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  • Measure Summary
  • NQMC:004941
  • Feb 2008
  • NQF-Endorsed Measure

Post-acute care functional status: mean change score in daily activity of patients in a post-acute care setting as assessed using the "Daily Activities" domain of the Activity Measure for Post-acute Care (AM-PAC).

Jette A, Haley SM, Coster WJ, Ni P. Instruction manual. Activity Measures for Post-acute Care (AM-PAC): basic mobility, daily activity, applied cognition functional domains. Boston (MA): Boston University, Health and Disability Research Institute; 2008 Feb 22. 45 p.
Jette A, Haley SM, Coster WJ, Ni P. Instruction manual. AM-PAC computerized adaptive testing (AM-PAC CAT™) personal computer version: basic mobility, daily activity and applied cognitive functional domains. Boston (MA): Boston University, Health and Disability Research Institute; 2007 May 1. 26 p.

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in April 2016.

Primary Measure Domain

Clinical Quality Measures: Outcome

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the mean change score in daily activity of patients in a post-acute care setting as assessed using the "Daily Activities" domain of the Activity Measure for Post-acute Care (AM-PAC).

Rationale

The effectiveness of rehabilitation services is best understood through repeated measurements of functional outcomes with a consistent, valid, and reliable assessment system. Within post-acute care, there is a growing demand for outcome assessment systems that can monitor interventions and programs on an ongoing basis across diagnostic groups and across the continuum of care settings. A well-accepted approach for addressing this need is the development of a clinical monitoring system designed for outcomes management. As highlighted in the long-range research plan of the National Institute on Disability and Rehabilitation Research, such clinical monitoring systems can provide important information on the outcomes of services to direct ongoing process and outcome improvements.

The Boston University Activity Measure for Post Acute Care (AM-PAC)™ is an activity limitations instrument developed using the World Health Organization's International Classification of Functioning, Disability and Health (ICF). According to the ICF, an activity limitation is defined as "difficulty in the execution of a task or action by an individual." The AM-PAC™ was developed as a functional outcomes system that can be used across post acute care settings and consists of a comprehensive list of 288 functional activities (i.e., the item bank). It measures functional outcome by using contemporary measurement techniques, such as Item Response Theory (IRT), to overcome the limitations of traditional functional outcome measures. Unlike these traditional functional outcome measures which are disease, condition, or setting-specific, the AM-PAC was designed to be used across patient diagnoses, conditions and settings where post acute care is being provided; therefore, the AM-PAC is the ideal measure for developing benchmarks and for examining functional outcomes over an episode of post acute care, as patients move across care settings.

Evidence for Rationale

Haley SM, Andres PL, Coster WJ, Kosinski M, Ni P, Jette AM. Short-form activity measure for post-acute care. Arch Phys Med Rehabil. 2004 Apr;85(4):649-60. PubMed External Web Site Policy

International Classification of Functioning, Disability and Health (ICF). Geneva, Switzerland: World Health Organization (WHO); 2001.

Jette A, Haley SM, Coster WJ, Ni P. Instruction manual. AM-PAC computerized adaptive testing (AM-PAC CAT™) personal computer version: basic mobility, daily activity and applied cognitive functional domains. Boston (MA): Boston University, Health and Disability Research Institute; 2007 May 1. 26 p.

Jette AM, Haley SM. Contemporary measurement techniques for rehabilitation outcomes assessment. J Rehabil Med. 2005 Nov;37(6):339-45. [44 references] PubMed External Web Site Policy

Primary Health Components

Post-acute care; daily activities

Denominator Description

Patients in the post-acute care setting who were assessed at baseline and at some follow-up point in time using the "Daily Activities" domain of the Boston University Activity Measure for Post-acute Care (AM-PAC)

Numerator Description

Mean change score in daily activity of patients in a post-acute care setting as assessed using the "Daily Activities" domain of the Boston University Activity Measure for Post-acute Care (AM-PAC)

Type of Evidence Supporting the Criterion of Quality for the Measure

  • Focus groups
  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

Initially, Activity Measure for Post-acute Care (AM-PAC) test items were administered to a large sample of patients from different care settings with different diagnoses. Factor analytic work identified three distinct, interpretable factors that accounted for 72% of the variance: Applied Cognition (44%), Daily Activities (19%) and Basic Mobility (9%). These factors were verified by a confirmatory factor analysis and defined as the three AM-PAC domains. Using Item Response Theory (IRT), items in each domain were scaled along a continuum of item difficulty. Items that were redundant or did not fit the model were eliminated. The remaining items formed the AM-PAC item banks, which included a wide range of items calibrated along a continuum of difficulty.

Adequate levels of reliability of individual items and validity of the AM-PAC have been established and have been reported. Refer to the articles referenced in the "Evidence for Extent of Measure Testing" field for further information.

Evidence for Extent of Measure Testing

Chan L, Sandel ME, Jette AM, Appelman J, Brandt DE, Cheng P, Teselle M, Delmonico R, Terdiman JF, Rasch EK. Does Post-Acute Care Site Matter? A longitudinal study assessing functional recovery after a stroke. Arch Phys Med Rehabil. 2012 Nov 1; PubMed External Web Site Policy

Haley SM, Gandek B, Siebens H, Black-Schaffer RM, Sinclair SJ, Tao W, Coster WJ, Ni P, Jette AM. Computerized adaptive testing for follow-up after discharge from inpatient rehabilitation: II. Participation outcomes. Arch Phys Med Rehabil. 2008 Feb;89(2):275-83. PubMed External Web Site Policy

Haley SM, Ni P, Jette AM, Tao W, Moed R, Meyers D, Ludlow LH. Replenishing a computerized adaptive test of patient-reported daily activity functioning. Qual Life Res. 2009 May;18(4):461-71. PubMed External Web Site Policy

Haley SM, Ni P, Lai JS, Tian F, Coster WJ, Jette AM, Straub D, Cella D. Linking the activity measure for post acute care and the quality of life outcomes in neurological disorders. Arch Phys Med Rehabil. 2011 Oct;92(10 Suppl):S37-43. PubMed External Web Site Policy

Jette AM, Haley SM, Ni P, Olarsch S, Moed R. Creating a computer adaptive test version of the late-life function and disability instrument. J Gerontol A Biol Sci Med Sci. 2008 Nov;63(11):1246-56. PubMed External Web Site Policy

Jette AM, Ni P, Rasch EK, Appelman J, Sandel ME, Terdiman J, Chan L. Evaluation of patient and proxy responses on the activity measure for postacute care. Stroke. 2012 Mar;43(3):824-9. PubMed External Web Site Policy

Latham NK, Mehta V, Nguyen AM, Jette AM, Olarsch S, Papanicolaou D, Chandler J. Performance-based or self-report measures of physical function: which should be used in clinical trials of hip fracture patients. Arch Phys Med Rehabil. 2008 Nov;89(11):2146-55. PubMed External Web Site Policy

Sandel ME, Jette AM, Appelman J, Terdiman J, Teselle M, Delmonico RL, Wang H, Camicia M, Rasch EK, Brandt DE, Chan L. Designing and Implementing a System for Tracking Functional Status After Stroke: A Feasibility Study. PM R. 2012 Nov 13; PubMed External Web Site Policy

Tao W, Haley SM, Coster WJ, Ni P, Jette AM. An exploratory analysis of functional staging using an item response theory approach. Arch Phys Med Rehabil. 2008 Jun;89(6):1046-53. PubMed External Web Site Policy

State of Use

Current routine use

Current Use

Internal quality improvement

Measurement Setting

Ambulatory/Office-based Care

Assisted Living Facilities

Home Care

Hospital Inpatient

Hospital Outpatient

Rehabilitation Centers

Skilled Nursing Facilities/Nursing Homes

Professionals Involved in Delivery of Health Services

Advanced Practice Nurses

Nurses

Occupational Therapists

Physical Therapists

Physicians

Least Aggregated Level of Services Delivery Addressed

Clinical Practice or Public Health Sites

Statement of Acceptable Minimum Sample Size

Unspecified

Target Population Age

Adults

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Getting Better

IOM Domain

Effectiveness

Case Finding Period

Unspecified

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Diagnostic Evaluation

Encounter

Institutionalization

Therapeutic Intervention

Denominator Time Window

Time window brackets index event

Denominator Inclusions/Exclusions

Inclusions
Patients in the post-acute care setting who were assessed at baseline and at some follow-up point in time using the "Daily Activities" domain of the Boston University Activity Measure for Post-acute Care (AM-PAC)

Exclusions
Unspecified

Exclusions/Exceptions

Unspecified

Numerator Inclusions/Exclusions

Inclusions
Mean change score in daily activity of patients in a post-acute care setting as assessed using the "Daily Activities" domain of the Boston University Activity Measure for Post-acute Care (AM-PAC)

Exclusions
Unspecified

Numerator Search Strategy

Fixed time period or point in time

Data Source

Patient/Individual survey

Type of Health State

Functional Status

Instruments Used and/or Associated with the Measure

Boston University Activity Measure for Post-acute Care (AM-PAC)™

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Composite/Scale

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Risk adjustment devised specifically for this measure/condition

Description of Allowance for Patient or Population Factors

Risk adjustment procedures are provided for the following variables: diagnosis, age, gender, surgery, admission basic mobility score, admission daily activity score, payment sources, number of days between accident date and admission date, severity. Refer to the original measure documentation for further information.

Standard of Comparison

Internal time comparison

Original Title

Daily Activities: Boston University Activity Measure for Post-acute Care (AM-PAC).

Measure Collection Name

Boston University Activity Measure for Post-acute Care (AM-PAC)™

Submitter

Boston University Health & Disability Research Institute - Academic Affiliated Research Institute

Developer

Boston University Health & Disability Research Institute - Academic Affiliated Research Institute

Funding Source(s)

Unspecified

Composition of the Group that Developed the Measure

Unspecified

Financial Disclosures/Other Potential Conflicts of Interest

Unspecified

Endorser

National Quality Forum

NQF Number

0430

Date of Endorsement

2008 Jul 31

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2008 Feb

Measure Maintenance

Unspecified

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in April 2016.

Source(s)

Jette A, Haley SM, Coster WJ, Ni P. Instruction manual. Activity Measures for Post-acute Care (AM-PAC): basic mobility, daily activity, applied cognition functional domains. Boston (MA): Boston University, Health and Disability Research Institute; 2008 Feb 22. 45 p.

Jette A, Haley SM, Coster WJ, Ni P. Instruction manual. AM-PAC computerized adaptive testing (AM-PAC CAT™) personal computer version: basic mobility, daily activity and applied cognitive functional domains. Boston (MA): Boston University, Health and Disability Research Institute; 2007 May 1. 26 p.

Measure Availability

Source not available electronically.

For more information, contact Mediware at 800-279-8456 ext. 200; Web site: http://pac-metrix.com External Web Site Policy.

NQMC Status

This NQMC summary was completed by ECRI Institute on March 31, 2009. The information was verified by the measure developer on June 22, 2009.

This NQMC summary was retrofitted into the new template on April 22, 2011.

The information was reaffirmed by the measure developer on April 5, 2016.

Copyright Statement

This NQMC summary is based on the original measure, which is subject to the measure developer's copyright restrictions.

For more information on obtaining this instrument, contact Mediware at 800-279-8456 ext. 200; Web site: http://pac-metrix.com External Web Site Policy.

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Readers with questions regarding measure content are directed to contact the measure developer.

Related HHS Measure

From the HHS Measure Inventory

Prior Functioning ADL/IADL: The Activity Measure for Post Acute Care (AM-PAC) is a functional status assessment instrument developed specifically for use in facility and community dwelling post acute care (PAC) patients. It was built using Item Response Theory (IRT) methods to achieve feasible, practical, and precise measurement of functional status (Hambleton 2000, Hambleton 2005). Based on factor analytic work and IRT analyses, a Daily Activity domain has been identified which consists of functional tasks that cover in the following areas: feeding, meal preparation, hygiene, grooming, and dressing (Haley, 2004, 2004a, 2004b). The AM-PAC adaptive short form (ASF) versions of the Daily Activity scale are being submitted to The National Quality Forum. The ASF version of the Daily Activity scale consists of 2 different 10-item forms, one for inpatients versus those receiving care in a community setting. Built using IRT methods, the Daily Activity ASFs allow different questions to be targeted to each setting (inpatient/community), generating an interval level score that is common across both ASFs. The scale is transformed from a logit scale to a standardized scale which ranges from 0 - 100 where 100 is the best possible daily activity function. We believe that these short forms are the best compromise between needed breadth of functional content across inpatient and community functional tasks, and the need to minimize response burden. The ASFs for Daily Activity were built from an item bank that contains a rich assortment of 88 calibrated items that have been developed, tested, and applied in clinical research over the past seven years. In developing and evaluating the AM-PAC, we employed two different samples of 1,081 patients who received post acute care in acute inpatient rehabilitation units, long-term care hospitals, skilled nursing homes, home health care, and outpatient therapy care settings. The ASFs were developed on an initial sample of 485 post acute care patients (see Coster et al., 2004). The existence of a detailed item bank enables the basic AM-PAC forms to be enhanced and improved in a very timely fashion (Jette et al., 2007; Haley et al., 2008 for examples of this process). Scoring estimates from the ASFs and the computer adaptive test (CAT) are directly comparable, given they are taken from the same item bank, the same IRT analysis and use the same scoring metric. Using computer simulations with the AM-PAC item bank, we demonstrated excellent scoring comparability between the AM-PAC adaptive short forms and the CAT (Haley et al., 2004). Advantages of using the CAT over the short forms include: less test burden on patients, decreased standard errors around score estimates, and improved scoring accuracy at the lower and higher ends of the AM-PAC functional scales (Haley et al., 2004). However, the ASFs can generate sufficiently accurate scores on the AM-PAC Daily Activity domains and those scores can be directly compared to scores provided from a CAT application of the same item pool.


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