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Activity Measure for Post Acute Care (AM-PAC™)
Frequently Asked Questions (FAQ)
Screenshots: Outcome/Visit Ratio Plots | Expected Performance of Each Stage
How was the AM-PAC™ developed?
The AM-PAC™ was developed at the Boston University Health and Disability Institute under the leadership of Drs. Alan Jette and Stephen Haley. First a comprehensive list of functional items was developed using the International Classification of Functioning and Disability and with input from patients and expert clinicians. These test items were administered to a large sample of patients from different care settings with a wide range of diagnoses. Using Item Response Theory (IRT) the test items were scaled to provide an estimate of a patient's functional ability. The computer-based version of the AM-PAC uses Computer Adaptive Testing (CAT) to select test items that are most appropriate for an individual patient, which increases measurement precision while minimizing respondent burden.
What advantages does the AM-PAC™ offer over traditional measures?
The AM-PAC™ is comprised of test items that cover a wide range of function—from "rolling over in bed" to "running 5 miles." Because test items are linked on a common scale, functional scores can be tracked across an entire episode of care as patients' functional ability changes and they move to different care settings. The AM-PAC is sensitive to change in functional status and detects changes that may be missed by other outcome instruments.
What are the advantages of the computer-based AM-PAC?
The computer-based AM-PAC™ uses computer adaptive testing (CAT) technology to select a small subset of items that are appropriate for an individual patient's functional level. This approach provides a precise estimate of a patient's functional ability by selecting a few test items, that are most appropriate for a patient's functional ability level, from the AM-PAC test item bank that cover a wide range of functional abilities. The computer-based AM-PAC provides an efficient method for collecting functional outcome data. On average, patient registration and background information data are collected in 30 seconds and it takes only 2 minutes to complete the assessment of each functional domain.
Can AM-PAC™ results be used for individual patient care planning?
The AM-PAC™ is designed as an outcomes monitoring system and, as such, it provides accurate and sensitive information about the functional status of all patients treated within an organization. While the AM-PAC is not designed to be used for individual care planning, therapists often use individual patient AM-PAC reports to discuss functional abilities with their patients. In addition, patients and referring physicians find that the individual patient reports provide useful information. The computerized AM-PAC format produces individual patient reports that summarize patients' functional status and graphs that display the changes in function from initial assessment.
What are the advantages of using the AM-PAC™ Outcomes Monitoring System?
The AM-PAC™ monitors outcomes in patients with a wide range of conditions and functional abilities. The computerized version matches test questions to a patient's functional ability level, which maximizes measurement precision while reducing test burden.
AM-PAC™ Sample Test Items
Basic Mobility Sample Items: Total number of items in this domain = 101
How much DIFFICULTY do you (does the patient) currently have...?
- Moving from lying on your back to sitting on side of the bed
- Getting up from the floor
- Reaching overhead while standing, as if to pull a light cord
- Using an escalator?
- Going up and down a flight of stairs inside, using a handrail
- Walking around inside a building (50 ft, or 16 meters) on the same level
- Going up and down three flights of stairs inside, using a handrail
- Carrying something in both arms while climbing a flight of stairs (e.g., laundry basket)
- Climbing stairs step-over-step without a handrail? (alternating feet)
- Walking quickly indoors to answer the telephone
- Lifting 25 pounds (e.g., dog food or a large bag of fertilizer)
- Carrying 2 plastic grocery bags with handles at your side for 50 feet
- Making sharp turns when running fast
- Climbing a step ladder (4-5 steps)
- Doing moderately heavy house or yard work (e.g., changing a ceiling light bulb, hanging a picture on the wall, weeding a garden, or sweeping a walkway)
- Taking part in strenuous activities (e.g., running 3 miles, swimming half mile, etc.)
How often can an assessment be completed?
There is no limit to the number of assessments that can be completed. The first assessment will be the baseline or 'admission assessment'. The final assessment or 'discharge assessment' will be the last one completed. These two assessments are used for outcomes statistical purposes when comparing across sites and organizations. Clients are encouraged to complete as many assessments as necessary to document the patient's progress through the course of care. It is highly encouraged to complete assessments during transitions from one care setting to another (i.e., at time of discharge from Inpatient Rehabilitation to Outpatient services).
What is Computerized Adaptive Testing (CAT)?
Computerized Adaptive Testing (CAT) is increasingly being proposed for use in routine functional and quality of life assessments in Outpatient Rehabilitation programs. It is considered the new wave of the future in healthcare outcome assessments. CAT employs a simple form of artificial intelligence that selects questions tailored to the patient, shortens or lengthens the test to achieve the desired precision, and scores everyone on a standard metric.