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Dissertation/Thesis Abstract

Functional Status in Hospitalized Senior Patients: Measurement, Prediction Models, and Cost-Saving Opportunities
by Kornuszko-Story, Margaret A., Ph.D., Thomas Jefferson University, 2018, 171; 10928212
Abstract (Summary)

Seniors have declining functional ability which is made worse from immobility during hospitalization. Accountable providers have underestimated how addressing patient function can reduce costs and improve quality by reducing length of stay, readmissions, and discharges to skilled nursing facilities (SNF). This study conducted a budget impact analysis to determine potential cost savings associated with an early patient function assessment and mobility intervention. Binary logistic regression was employed to explore whether prediction models for discharge disposition and 30-day all-cause hospital readmissions can be improved with the addition of Ambulatory Measure Post-Acute Care (AM-PAC) predictors. Semi-structured interviews were conducted with process stakeholders to understand how function measurement and patient mobility can be supported in acute care facilities. Results indicated that acute care facilities in this Network would save a net of $6.4 million; and the Accountable Care Organization by reducing discharges to SNFs and readmissions would generate $4.6 million and $4.5 million respectively. AM-PAC Mobility and Self-Care scores are good predictors of discharge destination (C = 0.890), and while not significant predictors of readmission, improved the C-statistic from 0.792 to 0.811. All interviewees (n=13) stated that a culture of mobility is an important aspect for an early patient assessment and mobility intervention.

Indexing (document details)
Advisor: LaNoue, Marianna D.
Commitee: Maio, Vittorio, Powell, Adam C., Schneider, Katherine A.
School: Thomas Jefferson University
Department: Jefferson School of Population Health
School Location: United States -- Pennsylvania
Source: DAI-B 79/12(E), Dissertation Abstracts International
Subjects: Aging, Economics, Health care management
Keywords: Ambulatory measure post-acute care, Budget impact analysis, Early mobility, Functional decline, Readmission risk prediction, Senior population
Publication Number: 10928212
ISBN: 978-0-438-27880-6
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