USING THE ACTIVITY MEASURE FOR POST-ACUTE CARE (AM-PAC) SCORE AND AGE TO IDENTIFY POTENTIAL OVERUTILIZATION OF PHYSICAL THERAPY CONSULTS

Background: Physical therapy (PT) is a valuable tool to help prevent the functional decline and loss of mobility hospitalized patients experience. Yet, it is a constrained resource in most hospital settings. The AM-PAC score is a validated tool that has been used to predict discharge destination within 48 hours of admission. It has also been used to assess overutilization of PT consults on a neurosurgery service. However, there have been no studies using AM-PAC scores to evaluate overutilization of PT consults on a hospital medicine service. We aimed to assess the potential overutilization of PT consults on a hospital medicine service using validated AM-PAC score cutoffs.

Methods: We conducted a retrospective chart review of all patients admitted to the uncovered hospital medicine services at a large academic hospital from 9/30/18 through 9/29/19. Patients who left AMA, died, or discharged to hospice were excluded. We identified patients who had a physical therapy consult at any time during their admission. For those eligible, we obtained age, admission AM-PAC score, and discharge disposition. PT consult orders were considered as “potentially overutilized” in patients with AM-PAC score >/=19 based on previous studies validating this cutoff for predicting discharge to home. Descriptive statistics were used to summarize percent of patients who were < 65 years old vs. 65 years and older and percent of patients discharged to home vs. to post-acute care (skilled nursing facility, subacute/acute rehab, or long-term acute care). Chi square tests were used to analyze the relationship between AM-PAC score and discharge to home for the sample stratified by older age.

Results: Of the 6,634 patients admitted during the study period, 58% (n=3582) had a PT consult during admission. The mean age was 66.3 +/-15.4 and the mean AM-PAC score was 18.3 +/- 5.3. Seventy percent of patients were discharged home (N = 2497). Using the AM-PAC score of 19 or above, 55% of PT consults were “potentially overutilized”. Compared to AM-PAC score < 19, AMPAC score >/= 19 was associated with higher proportion discharged to home [88% vs 47%, X2 = 715.2, P < 0.001]. Adding younger age (< 65 years) to AM-PAC score >/=19 yielded a slightly higher percentage discharged home [91% vs 61%, X2 = 317.35, P < 0.001], the former representing 27% of all PT consults. Adjusting the AM-PAC score cutpoint to 23 in patients younger than 65 years identified 94% patients discharged to home [94% vs 64%, X2 = 230.02, P < 0.001], the former representing 17% of all PT consults.

Conclusions: These results suggest that more than half of PT consults on an uncovered hospital medicine service represent potential overutilization. Conservatively, using age < 65 with AM-PAC score >/= 19, 27% of all PT consults were potentially overutilized. Increasing the AMPAC cutoff to >/=23 in those < 65 years old identified 17% of all PT consults as potentially overutilized. Avoiding these could have saved 311 hours of PT referrals by conservative estimate. AM-PAC score and age should be considered prior to ordering PT consults. Future work should consider how other variables coupled with AM-PAC score can increase the specificity of identifying patients who may be lower priority for inpatient PT consultation.