scores to models containing electronic health record data and nurse-rated measures improved discrimination, with optimal models accounting for 47% of the variance in discharge location.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study was conducted at a single academic medical center, so results may not apply to other hospital settings or patient populations. The FAMCAT was administered at various times during the hospital stay, with a median of 1 to 3 days after admission, which may affect prediction accuracy. Discharge decisions are influenced by social factors and caregiver availability, which were not included in the analysis. There is no established gold standard for determining the 'correct' discharge setting, so the study measures prediction of actual discharge, not optimal discharge.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not assume that high FAMCAT scores guarantee a patient can safely return home without support. The study predicts where patients were actually discharged, not where they ideally should have been discharged, and does not account for social determinants like caregiver availability.