Utility of functional metrics assessed during acute care on hospital outcomes: A systematic review

Model System:

TBI

Reference Type:

Journal article

Accession No.:

J74052

Journal:

PM & R

Year, Volume, Issue, Page(s):

2019 , 11, 5, 522-532

Publication Website:

Abstract:

Study reviewed the literature examining the association between acute hospital physical function and various hospital outcomes and healthcare utilization. A search of the MEDLINE database was performed using term that included acute functional outcomes and frailty outcomes. Studies up to September 2017 were selected if they were in English and examined how functional metrics collected at acute care hospitalization affected hospital outcomes. Cohort characteristics and measures of associations were extracted from the studies. Outcomes include hospital readmission, length of stay (LOS), mortality, discharge location, and physical function post-acute care. The studies were assessed for potential confounders as well as selection, attrition, and detection bias. A total of 30 studies were identified: 6 studies reported on hospital readmissions, 11 reported on discharge location, 4 reported on LOS, 15 reported on mortality, and 6 reported on function. Thirteen different metrics assessed function during acute care. Lower function during acute care was associated with statistically significant higher odds of hospital readmission, lower likelihood of discharge to home, longer hospital LOS, increased mortality, and worse functional recovery when compared to patients with higher function during acute care, when adjusted for age and gender. Findings suggest that the Barthel Index may be a useful marker for mortality in the elderly, whereas the Functional Independence Measure instrument may be valuable for examining discharge location. This study shows that there is increasing evidence that function measured during acute care predicts a broad array of meaningful clinical outcomes.

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