{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T06:47:58Z","timestamp":1791787678809,"version":"4.3.4"},"reference-count":25,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T00:00:00Z","timestamp":1791676800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T00:00:00Z","timestamp":1791676800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["shmpublications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Hospital Medicine"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Physical function (PF) impairment is a key determinant of hospital discharge disposition, yet real\u2010time PF assessments remain underutilized in inpatient care. The Patient\u2010Reported Outcomes Measurement Information System Physical Function 5\u2010item tool (PROMIS PF5, or PF5) was embedded into the electronic health record (EHR) across 21 Kaiser Permanente Northern California (KPNC) hospitals to standardize PF assessment and integrate it into care. Here, we evaluated its performance in predicting discharge disposition (to home, home with home health services [home health], or to a skilled nursing facility [SNF]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Our retrospective cohort study included inpatient and observation encounters from 21 KPNC hospitals (January 1, 2022, through March 31, 2024). PF5 data included patient\u2010reported prior level of function (PLOF) and clinician\u2010assessed current level of function (CLOF), updated daily. Gradient\u2010boosted machine models predicted discharge disposition within the next 24\u2009h using demographic, clinical, and functional covariates. Model performance was evaluated across the first 7 days of hospitalization using area under the receiver operating characteristic curve (AUC), precision\u2010recall AUC (prAUC), and number needed to evaluate (NNE) and were compared with models using clinician\u2010entered expected discharge dispositions (EDD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>PF5\u2010based models outperformed clinician\u2010entered EDD, especially early during hospitalization when EDD was often missing. Across 493,035 hospital encounters, PF5\u2014particularly CLOF\u2014strongly predicted discharge disposition. For example, on Day 3 of hospitalization, SNF discharge predictions using models with PF5 achieved an AUC of 0.89 (vs. 0.75 using EDD alone). CLOF was the most influential predictor across models. The NNE for SNF discharge improved from 4.0 (Day 1) to 1.4 (Day 7) at a sensitivity threshold of 60%. Models for home and home health disposition similarly showed improved accuracy with PF5.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Models incorporating physical function enhanced prediction of discharge disposition, significantly outperforming models using expected discharge disposition alone. Our findings suggest that EHR\u2010integrated functional assessment tools may provide earlier, more objective insight into discharge disposition compared with clinician\u2010entered estimates. Further studies should evaluate whether incorporating such tools into clinical workflows improves discharge processes or patient outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jhm.70500","type":"journal-article","created":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T06:27:00Z","timestamp":1791786420000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Real\u2010time physical function assessment in hospitalized patients: Enhanced discharge disposition predictions with the PROMIS PF5 tool"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8896-643X","authenticated-orcid":false,"given":"Michael S.","family":"Yoo","sequence":"first","affiliation":[{"name":"The Permanente Medical Group Pleasanton California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colleen","family":"Plimier","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Division of Research Pleasanton California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Kipnis","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Division of Research Pleasanton California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel J.","family":"Escobar","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Division of Research Pleasanton California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6790-5689","authenticated-orcid":false,"given":"Caitlin M.","family":"Lydon","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Division of Research Pleasanton California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9111-2712","authenticated-orcid":false,"given":"David","family":"Schlessinger","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Division of Research Pleasanton California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0859-6828","authenticated-orcid":false,"given":"John D.","family":"Greene","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Division of Research Pleasanton California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian L.","family":"Lawson","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Division of Research Pleasanton California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather E.","family":"Brown","sequence":"additional","affiliation":[{"name":"Kaiser Foundation Hospitals and Health Plan Pleasanton California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3244-9101","authenticated-orcid":false,"given":"Joeffrey R.","family":"Hatton","sequence":"additional","affiliation":[{"name":"The Permanente Medical Group Pleasanton California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent X.","family":"Liu","sequence":"additional","affiliation":[{"name":"The Permanente Medical Group Pleasanton California USA"},{"name":"Kaiser Permanente Division of Research Pleasanton California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,11]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1089\/pop.2019.0176"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.14577"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/54.10.M521"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/jhm.2546"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2014.7756"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.16260"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2018.5145"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11136-022-03089-z"},{"issue":"1","key":"e_1_2_9_10_1","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1097\/01.mlr.0000103520.43902.6c","article-title":"Activity outcome measurement for 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