Physical Function Tracking

Monitoring Physical Function Following Acute Hospitalization

Longitudinal Tracking for Post Hospitalization Outcomes
Funded by The Center on Health Services Training and Research - CoHSTAR

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Acute hospitalization, particularly for older adults, can have profound and persistent consequences on physical function. 1,2 Many studies have reported declines in physical function during and after an acute hospital stay with functional deficits persisting at least a year following hospitalization. 3–5 Sustained deficits in physical function are an important risk factor for several adverse post-hospitalization outcomes.

Inconsistent assessment of physical function has hampered our ability to learn what interventions ought to be implemented to maximize physical function across the continuum of care settings.

Our long-term goals

1. Define a process for consistent physical function data collection beginning in the acute hospital and following patients as they proceed to post-acute care settings and return to community living
2. Create a place for those data to be shared and used for understanding and improving long-term changes in physical function.

Our team, with representatives from University of Utah Health, Johns Hopkins Medicine, and the Cleveland Clinic received pilot funding to help define a standard data tool kit for longitudinal tracking of physical function from acute care hospitalization through post-acute care settings and into the community. Defining the tool kit involved facilitating consensus from key stakeholders including rehabilitation therapists, case managers, discharge planners, registered nurses, administrators, patients and a core group of experts.

The purpose of this website is to share the current tool kit with other interested health systems and individuals and to provide a mechanism for discussion and input. This tool kit represents a first step in standardizing a minimum set of data to collect in the inpatient and home health settings only. We anticipate including other care settings in the future.

Have feedback or questions?

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Contact Robin Marcus

Minimum Data Set

Administrative data 

Data routinely collected and documented in the electronic health record; collected only one time.

Provider collected data

Data collected by a health care provider. Collected at one time only. In order to minimize burden we are recommending using common, standard questionnaires and patient reported outcomes currently available and often required by regulatory bodies. Most are available at no or low cost.

The Continuity Assessment Record and Evaluation (CARE) Item Set Questions (B1, B3, B3a, B5a-e, B6, B7)

1. Prior to this hospitalization, where did the patient live?
   1. Private Residence
   2. Community based residence (e.g., assisted living residence, group home, adult foster care)
   3. Long term care facility (e.g., nursing home)
   4. Other (e.g., shelter, jail, no known address)
   5. Unknown
2. If the patient lived in the community prior to this illness, what help was used?
   1. No help received or no help necessary
   2. Unpaid assistance
   3. Paid assistance
   4. Unknown
3. If the patient lived in the community prior to this illness, who did the patient live with?
   1. Lives alone
   2. Lives with paid helper
   3. Lives with other(s)
   4. Unknown 
4. Indicate the patient’s usual ability with everyday activities prior to this current illness, exacerbation or injury (Use the following to score – 1. Independent, 2. Needs Some Help, 3. Dependent, 4. NA, 5. Unknown)
   1. Self-Care (Did the patient need help bathing, dressing, using the toilet or eating?)
   2. Indoor Mobility - Ambulation (Did the patient need assistance with walking from room to room (with or without devices such as cane , crutch or walker)?)
   3. Indoor Mobility – Stairs (Did the patient need assistance with internal or external stairs (with or without devices such as cane , crutch or walker)?)
   4. Indoor Mobility – Wheelchair (Did the patient need assistance moving from room to room using a wheelchair, scooter, or other wheeled mobility device?)
   5. Functional Cognition (Did the patient need help planning regular tasks such as shopping or remembering to take medication?)
5. Mobility devices or aids used prior to hospitalization
   1. Cane/crutch
   2. Walker
   3. Orthotics/prosthetics
   4. Wheelchair/scooter full time
   5. Wheelchair/scooter part time
   6. Mechanical lift
   7. Other (specify)_________________________
   8. None apply
   9. Unknown
6. History of falls prior to hospitalization – Has the patient had two or more falls within the past year or any fall with injury in the past year?
   1. Yes
   2. No
   3. Unknown

Other – collected daily or at each visit

Instruments

CARE Tool

OASIS

The Activity Measure for Post Acute Care (AM-PAC)

Confusion Assessment Method for the ICU (CAM-ICU)

Johns Hopkins Highest Level of Mobility (JH-HLM)  

JH-HLM Mobility Goal Calculator

Johns Hopkins Daily Mobility Goal Calculator
 
Johns Hopkins Highest Level of Mobility Score               AM-Pac Mobility Score
8 – Walk 250 feet or more                                                   24
7 – Walk 25 feet or more                                                     22-23
6 – Walk 10 steps or more                                                   18-21
5 – Standing (1 or more minutes)                                       16-17
4 – Move to chair or commode                                        10-15
3 – Sit at edge of bed                                                          8-9
2 – Bed activities/dependent transfer                              6-7
1 – Lying in bed                                                                     --