AM-PAC “6-clicks” Predicts Discharge Destination for Patients Hospitalized with COVID-19

Clancy, Malachy; Tevalad, Michael; Butler, Kelly; Drollinger, Megan; Adler, Joe; Malone, Daniel

Research Objectives To investigate the ability of the initial Activity Measure for Post-Acute Care (AM-PAC) “6-clicks” mobility and activity scores to predict discharge disposition for patients hospitalized with COVID-19. Design Retrospective cohort using data from a COVID-19 registry. Setting Five inpatient hospitals in a single academic Health System within the United States. Participants Adults (> 17 years) who were urgently or emergently admitted to one of the five acute hospitals between March 1st and July 31st, 2020, tested positive for COVID-19 during their hospitalization, and had at least 1 AM-PAC “6-clicks” score in their medical record. Interventions N/A. Main Outcome Measures Discharge destination, dichotomized as home vs. facility. Results Of the 2565 records in the registry, 1486 included AM-PAC “6-clicks” mobility scores and 1200 included activity scores. Median age was 64 years (IQR=26), COVID-19 was primary or admitting diagnosis for 47% (n = 700), and 61.6% (n = 915) were discharged home. Initial AM-PAC was assessed 1 (IQR=3) days after admission, and the median for both mobility and activity scores was 18 (IQR=14). Multivariate logistic regression analyses revealed that, after controlling for the influence of covariates, initial mobility and activity scores were both independent predictors of discharge destination. Each point decrease in initial AM-PAC score increased the odds of discharge to a faculty by 1.15 (95 CI% 1.12 - 1.19; p < 0.001) and 1.16 (95 CI% 1.11 - 1.22; p < 0.001) fold for mobility and activity scores, respectively. Receiver operating characteristic (ROC) curve analysis revealed that initial AM-PAC scores were strong predictors of discharge destination, with area under the curve (AUC) of 0.806 (95 CI% 0.781 - 0.831; p < 0.001) and 0.796 (95% CI 0.767 - 0.826; p < 0.001) for mobility and activity scores, respectively. A score of 17.5 predicted discharge with a sensitivity of .687 and specificity of 0.81 for mobility and 0.724 and 0.770 for activity. Conclusions Initial AM-PAC “6-clicks” activity and mobility scores were both predictive of discharge destination in individuals hospitalized with COVID-19. Author(s) Disclosures Dr. Adler is a paid consultant for MedBridge Education.