@article {168, title = {Activity outcome measurement for postacute care}, journal = {Medical Care}, volume = {42}, number = {1 Suppl}, year = {2004}, note = {0025-7079Journal ArticleMulticenter Study}, pages = {I49-161}, abstract = {BACKGROUND: Efforts to evaluate the effectiveness of a broad range of postacute care services have been hindered by the lack of conceptually sound and comprehensive measures of outcomes. It is critical to determine a common underlying structure before employing current methods of item equating across outcome instruments for future item banking and computer-adaptive testing applications. OBJECTIVE: To investigate the factor structure, reliability, and scale properties of items underlying the Activity domains of the International Classification of Functioning, Disability and Health (ICF) for use in postacute care outcome measurement. METHODS: We developed a 41-item Activity Measure for Postacute Care (AM-PAC) that assessed an individual{\textquoteright}s execution of discrete daily tasks in his or her own environment across major content domains as defined by the ICF. We evaluated the reliability and discriminant validity of the prototype AM-PAC in 477 individuals in active rehabilitation programs across 4 rehabilitation settings using factor analyses, tests of item scaling, internal consistency reliability analyses, Rasch item response theory modeling, residual component analysis, and modified parallel analysis. RESULTS: Results from an initial exploratory factor analysis produced 3 distinct, interpretable factors that accounted for 72\% of the variance: Applied Cognition (44\%), Personal Care \& Instrumental Activities (19\%), and Physical \& Movement Activities (9\%); these 3 activity factors were verified by a confirmatory factor analysis. Scaling assumptions were met for each factor in the total sample and across diagnostic groups. Internal consistency reliability was high for the total sample (Cronbach alpha = 0.92 to 0.94), and for specific diagnostic groups (Cronbach alpha = 0.90 to 0.95). Rasch scaling, residual factor, differential item functioning, and modified parallel analyses supported the unidimensionality and goodness of fit of each unique activity domain. CONCLUSIONS: This 3-factor model of the AM-PAC can form the conceptual basis for common-item equating and computer-adaptive applications, leading to a comprehensive system of outcome instruments for postacute care settings.}, keywords = {*Self Efficacy, *Sickness Impact Profile, Activities of Daily Living/*classification/psychology, Adult, Aftercare/*standards/statistics \& numerical data, Aged, Boston, Cognition/physiology, Disability Evaluation, Factor Analysis, Statistical, Female, Human, Male, Middle Aged, Movement/physiology, Outcome Assessment (Health Care)/*methods/statistics \& numerical data, Psychometrics, Questionnaires/standards, Rehabilitation/*standards/statistics \& numerical data, Reproducibility of Results, Sensitivity and Specificity, Support, U.S. Gov{\textquoteright}t, Non-P.H.S., Support, U.S. Gov{\textquoteright}t, P.H.S.}, author = {Haley, S. M. and Coster, W. J. and Andres, P. L. and Ludlow, L. H. and Ni, P. and Bond, T. L. and Sinclair, S. J. and Jette, A. M.} } @article {167, title = {Score comparability of short forms and computerized adaptive testing: Simulation study with the activity measure for post-acute care}, journal = {Archives of Physical Medicine and Rehabilitation}, volume = {85}, number = {4}, year = {2004}, note = {Haley, Stephen MCoster, Wendy JAndres, Patricia LKosinski, MarkNi, PengshengR01 hd43568/hd/nichdComparative StudyMulticenter StudyResearch Support, U.S. Gov{\textquoteright}t, Non-P.H.S.Research Support, U.S. Gov{\textquoteright}t, P.H.S.United StatesArchives of physical medicine and rehabilitationArch Phys Med Rehabil. 2004 Apr;85(4):661-6.}, month = {Apr}, pages = {661-6}, edition = {2004/04/15}, abstract = {OBJECTIVE: To compare simulated short-form and computerized adaptive testing (CAT) scores to scores obtained from complete item sets for each of the 3 domains of the Activity Measure for Post-Acute Care (AM-PAC). DESIGN: Prospective study. SETTING: Six postacute health care networks in the greater Boston metropolitan area, including inpatient acute rehabilitation, transitional care units, home care, and outpatient services. PARTICIPANTS: A convenience sample of 485 adult volunteers who were receiving skilled rehabilitation services. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Inpatient and community-based short forms and CAT applications were developed for each of 3 activity domains (physical \& mobility, personal care \& instrumental, applied cognition) using item pools constructed from new items and items from existing postacute care instruments. RESULTS: Simulated CAT scores correlated highly with score estimates from the total item pool in each domain (4- and 6-item CAT r range,.90-.95; 10-item CAT r range,.96-.98). Scores on the 10-item short forms constructed for inpatient and community settings also provided good estimates of the AM-PAC item pool scores for the physical \& movement and personal care \& instrumental domains, but were less consistent in the applied cognition domain. Confidence intervals around individual scores were greater in the short forms than for the CATs. CONCLUSIONS: Accurate scoring estimates for AM-PAC domains can be obtained with either the setting-specific short forms or the CATs. The strong relationship between CAT and item pool scores can be attributed to the CAT{\textquoteright}s ability to select specific items to match individual responses. The CAT may have additional advantages over short forms in practicality, efficiency, and the potential for providing more precise scoring estimates for individuals.}, keywords = {Boston, Factor Analysis, Statistical, Humans, Outcome Assessment (Health Care)/*methods, Prospective Studies, Questionnaires/standards, Rehabilitation/*standards, Subacute Care/*standards}, isbn = {0003-9993 (Print)}, author = {Haley, S. M. and Coster, W. J. and Andres, P. L. and Kosinski, M. and Ni, P.} }