AM-PAC “6-Clicks” for the Prediction of Short Term Clinical Outcomes in Individuals Hospitalized with COVID-19: A Retrospective Cohort Study

Tevald, Michael A.; Clancy, Malachy J.; Butler, Kelly; Drollinger, Megan; Adler, Joe; Malone, Daniel

OBJECTIVE To determine the ability of the Activity Measure for Post-Acute Care (AM-PAC) assessments of mobility and activity to predict key clinical outcomes in patients hospitalized with COVID-19. DESIGN Retrospective cohort study SETTING An academic health system in the United States consisting of five inpatient hospitals. PARTICIPANTS Adult patients (N=1486) urgently or emergently admitted, tested positive for COVID-19, and had at least 1 AM-PAC assessment. INTERVENTIONS Not applicable MAIN OUTCOME MEASURES Discharge destination, hospital length of stay, in-hospital mortality, and readmission. RESULTS 1486 admission records were included in the analysis. After controlling for covariates, initial and final mobility (OR = 0.867 and 0.833, respectively) and activity scores (OR = 0.892 and 0.862, respectively) were both independent predictors of discharge destination with a high accuracy of prediction (AUC = 0.819-0.847). Using a threshold score of 17.5, sensitivity ranged from 0.72-0.79, while specificity ranged from 0.74-0.83. Both initial AM-PAC mobility and activity scores were independent predictors of mortality (OR = 0.885 and 0.877, respectively). Initial mobility, but not activity, scores were predictive of prolonged LOS (OR = 0.957 and 0.980, respectively). However, the accuracy of prediction for both outcomes was weak (AUC = 0.659-0.679). AM-PAC scores did not predict re-hospitalization. CONCLUSION Functional status as measured by the AM-PAC “6-clicks” measures of mobility and activity are independent predictors of key clinical outcomes individual hospitalized with COVID-19.