W.D. Rieger1, M.O. Fajemisin1, R.W. Green1, S.D. MartinezUgarte1, L.S. Kao1 1McGovern Medical School at UTHealth Houston, Surgery, Houston, TX, USA
Introduction: The Activity Measure Post Acute Care Score (AM-PAC), measured by physical therapy, predicts rehabilitative needs. However, discharge disposition is dependent on social factors in addition to functional status. We hypothesized that increased social vulnerability is associated with decreased appropriate discharge to post-acute care rehabilitation as informed by AM-PAC scores.
Methods: A retrospective single-center cohort study was conducted of adult patients who underwent trauma laparotomy, survived to discharge, and had physical therapy between 1/2020 and 6/2023. Patient demographics, payment method, injury details, length of stay (LOS), and hospital discharge data was collected from the trauma registry. Social Vulnerability Index (SVI) and Area Deprivation Index (ADI) values were obtained by geocoding census data and comparing to existing registries. Inpatient physical therapy data, was collected from medical records with AM-PAC scores summed from 6 activities of daily living (ADLs), each graded 1-4, for a total range 6-24. The primary outcome was discharge disposition consistent with AM-PAC scores with <16 predictive of rehabilitative service need. Descriptive statistics, univariate, and multivariate analysis were performed.
Results: Of the 572 patients included, median age was 33 (IQR 13-53), 75% were Male and majority Black (36.4%) with 23.8% White, 51.5% with a public payer (Medicare, Medicaid, Tricare) and 10.3% were self pay. The mean SVI and ADI values were 0.670 (SD 0.271) and 61.4 (SD 22.9), respectively, with values closer to 1 and 100 showing greater vulnerability. Most patients (n=462, 79.5%) were discharged without rehabilitative services with 495 patients (77%) discharged appropriately per AM-PAC scoring. Two binomial logistic regression models were run examining appropriate discharge disposition based on AM-PAC scores as influenced by SVI and ADI independently. The SVI model (AIC 364) showed better fit compared to ADI (AIC 402) and was explored. Appropriate discharge disposition was associated with older age (OR 1.02, CI 1-1.03 with p =0.04), higher Injury Severity Score (OR 1.02, CI 1.00-1.04, p=0.046), and longer LOS (OR 1.02, CI 1.0-1.03, p=0.027). Black patients had lower odds of appropriate discharge disposition than white patients (OR 0.36, CI 0.15-0.83, p=0.017). SVI showed no significant association with appropriate discharge disposition (OR 1.37, CI 0.39-3.25, p=0.81).
Conclusion: Patient performance of ADLs should continue to drive rehabilitative care upon discharge regardless of socioeconomic factors. While social vulnerability did not alter ultimate discharge disposition with that conferred by AM-PAC scores, Black patients were at increased odds of being discharged to a different location than their functionality would suggest. Further examination of this disparity is required to determine causal factors.