Measuring Functional Status in Hospitalized Older Adults Through Electronic Health Record Documentation. Issue 4 (April 2018)

• Record Type: Journal Article
• Authors: Sinvani, Liron; Kozikowski, Andrzej; Patel, Vidhi; Mulvany, Colm; Smilios, Christopher; Qiu, Guang; Zhang, Meng; Wolf-Klein, Gisele; Pekmezaris, Renee
• Is Part Of: Southern medical journal. Volume 111:Issue 4(2018)
• Publication Date: 2018-04
• Subjects: electronic health record -- functional status -- hospital-associated disability; Medicine -- Periodicals; 610.5
• DOI: 10.14423/SMJ.0000000000000788
• Languages: English
• ISSNs: 0038-4348

Abstract

Abstract : Objectives: Hospitalization-associated disability affects up to 60% of older adults; however, standardized measures of function are not routinely used and documented. We sought to determine whether nursing documentation in electronic medical records can be used to determine mobility status and associated clinical outcomes. Methods: A retrospective study of 2383 medical patients aged 75 years and older was conducted at a large academic tertiary hospital in New York. Mobility (low, intermediate, and high) was the primary variable of interest. Short-term clinical outcomes, including length of stay (LOS), discharge disposition, and readmissions, were the primary outcome variables. Results: Average age and Charlson Comorbidity Index were 84.7 (range 74–107) and 6.46, respectively; 84.5% of patients were documented to have been ambulatory before admission. More than half (52.8%) of the subjects with in-hospital mortality were in the low mobility group (27.2 vs 0.27 vs 0, P < 0.0001). Low mobility was associated with increased LOS (7.42 vs 5.69 vs 4.14, P < 0.0001), discharge to a skilled nursing facility (39.36 vs 14.67 vs 1.91, P < 0.0001), and 30-day readmission (24.40 vs 16.67 vs 10.93, P < 0.0001). After controlling for demographics, ambulatory status before admission, and Charlson Comorbidity Index, low mobility was statistically significantly associated with increased LOS, discharge to a skilled nursing facility, and 30-day readmissions. Conclusions: The use of documented nursing observation may provide a practical way to systematically identify patients at risk for poor outcomes associated with low mobility to ultimately improve outcomes of hospitalized older adults. Abstract : Hospitalization of older adults often results in debilitating and persistent functional decline, which ultimately leads to significant and costly morbidity and mortality. Despite the existence of numerous validated functional measures, their systematic use across hospitals is lacking. The authors investigated whether nursing documentation in electronic medical records can be used to determine mobility status and associated clinical outcomes.