The Six-Clicks Mobility Measure: A Useful Tool for Predicting Discharge Disposition

Area of Science:

• Gerontology
• Health Services Research
• Clinical Prediction Models

Background:

• Accurate prediction of hospital discharge destination is crucial for effective patient care and resource allocation.
• Functional mobility is a key factor influencing discharge disposition.
• Existing tools for assessing mobility may have limitations in predictive accuracy.

Purpose of the Study:

• To evaluate the predictive performance of the 6-clicks score and the Braden scale mobility score for hospital discharge destination.
• To determine the added value of electronic health record (EHR) data to these mobility measures.

Main Methods:

• A retrospective cohort study was conducted on 19,963 inpatient admissions from a large integrated health system.
• Predictive models incorporated patient demographics, laboratory values, vital signs, and functional mobility (6-clicks score, Braden scale) within 48 hours of admission.
• The primary outcome was discharge destination (home vs. other).

Main Results:

• The 6-clicks score demonstrated moderate discrimination for discharge destination (c-statistic=0.78), outperforming the Braden scale (c-statistic=0.68).
• EHR data alone showed poor predictive ability (c-statistic=0.66).
• Adding EHR data to the 6-clicks model resulted in a modest increase in predictive accuracy (adjusted c-statistic=0.80).

Conclusions:

• The 6-clicks score is a valuable tool for predicting discharge destination within 48 hours of hospital admission.
• Early identification of patients likely to be discharged home can facilitate timely discharge planning.
• While EHR data offers some additional predictive value, functional mobility assessment remains a primary predictor.