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Reexamining occupational and physical therapists' use of the "6-Clicks" assessment in acute care as a tool to inform discharge location recommendations




Fawaz, Emily O'Connor, author
Pergolotti, Mackenzi, advisor
Malcolm, Matthew, committee member
Sharp, Julia, committee member

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Background: The "6-Clicks" is a functional status measure used in acute care rehabilitation settings to inform discharge recommendations. Research is limited examining the assumption of first versus last score on outcomes measures and other factors known to influence discharge recommendation. The purpose of this study was to address those gaps in research. Methods: Hospital electronic medical record data from adults admitted to a neurosciences unit between June 2014 and June 2016 were analyzed retrospectively. Logistic regression models were used to compare initial and final "6-Clicks" score for both the Daily Activity and Basic Mobility forms used in acute care as predictors of a home versus not-home discharge. Hierarchical linear regression models were used to examine the impact of predisposing, enabling and illness level factors on discharge location. Results: 1513 individuals were included; 55% of which were discharged home. Final scores were significantly higher than initial scores. Compared to those discharged home, individuals had significantly lower scores across both forms. Final scores were stronger predictors than initial scores. "6-clicks" score, length of stay, and having Medicaid emerged as significant predictors of discharge location. Conclusions: Final "6-Clicks" scores may indicate a more appropriate discharge location based on current status rather. Recommendations based on factors other than need, such as payer type, may have severe implications, potentially on readmission and disparities in quality of care.


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