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  • New White Paper Presses for Consistent Mobility Assessments, More Outcome Measures for Hospitalized Older Adults

    The impact that loss of mobility can have on hospitalized older adults can reach far beyond the hospital stay, yet there is little consistency in the ways hospitals assess and promote movement, and almost no acknowledgement of mobility as an outcome measure. That needs to change, and soon, say authors of a new white paper advocating for a shift in "a hospital culture that does not value or prioritize mobility." APTA was among the organizations that participated in a peer review of the document, with member James Tompkins, PT, DPT, conducting the review.

    The white paper, produced by the American Geriatric Society's (AGS) Quality and Performance Measurement Committee, describes the current state of mobility assessment in acute care settings as spotty at best, with a few hospitals conducting regular, validated mobility reviews with patients, and many others using inconsistent assessments or relying too much on hospital physical therapy departments to keep up with tests and measures that could be conducted by nurses. The assessment gaps, coupled with what researchers describe as a "focus on fall prevention at all costs," result in dramatic and potentially long-lasting losses in mobility in a population already at risk.

    The lack of thorough and consistent assessments isn't necessarily surprising, given the general lack of attention paid to mobility as an outcome measure for acute care, according to authors of the white paper. "Nursing staff may be assessing mobility routinely and repeatedly, but they are not doing so in the standard or validated manner necessary for mobility quality measurement or intervention," authors write, adding that entities including the Joint Commission and the US Centers for Medicare and Medicaid Services (CMS) largely ignore mobility as an outcome measure.

    To help fuel the needed changes, the white paper offers 7 recommendations:

    • Promote mobility assessment in acute care through "incentives for the use of standard, validated, mobility assessments" by CMS and other regulators
    • Advocate for more research funding for translational research in mobility assessment and intervention programs
    • Develop a consensus on standard methods to assess mobility "appropriate for acute care settings and clinically meaningful for providers and patients"
    • Minimize the burden of mobility measurement through, among other efforts, "optimizing workflow and documentation and minimizing redundancy by specifying the roles of various health care professionals such as nurses and physical therapists"
    • Evaluate the feasibility of a mobility quality measure for use by CMS
    • Reframe the current regulatory focus on falls in acute care to focus on safe mobility "in the face of little evidence of the effectiveness of strategies to prevent falls in acute care"
    • Develop resources for acute care providers available from AGS and other entities

    One bright spot, according to the white paper authors, is that several standardized mobility assessments could fit the bill. Authors identified 6 assessments as especially promising, with most able to be administered by a nurse: the Activity Measure for Post-Acute Care 6-Clicks; the Banner Mobility Assessment Tool; the de Morton Mobility Index; the Hierarchical Assessment of Balance and Mobility; the Johns Hopkins Highest Level of Mobility assessment; the Minimum Data Set 3.0 version 1.14, Section G; and the Minimum Data Set 3.0 version 1.14, Section GG. [Editor's note: many of these assessments are available in APTA's PTNow online resource center.]

    The end result, according to white paper authors: "We anticipate that routine mobility assessment will lead to a new paradigm in which stabilization of or improvement in mobility will be a universal indicator of high-quality hospital care."

    Comments

    • I agree with the author, however I believe falls assessment and prevention should be used as well to prevent hospital re-admission.

      Posted by Bhavik Hindocha on 10/12/2018 7:26 PM

    • I am thrilled to see this article. I have been very frustrated with the over-emphasis on fall prevention vs a focus on safe mobility, and love the idea of a mobility quality measure for use by CMS. I often find myself encouraging patients to be their own best advocate by asking nursing to get them up for a walk, because, as I explain to them, "We have a bad habit of sending patients home weaker than when they came in because we have such a strict fall policy that doesn't allow people to get up by themselves". I would LOVE to see "a new paradigm in which stabilization of or improvement in mobility will be a universals indicator of high-quality hospital care". I am behind this all the way!!!

      Posted by JENNIFER JESSUP-ROSECRANCE on 10/13/2018 12:03 AM

    • I certainly agree that hospitals have lost the focus on mobility. I fear that another assessment tool that must be completed by staff takes time which could be used to just get patients up and walking. Improved mobility can help reduce those readmission rates.

      Posted by Cynthia MacDougall on 10/14/2018 11:55 AM

    • I absolutely agree that we have a problem . My older patients come back to home health care very often at SIGNIFICANTLY reduced functional levels . This INCLUDES acute rehab settings. ! Patients say they are absolutely forbidden to stand or walk , even if they have the capacity . Thank you for publishing this hopeful study .

      Posted by Lorraine Gohr on 10/16/2018 2:39 PM

    • Just a couple of points: 1. Kay Hashagen, PT, MBA, RAC-CT advocated the 6-clicks for acute care in a recent course on improved goal writing and use of standardized outcome measures for reimbursement. 2. Pertinent recently published PTJ study: Breaking Down Barriers to the Utilization of Standardized Tests and Outcome Measures in Acute Care Physical Therapist Practice: An Observational Longitudinal Study Brian McDonnell; Shannon Stillwell; Shelby Hart; Roger B Davis Physical Therapy, Volume 98, Issue 6, 1 June 2018, Pages 528–538, https://doi.org/10.1093/ptj/pzy032

      Posted by Teresa Hanak -> BFX^DI on 10/23/2018 2:15 PM

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