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OBJECTIVES/GOALS: Physical therapy (PT) is key for treating functional decline that inpatients experience but is a constrained resource in hospital settings. The Activity Measure Post-Acute Care (AM-PAC) score is a mobility measurement tool that has been used to define misallocation of PT. We aim to optimize PT referrals using AM-PAC-based clinical decision support . METHODS/STUDY POPULATION: We conducted a prospective study of patients admitted to University of Chicago Medical Center. AM-PAC scores were assessed by nursing staff every 12 hours. Clinical decision support was designed using validated AM-PAC cutoffs (> 18, a predictor of discharge to home). The tool was embedded in hospital medicine note templates, requiring providers to indicate PT referral status based on current AM-PAC scores. The primary outcome, unskilled consult , was defined as PT referral for patients with AM-PAC > 18. Data were collected for one year prior to implementation and one year after implementation for intervention (hospital medicine) and control (general internal medicine) services. Difference in differences analysis was used to assess the association between the intervention and unskilled consults. RESULTS/ANTICIPATED RESULTS: Between October 2018 and March 2021, 18,241 admissions were eligible for the study. Compared to preintervention, there was a lower rate of referral to PT for patients with high AM-PAC mobility scores in the post-intervention period [18.5% vs 16.6%; X2(1) = 7.02; p < 0.01]. In the postintervention time period, the control group experienced a 2.6% increase in unskilled consults while the intervention group experienced a 2.3% decrease, a difference in differences of 4.9% (95% CI -0.07–-0.03 for difference in differences) controlling for age sex, race, LOS, and change in mobility. Compared to preintervention, there was no statistically significant difference in mean change in mobility score post-intervention for either group. DISCUSSION/SIGNIFICANCE: Our results suggest that clinical decision support can decrease unskilled PT consults. Many functionally independent patients can mobilize with nursing or other mobilization staff. Hospitals should consider mobility score-based decision support to prioritize PT for impaired and at-risk patients.
Focusing on the deployment of Goryeo troops to China in 1354, this chapter begins by tracing contemporary developments within the Yuan, which shaped the broader geopolitical environment in which the Goryeo regime operated. It then examines the choices Wang Gi and his court made when confronted with the largest military mobilization in East Asia in decades. The chapter concludes with a discussion of what the Yuan dynasty’s southern campaign likely revealed to Wang Gi and his advisers about military and political dynamics within the Great Khan’s realm and what they meant for the Goryeo court. This chapter’s narrative details convey a sense of dynamics within the Great Khan’s regime, which in turn sheds light on the Goryeo–Yuan alliance and Wang Gi’s place in the world.
As a boy, what was Wang Gi's experience of the Mongol empire? How did he and the people around him understand the ties between his family and the Chinggisids, between the Goryeo and Yuan polities? Wang Gi left no memoir of his childhood, and detailed – in fact any – accounts of his first years are vanishingly rare. What follows is a reconstruction of some key structural elements that would shape Wang Gi’s life – his family’s relationship with the Chinggisid ruling house, the broad network of personal relationships between the Goryeo and Mongol courts, and the place of the Goryeo dynasty in the wider Mongol empire.
This chapter is organized into four sections. The first traces Zhu Yuanzhang’s rise, including his consolidation of power over regional polities and his military campaigns against the Yuan court. The second section examines Wang Gi’s relationship with the new master of China, and the third section explores Wang Gi’s ties to the Yuan court after its relocation to the steppe. The final section considers Wang Gi’s 1370 military strikes into Liaodong, a region strategically vital to the Yuan, Ming, and Goryeo courts, in a time of rapidly shifting alliances.
The Chinggisids’ retreat northward from Daidu in 1368, the loss of nearly all their Chinese territory, and Zhu Yuanzhang’s rise to dominance posed monumental choices for Wang Gi. What would he do about his family’s century-old alliance with the Chinggisid ruling house? If Wang Gi remained true to Toghan-Temür, what – if any – alterations would he make to the Goryeo–Yuan alliance? If he abandoned his family’s long-standing ally and lord, how would he justify his action at home and abroad? If he offered his allegiance to Zhu Yuanzhang’s fledgling Ming dynasty, what would be the terms of the relationship?
This chapter looks at the Yuan dynasty in a time of growing chaos. It undertook distant military campaigns, major relief efforts, ambitious river projects, a new legal code, and massive dynastic historical compilations. Envoys like Marignolli came to the Yuan court from the other side of world, a clear reminder of the Great Yuan’s international standing and ties to other lands. If all this evidenced formidable state capacity, Korean observers also saw acute problems: widespread drought and flooding that led to famine and occasionally even cannibalism, virulent banditry that blurred readily into revolt, and court intrigue that shook vast political patronage networks and threw dynastic policy into tumult.
In times of crisis and change, what becomes of the vast and complex network of alliances that undergird all empires? Rather than focus on the major powers or “Great States,” the most common way to think about the rise and fall of empires, here is the story of “the little guy” or the lesser power, the experiences of the Wang Gi and his court as ally first to the Mongols and later to the Ming dynasty of China. The unsettled times threw up both danger and opportunity, and far from passively reacting to the actions of the Great Khan and the Ming emperor, Wang Gi and his advisers actively pursued their interests through diplomacy, military action, and domestic reform. Their efforts failed as often as they succeeded, and if their story reveals the underappreciated initiative and influence of alliances’ junior partners, it also makes clear that stark imbalances of power cannot be waved away by invoking the agency of lesser states.
This chapter analyzes political developments at the Goryeo court during the 1340s, the decade before Wang Gi took the throne. It pays particular attention to how connections to the Yuan dynasty figured in Goryeo politial dynamics and how the young Wang Gi may have understood contemporary events.
This chapter revisits Wang Gi’s measures in the summer of 1356 with attention to two points. First, what do they reveal about the Goryeo–Yuan alliance? Second, and inversely, how does attention to the broader developments of Chinggisid rule in East Asia offer insight into Wang Gi’s actions? As was true in previous chapters, this chapter argues that only through close attention to developments in the Yuan dynasty is it possible to fully appreciate the perceptions, motivations, and strategies of Wang Gi and Toghan-Temür. For this reason, the chapter includes more detail of local events in Yuan territories than is commonly found in histories of Goryeo–Yuan relations.
In the decade from 1357 to 1367, the Goryeo–Yuan alliance reached an inflection point, as mounting instability in the Yuan dynasty meant both steepening costs and broadening opportunities for the Goryeo dynasty. This chapter traces three developments: (a) the Red Turban invasions of Goryeo from 1359 to 1362, (b) the Yuan court’s abortive effort in 1362–1363 to depose Wang Gi, and (c) the rapid expansion of relations between Wang Gi’s court and regional powerholders emerging out of the tottering Yuan realm.
This chapter looks at the earliest years of Wang Gi’s rule, circa 1351–1353, and pursues two interrelated questions. First, what was Wang Gi’s experience as a Yuan ally in a time of increasing chaos? Second, how did Wang Gi’s place in the empire influence his rule at home? These two questions in fact run through the next several chapters. Rather than attempt an exhaustive account of the 1351–1353 period, this chapter focuses on two moments. The first is Wang Gi’s first year on the throne, when the fledgling king strove to eliminate potential rivals and secure legitimacy within Goryeo. The second is a puzzling, abortive coup in 1352 by one of Wang Gi’s close advisers who had attended him in Daidu.