AM-PAC™ Short Forms - mediware.com€¦ · AM-PA Inpatient “Six licks” Short Forms + Six items, ... Going up and down a flight of stairs outside, without using a handrail? 1

AM-PAC™ Short Forms: Measuring Rehabilitation Functional

Outcomes Across Settings

Presented by: Mary Slavin, PT, PhD, Director, Education and Dissemination, Health and Disability Research Institute; Boston University School of Public Health

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Activity Measure for Post-Acute Care (AM-PAC)TM Short Forms

Presented by:

Mary D. Slavin, PT, PhD Director of Education and Dissemination Health and Disability Research Institute Boston University 2/27/2014

Learning Objectives

+ Describe how the AM-PAC was developed. + Understand the difference between short forms and

computerized adaptive tests (CATs). + List the different types of short forms available and

identify which form(s) is (are) most appropriate for a given diagnosis or patient population.

+ Describe procedures for reliable administration of the AM-PAC short forms and identify potential areas of concern regarding reliability.

+ Discuss how to interpret AM-PAC short form scores and describe how to use scores to guide patient treatment and quality improvement efforts.

Learning Objective

1. Describe how the AM-PAC was developed.

Step 1. AM-PAC Items

+ Developed items that assess important functional activities

+ Incorporated items from existing instruments

+ Conducted focus group sessions with patients and their families to developed new items

+ Cognitively tested items – do people correctly interpret the items?

+ AM-PAC development used the World Health Organization’s International Classification of Functioning, Disability and Health (ICF) as a conceptual framework.

Step 2. Item Calibration Study

+ Administered items to a large sample of persons with a wide range of functional abilities

+ Calibration sample characteristics

+ 1,041 patients in 4 different post-acute care settings: + Outpatient Therapy (n=237)

+ Home Health Care (n=246)

+ Skilled Nursing or Transitional Care (n=138)

+ Inpatient Rehabilitation (n=420)

Step 3. Identify Unidimensional Domains1

Exploratory factor analysis of AM-PAC items

+ Three distinct, interpretable factors identified and accounted for 72% of the variance:

+ Applied Cognitive (44%)

+ Daily Activity (19%)

+ Basic Mobility (9%);

Confirmatory Factor Analysis verified 3 factors

1Haley SM, Coster WJ, Andres PL, et al. Activity outcome measurement for postacute care. Med Care. 2004;42:I-49 –I-61.

Activity Measure for Post-acute Care (AM-PAC) 269 items

Basic Mobility 131 items

Ambulation

Transfer

Bend, Carry, Lift

Locomotion with Device

Daily Activities 88 items

Feeding

Meal Preparation

Grooming/Dressing

Applied Cognitive 50 items

Communication

Print Information

Complex Instructions

Step 4. Item Response Theory (IRT) Analyses

Create calibrated item banks for each domain + Scale items in each domain hierarchy of difficulty

+ Scaling assumptions met for each domain. + Internal consistency reliability high for the total

sample (Cronbach alpha = 0.92 to 0.94), and for specific diagnostic groups (Cronbach alpha = 0.90 to 0.95).

+ Scaling, residual factor, differential item functioning, and modified parallel analyses supported the unidimensionality and goodness of fit of each unique activity domain

Step 5. Develop CATs and Short Forms

+ Computerized Adaptive Tests (CATs)

+ Computer program administers calibrated item banks

+ Selects items based on response to previous items

+ Items selected to match a person’s ability level

+ Short Forms

+ Items selected from the calibrated item banks to construct short forms

Learning Objective

2. Understand the difference between short forms and computerized adaptive tests (CATs).

AM-PAC Options

+ AM-PAC e-CAT + Computer adaptive test

+ Easy to input data and calculate scores

+ Can be used across all care settings

+ Requires access to program and computer

+ AM-PAC Short Forms + Does not require program or computer

+ Need different forms for inpatient and outpatient settings

+ Administration + Paper and pencil

+ Develop electronic system

High Correlation Between CAT and Score Estimates from the Total Item Pool in Each Domain

Short Form Scores provided good, but less consistent, estimates (especially in Applied Cognitive Domain), with larger confidence intervals

Accurate Scoring of AM-PAC Domains is Possible with Short Forms and CAT application

Overall, CAT provides a closer estimate with higher correlation, but Short Forms still provide a good estimate

Comparing CAT and Short Forms to Item Pools in the 3 Domains

Reference: Haley SM, Coster WJ, Andres PL, et al. Score comparability of short forms and computerized adaptive testing: simulation study with the activity measure for postacute care. Arch Phys Med Rehabil. 2004; 85:661–666.

+ All short forms include items calibrated on the same metric

+ Scores from inpatient and outpatient short forms assess patients’ function as they move from inpatient to outpatient settings

AM-PAC Short Form Development

+ Carefully selected items from the AM-PAC calibrated item banks to develop short forms + Inpatient (‘6-clicks’)

+ Items are appropriate for inpatients + Functional scores estimated with only 6 items

+ Outpatient + Generic (more high-level items) + DOPTA (more low-level items, including use of wheelchair,

developed for use in the Medicare population)

Short Form Development Process

+ Involves careful selection of items from a scaled item bank for a specific domain based on 3 criteria:

+ high information function (determined from IRT analysis)

+ assess a range of functional ability (determined from IRT analysis)

+ represent relevant types of functioning (clinical judgment)

-3

-2

-1

0

1

2

3Daily Activity Short Form Item Difficulty N = 88

Selected 6 Items for Inpatient; 15 Items for Outpatient

Inpatient

Outpatient

AM-PAC Short Form Integrity

+ Each AM-PAC short form was developed to meet specific criteria

+ Items were carefully selected from the item banks

+ Short form scoring is based on the items included in each form

+ Do NOT change or alter short form items

Learning Objective

3. List the different types of short forms available and identify which form(s) is (are) most appropriate for a given diagnosis or patient population.

Basic Mobility

Daily Activity

Applied Cognitive

AM-PAC Inpatient “Six Clicks” Short Forms

+ Six items, appropriate for the inpatient setting, were selected from the calibrated AM-PAC item banks

+ Measure functional ability in three domains:

+ Basic Mobility

+ Daily Activity

+ Applied Cognitive

AM-PAC Items

AM-PAC Short Forms include two different types of questions and response options: + Difficulty Items: “How much difficulty does the patient currently

have…” 1 Unable 2 A lot 3 A little 4 None

+ Help from another person items: “How much help from another person does the patient currently need…”

1 Total 2 A lot 3 A little 4 None

Examples: Inpatient Short Forms

How much difficulty does the patient currently have… Unable A

Lot A

Little None

Turning over in bed (including adjusting bedclothes, sheets and blankets)?

1 2 3 4

Sitting down on and standing up from a chair with arms (e.g., wheelchair, bedside commode, etc.)

1 2 3 4

Moving from lying on back to sitting on the side of the bed?

1 2 3 4

How much help from another person does the patient currently need…

Total A Lot A Little None

Moving to and from a bed to a chair (including a wheelchair)?

1 2 3 4

Need to walk in hospital room?

1 2 3 4

Climbing 3-5 steps with a railing?

1 2 3 4


Total A lot A Little None

Putting on and taking off regular lower body clothing? 1 2 3 4

Bathing (including washing, rinsing, drying)? 1 2 3 4

Toileting, which includes using toilet, bedpan or urinal? 1 2 3 4

Putting on and taking off regular upper body clothing?

1 2 3 4

Taking care of personal grooming such as brushing teeth?

1 2 3 4

Eating meals? 1 2 3 4

How much difficulty does the patient currently have… Unable A Lot A Little None

Following/understanding a 10 to 15 minute speech or presentation (e.g., lesson at a place of worship, guest lecturer at a senior center)?

1 2 3 4

Understanding familiar people during ordinary conversations?

1 2 3 4

Remembering to take medications at the appropriate time?

1 2 3 4

Remembering where things were placed or put away (e.g., keys)?

1 2 3 4

Remembering a list of 4 or 5 errands without writing it down?

1 2 3 4

Taking care of complicated tasks like managing a checking account or getting appliances fixed?

1 2 3 4

AM-PAC Short Forms: Outpatient Setting

Outpatient Short Form Options:

Generic

Medicare Part B (DOTPA)

AM-PAC Outpatient Short Forms

Items banks were reviewed and items appropriate for the outpatient setting, were selected from the scaled AM-PAC item banks in three different domains

+Basic Mobility

+Daily

+Applied Cognitive

AM-PAC Item Format

AM-PAC Outpatient Short Forms use the following response options:

+ Difficulty Items: “How much difficulty do you currently have…”

1. Unable

2. A lot

3. A little

4. None

Example: Generic Outpatient Short Forms

How much difficulty do you currently have… Unable A Lot A Little None

Bending over from a standing position to pick up a piece of clothing from the floor

without holding onto anything? 1 2 3 4

Standing up from a low, soft couch? 1 2 3 4

Taking a 1-mile brisk walk, without stopping to rest? 1 2 3 4

Running for 5 minutes on even surfaces? 1 2 3 4

Walking several blocks? 1 2 3 4

Walking up and down steep unpaved inclines (e.g., steep gravel driveway)? 1 2 3 4

Running a short distance, such as to catch a bus? 1 2 3 4

Carrying something in both arms while climbing a flight of stairs (e.g., laundry)? 1 2 3 4

Going up and down a flight of stairs outside, without using a handrail? 1 2 3 4

Making sharp turns when running fast? 1 2 3 4

Taking part in strenuous activities (e.g., running 3 miles, swimming half mile, etc.)? 1 2 3 4

Standing up from an armless straight chair (e.g., dining room chair)? 1 2 3 4

Walking on an uneven surface (e.g., grass, dirt road or sidewalk, brick walkways,

sidewalks with curb and driveways cuts)? 1 2 3 4

Walking around one floor of their home, taking into consideration thresholds,

doors, furniture, and a variety of floor coverings? 1 2 3 4

Doing light housework (e.g., dusting, minor sweeping)? 1 2 3 4

Moving up in bed (e.g., reposition self)? 1 2 3 4

Getting into and out of a car/taxi (sedan)? 1 2 3 4

Cleaning up spills on the floor with a mop? 1 2 3 4

How much difficulty do you currently have… Unable A

Lot A

Little None

Tying shoes? 1 2 3 4

Sewing on button? 1 2 3 4

Pounding a nail in straight with a hammer to hang a picture? 1 2 3 4

Unscrewing the lid off a previously unopened jar without using devices? 1 2 3 4

Replacing or tightening small parts using only hands (e.g., screws)? 1 2 3 4

Removing stiff plastic packaging using hands and scissors? 1 2 3 4

Cutting toenails? 1 2 3 4

Hanging wash on a line at eye level or above? 1 2 3 4

Washing indoor windows? 1 2 3 4

Moving a sofa to clean under it? 1 2 3 4

Holding a screw and screwing it tight with a manual screwdriver? 1 2 3 4

Lifting 25 pounds from the ground to table height? 1 2 3 4

Lifting 100 pounds or more? 1 2 3 4

Doing 5 push-ups without stopping? 1 2 3 4

Managing clothing behind their back (belt loops, tucking in shirt, bra, etc.)?

1 2 3 4

How much difficulty do you currently have… Unable A Lot A Little None

Understanding familiar people during ordinary conversations? 1 2 3 4

Making yourself understood to other people during ordinary conversations? 1 2 3 4

Remembering things such as steps to complete daily activities, people's names, etc.? 1 2 3 4

Making yourself understood to familiar people over the phone? 1 2 3 4

Describing something that has happened to you so that others can understand you? 1 2 3 4

Carrying on a conversation with a small group (e.g., family or a few friends)? 1 2 3 4

Asking a stranger for information (e.g., asking a clerk where something is located in the store)? 1 2 3 4

Requesting information or assistance from the person who answers the phone (e.g., Ask store

hours, make an appointment, or notify someone about a problem)? 1 2 3 4

Explaining how to do something involving several steps to another person? 1 2 3 4

Managing your time to do most of your daily activities? 1 2 3 4

Reading a long book (over 100 pages) over a number of days? 1 2 3 4

Reading and following complex instructions (e.g., directions to operate a new appliance or for a

new medication) 1 2 3 4

Looking up a phone number or address in the phone book or in your own address book? 1 2 3 4

Planning for and keeping appointments that are not part of your weekly routine (e.g., a therapy,

doctor appointment, or a social gathering with friends and family)? 1 2 3 4

Remembering to take medications at the appropriate time? 1 2 3 4

Remembering where things were placed or put away (e.g., keys)? 1 2 3 4

Remembering a list of 4 or 5 errands without writing it down? 1 2 3 4

Taking care of complicated tasks like managing a checking account or getting appliances fixed? 1 2 3 4

Keeping important personal papers such as bills, insurance documents and tax forms organized? 1 2 3 4

Example: Medicare Outpatient Short Forms

Medicare Outpatient Short Forms

+ Developed to assess persons with lower level of functioning, seen in outpatient settings

+ Items at the lower end of the functional scale + Includes items asking about how much help from another person

is needed

+ Optional items for persons who use a wheelchair

+ Better choice than the Generic Outpatient Short Form for persons with lower level of functional ability

+ Available for all domains (Basic Mobility, Daily Activity and Applied Cognitive)

AM-PAC DOPTA Short Forms

+ Includes ‘help from another person’ items

+ Includes items about wheelchair use

Examples: DOPTA Short Forms

How much DIFFICULTY do you currently have…

(If you have not done an activity recently, how much difficulty do you think you would have if you

tried?)

Unable A Lot A Little None

Moving from sitting at the side of the bed to lying down on your back? 0 1 2 3

Moving up in bed (e.g., reposition self)? 0 1 2 3

Standing for at least one minute? 0 1 2 3

Sitting down in an armless straight chair (e.g., dining room chair)? 0 1 2 3

Standing up from an armless straight chair (e.g., dining room chair)? 0 1 2 3

Getting into an out of a car/taxi (sedan)? 0 1 2 3

Walking around on one floor, taking into consideration thresholds, doors, furniture, and a variety of floor coverings?

0 1 2 3

Going up and down a flight of stairs inside, using a handrail? 0 1 2 3

Bending over from a standing position to pick up a piece of clothing from the floor without holding onto anything?

0 1 2 3

Walking several blocks? 0 1 2 3

Walking up and down steep unpaved inclines (e.g., steep gravel driveway)? 0 1 2 3

Carrying something in both arms while climbing a flight of stairs (e.g., laundry basket)? 0 1 2 3

How much HELP from another person do you currently need... (If you have not done an activity recently, how much help do you think you would need if you tried?) Unable A Lot A Little None

Moving to and from a bed to a chair (including a wheelchair)? 0 1 2 3

Do you also use a wheelchair to get around? Yes No

Without help from another person, when you are using your wheelchair, how much DIFFICULTY do you currently have… (If you have not done an activity recently, how much difficulty do you think you would have if you tried?)


Moving around within one room, including making turns in a wheelchair? 0 1 2 3

Opening a door away from a wheelchair? 0 1 2 3

Opening a door toward a wheelchair? 0 1 2 3

Transferring between a wheelchair and other seating surfaces, such as a chair or bed? 0 1 2 3

Propelling/driving a wheelchair several blocks? 0 1 2 3

How much HELP from another person do you currently need… (If you have not done an activity recently, how much help do you think you would need if you tried?)


Taking care of your personal grooming such as brushing teeth, combing hair, etc.? 0 1 2 3

Bath yourself (including washing, rinsing, drying the body)? 0 1 2 3

How much DIFFICULTY do you currently have… (If you have not done an activity recently, how much difficulty do you think you would have if you tried?)


Picking up thin, flat objects from a table (e.g., coins, post card, envelope)? 0 1 2 3

Putting on and taking off a shirt or blouse? 0 1 2 3

Putting on and taking off socks? 0 1 2 3

Opening small containers like aspirin or vitamins (regular screw tops)? 0 1 2 3

Removing stiff plastic packaging using hands and scissors? 0 1 2 3

Tying shoes? 0 1 2 3

Unscrewing the lid off a previously unopened jar without using devices? 0 1 2 3

Washing indoor windows? 0 1 2 3

Lifting 25 pounds from the ground to a table? 0 1 2 3

Cutting your toenails? 0 1 2 3

How much DIFFICULTY do you currently have…(If you have not done an activity recently, how much difficulty do you think you would have if you tried?)


Following/understanding a 10- to 15- minutes speech or presentation (e.g.,

lesson at a place of worship, guest lecture) 0 1 2 3

Making yourself understood to other people during ordinary conversations? 0 1 2 3

Explaining how to do something involving several steps to another person? 0 1 2 3

Reading and following complex instructions (e.g., directions to operate a new

appliance or for a new medication)? 0 1 2 3

Planning for and keeping appointments that are not part of your weekly

routine (e.g., a therapy or doctor appointment, or a social gathering with

friends and family)?

0 1 2 3

Reading simple material (e.g., a menu or the TV or radio guide)? 0 1 2 3

Filling out a long form (e.g., insurance form or an application for services)? 0 1 2 3

Writing down a short message or note? 0 1 2 3

Remembering where things were placed or put away (e.g., keys)? 0 1 2 3

Keeping track of time (e.g., using a clock)? 0 1 2 3

Putting together a shopping list of 10 to 15 items? 0 1 2 3

Remembering a listing of 4 or 5 errands without writing it down? 0 1 2 3

Taking care of complicated tasks like managing a checking account or getting

appliances fixed? 0 1 2 3

Learning Objective

4. Describe procedures for reliable administration of the AM-PAC short forms and identify potential areas of concern regarding reliability.

Reliable Administration

+ Administration should reflect the way the items were administered to the calibration sample

+ Use exact item wording

+ Do not replace or alter items

+ Train staff to administer the short forms

AM-PAC In-Patient Administration Guidelines

+ Clinicians select the appropriate response for the AM-PAC Inpatient Short Form items based on observed patient activity and/or professional judgment.

How to Score?

+ Score the person’s ability to do the activity

+ Do NOT change the intent of the item to suit the patient’s issues

+ EXAMPLE: For an upper extremity function item, if the patient has one hand involved, DO NOT score the item based on only on using the involved extremity.

+ If you have not observed the activity, score based on your clinical judgment

Outpatient Patient Administration Guidelines

Patients select the appropriate response for each AM-PAC Outpatient Short Form item.

May need to use a proxy or recorder if the patient is not able to complete the assessment. Indicate the proxy was used.

Response Clinical Guide

Total Total/Dependent Assist

A lot Max/Mod Assist

A little Min/Contact Guard Assist/Supervision

None Modified Independence/Independent

Response Selection Guidelines: Help from another person items

Response Selection Guidelines: Help from another person items

Response Clinical Guide

Unable patient is not able to do the activity.

a lot of difficulty it is a struggle, requiring great effort and/or time

a little difficulty can manage to do the activity, but it takes more effort and/or time than you think it should.

No difficulty patient does not experience any problems

Response Selection Guidelines: Difficulty Items

Use of Proxies and Recorders

+ Proxy

+ Answers questions, based on knowledge or observation of the patient

+ Can be a family member, close personal friend, or a clinician

+ Recorder

+ Enters responses provided by a patient who can respond reliably; does NOT influence response

+ Can be a family member, close personal friend, or a clinician

Proxy Respondents

High correlations between patient self-report and proxy responses for all 3 AM-PAC domains (lower for applied cognitive)

AM-PAC Domain Andres et al (2003) Haley et al (2006)

Mobility 0.86 0.92

Daily Activities 0.90 0.93

Applied Cognitive 0.68 0.77 __

How to Score?

+ Instruct the patient to select the response that best describes his/her ability to do the activity

+ Do NOT change the intent of the item to suit the patient’s issues

+ EXAMPLE: For an upper extremity function item, if the patient has one hand involved, DO NOT instruct the patient to respond based on their ability only using the involved extremity.

+ If the patient has not performed the activity, instruct to estimate how difficult it would be

AM-PAC Short Form Scoring

1. Obtain raw score: Sum scores for each domain

2. Convert to standardized score: Use conversion table*

3. Convert to % of function: Use conversion table*

4. Determine G Code: Use conversion table*

*NOTE: there are separate tables for each domain and setting

Use of Equipment and/or Help

+ Responses should reflect ability WITHOUT using equipment or help from another person unless specifically stated in the question.

Standardized Scores

+ Scale raw scores using a t-score metric that has an average of 50 with a 10 point difference for each standard deviation

+ Critical to AM-PAC scoring

+ Allows comparison across different short form versions (inpatient, outpatient and Medicare) and AM-PAC e-CAT

+ Raw scores should NOT be used

CMS Functional Modifier ‘G-Codes’ and the AM-PAC

Centers for Medicare and Medicaid (CMS) requirement for therapy functional reporting.

+ Uses severity modifiers - % functional impairment determined by the therapist

+ Determined from standardized score (t-scale score)

+ 7 percentage intervals (range from 0% - 100%) use a two-letter modifier code

AM-PAC Raw Score

AM-PAC t-Scale Score

Scale Score Standard Error

CMS 0-100% score CMS ‘G Code’

Modifier

6 23.55 4.57 100.00% CN

7 26.42 4.33 92.36% CM

8 28.58 4.04 86.62% CM

9 30.55 3.69 81.38% CM

10 32.29 3.42 76.75% CL

11 33.86 3.22 72.57% CL

12 35.33 3.08 68.66% CL

13 36.74 2.99 64.91% CL

14 38.10 2.95 61.29% CL

15 39.45 2.93 57.70% CK

16 40.78 2.95 54.16% CK

17 42.13 3.03 50.57% CK

18 43.63 3.20 46.58% CK

19 45.44 3.55 41.77% CK

20 47.67 4.06 35.83% CJ

21 50.25 4.69 28.97% CJ

22 53.28 5.43 20.91% CJ

23 56.93 6.22 11.20% CI

24 61.14 6.94 0.00% CH

Scoring: AM-PAC Inpatient Basic Mobility Short Form

CMS Modifier ‘G-Code’

Impairment Limitation Restriction Description

CH 0 percent impaired, limited or restricted CI At least 1 percent but less than 20 percent

impaired, limited or restricted CJ At least 20 percent but less than 40 percent

impaired, limited or restricted CK At least 40 percent but less than 60 percent

impaired, limited or restricted CL At least 60 percent but less than 80 percent

impaired, limited or restricted CM At least 80 percent but less than 100 percent

impaired, limited or restricted CN 100 percent impaired, limited or restricted

Able to score patients using G-Code Conversion Calculator available online, as well as in app formats

For easier G-Code conversion, download the free Mediware app for your smartphone!

AM-PAC ‘Six-Clicks’ Inpatient Basic Mobility Example

1. Raw Score (sum of scores for each item) = 15 2. Scaled Score (use table to convert raw score) = 49.45 3. % functional impairment (use table to convert scale score to %) = 57.70% 4. G-Code (use table to convert %) = CK

How much difficulty does the patient currently have…


1. Turning over in bed (including adjusting bedclothes, sheets and

blankets)?

1 2 3 4

2. Sitting down on and standing up from a chair with arms (e.g.,

wheelchair, bedside commode, etc.)

1 2 3 4

3. Moving from lying on back to sitting on the side of the bed?

1 2 3 4

How much help from another person does the patient currently need… Total A Lot A Little None

4. Moving to and from a bed to a chair (including a wheelchair)?

1 2 3 4

5. Need to walk in hospital room?

1 2 3 4

6. Climbing 3-5 steps with a railing?

1 2 3 4

AM-PAC ‘Six-Clicks’ Inpatient Daily Activity Example

1. Raw Score (sum of scores for each item) = 20 2. Scaled Score (use table to convert raw score) = 37.08 3. % functional impairment (use table to convert scale score to %) = 81.25% 4. G-Code (use table to convert %) = CM


Total A lot A Little None

1. Putting on and taking off regular lower body clothing? 1 2 3 4

2. Bathing (including washing, rinsing, drying)? 1 2 3 4

3. Toileting, which includes using toilet, bedpan or urinal? 1 2 3 4

4. Putting on and taking off regular upper body clothing?

1 2 3 4

5. Taking care of personal grooming such as brushing teeth?

1 2 3 4

6. Eating meals? 1 2 3 4

How much difficulty does the patient currently have…


1. Following/understanding a 10 to 15 minute speech or presentation (e.g.,

lesson at a place of worship, guest lecturer at a senior center)?

1 2 3 4

2. Understanding familiar people during ordinary conversations?

1 2 3 4

3. Remembering to take medications at the appropriate time?

1 2 3 4

4. Remembering where things were placed or put away (e.g., keys)?

1 2 3 4

5. Remembering a list of 4 or 5 errands without writing it down?

1 2 3 4

6. Taking care of complicated tasks like managing a checking account or

getting appliances fixed?

1 2 3 4

AM-PAC ‘Six-Clicks’ Inpatient Applied Cognitive Example

1. Raw Score (sum of scores for each item) = 19 2. Scaled Score (use table to convert raw score) = 39.77 3. % functional impairment (use table to convert scale score to %) = 41.16% 4. G-Code (use table to convert %) = CK

AM-PAC Short Forms: Sensitivity to Change

Compared AM-PAC Short Forms to the Functional Independence Measure (FIM) across a 12-month period after discharge from rehabilitation hospital:

+ 3 AM-PAC scales sensitive to both positive and negative change

+ AM-PAC standardized response means larger than for the FIM across patient and severity groups

+ Larger percentage of patients with change exceeding the minimal detectable change on the FIM at 6- and 12-month follow-ups

Coster WJ, Haley SM, Jette AM. Measuring patient-reported outcomes after discharge from inpatient rehabilitation settings. J Rehabil Med. 2006;38:237–242.

Learning Objective

5. Discuss how to interpret AM-PAC short form scores and describe how to use scores to guide patient treatment and quality improvement efforts.

AM-PAC Advantages

+ Provides a quantitative score

+ Compare functioning (admission to discharge)

+ Individual patients

+ Aggregated data

+ Can compare across an episode of care: transitions from inpatient – to outpatient – to home settings

+ Clinically meaningful based on stages of functional ability

What do the AM-PAC Scores Mean?

+ Items calibrated on a sample of persons receiving rehabilitation services in inpatient and outpatient settings

+ 50 = mean; 10 points = 1 Standard Deviation

10 20 30 40 50 60 70 80 90 100

Mean

Example: Score of 30 is 2 Standard Deviations from the mean

Mobility Functional Profiles

Level of difficulty doing…

Activities within a room or building

Activities outside

Recreation or sports activities

Stage 5 Score of 84 or greater

“None” “None” “None”


“None” “None” to “A little”

“A lot” to “Can’t do”


“None” to “A little”

“A little” to “A lot” to “Can’t do”

“Can’t do”


“Can’t do” to “A lot” “Can’t do” “Can’t do”

Stage 1 Score less than 39

“Can’t do” “Can’t do”

“Can’t do”

Interpreting AM-PAC Scores: Basic Mobility

Example: Basic Mobility score = 72.03

Stage 4 Profile…

Independent mobility in a room and in a building

Mobile in the community but with difficulty

Some sport/recreational activity but with considerable difficulty

What do AM-PAC Scores Mean?

Staging provides a description of typical functioning for different score ranges.

+ Example:

Daily Activity score = 45.03

Daily Activity

Level of difficulty doing…

Basic and Instrumental Activities of Daily Living

Fine Motor Activities


“None” “None”

Stage 4

Score of 62 or greater “None” to

“A little”

“None”


“None” to

“A little”

“A lot” to “A little”


“A lot” to “A little”

“Can’t do” to “A lot” to “A little”

Stage 1 Score of less than 41

“Can’t do” “Can’t do” to “A lot”

Interpreting AM-PAC Scores: Daily Activity

Example: Daily Activity Score = 45.03

Stage 4 Profile…

+ Independent mobility in a room and in a building

+ Mobile in the community but with difficulty

+ Some sport/recreational activity but with considerable difficulty

+ Short Forms able to classify patients into functional stages throughout their recovery process

+ Functional stages were as good – and in many cases better than – the existing functional staging system developed for the FIM

Reference: Tao, W., S. Haley, et al. (2008). "An exploratory analysis of functional staging using an item response theory approach." Archives of Physical Medicine and Rehabilitation 89(6): 1046-1053.

Track Functional Changes Across Care Settings

+ All AM-PAC items (CAT and Short Form Versions) are derived from a common scale

+ Within a specific domain, scores can be compared

+ Compare AM-PAC short form versions (inpatient, generic outpatient, DOTPA outpatient)

+ Compare AM-PAC Short Form scores and AM-PAC e-CAT

AM-PAC ‘6-Clicks’ Validity

+ 84,466 patients seen at Cleveland Clinics with first or last physical therapy or occupational therapy visits

+ AM-PAC Short Form data for Basic Mobility (Physical Therapy) and Daily Activity (Occupational Therapy)

+ Examined AM-PAC first visit score differences based on + Number of visits

+ Age

+ Preadmission living situations

Jette DU, Stilphen M, Ranganathan V, Passek SD, Frost FS, Jette AM. Validity of the AM-PAC “6-Clicks” Inpatient Daily Activity and Basic Mobility Short Forms, Physical Therapy (available online ahead of publication March 2014)

First Visit Scores by Basic Mobility Daily Activity

Number of Visits Mean (CI) Mean (CI)

One visit 47.2 (47.1-47.3) 40.3 (40.2-40.4)

More than one visit 40.2 (40.1-40.4) 36.1 (36.0-36.1)

Age Mean (CI) Mean (CI)

18-40 49.5 (49.2-49.9) 41.8 (41.5-42.2)

41-64 47.3 (47.1-47.4) 40.2 (40.1-40.3)

65-85 44.4 (44.3-44.5) 38.0 (37.9-38.1)

>85 41.8 (41.6-42.0) 35.8 (35.7-36.0)

Living Situation Prior to Admission

Mean (CI) Mean (CI)

Home alone 46.1 (46.0-46.3) 39.2 (39.1-39.4)

Home with other(s) 46.1 (46.0-46.2) 39.2 (39.1-39.3)

Independent or assisted living 42.4 (42.0-42.7) 36.5 (36.2-36.7)

IRF/SNF 35.8 (35.4-36.2) 32.5 (32.2-32.9)

Long term care 34.8 (34.4-35.2) 30.1 (29.7-30.4)

AM-PAC “6 Clicks” Validity

AM-PAC “6 Clicks” ROC Curve

+ Receiver operating characteristic (ROC) curves + Used first visit AM-PAC scores initial scores to determine sensitivity

and specificity for receiving more than one visit for each possible score

cutpoints.

AM-PAC ROC Curve

Example: Mobility score of 43.7

Sensitivity: 63% of patients with a score below correctly classified as needing more than one visit

Specificity: 73% of patients with a score above correctly classified as not needing more than one visit.

Trade-off: Risk of providing more than one visit to those who might not need them vs. providing only one visit to those who might need more.

http://www.am-pac.com

For more information on the web-based and online AM-PAC e-CAT short forms,

visit:

http://www.mediware.com/rehabilitation/tools/item/mediware-g-codeapp

AND

To use the G-Code Conversion Calculator or to Download the App

from Mediware, visit:

http://www.mediware.com/rehabilitation/tools/item/g-code-conversion-calculator

















Questions?

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Contact us!

1-800-279-8456

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AM-PAC short forms, Web-based AM-PAC, outcomes assessments

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Documents

AM-PAC™ Short Forms - mediware.com€¦ · AM-PA Inpatient “Six licks” Short Forms + Six items, ... Going up and down a flight of stairs outside, without using a handrail? 1