Activity outcome measurement for postacute care
Activity outcome measurement for postacute care
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DOI：
10.1097/01.mlr.0000103520.43902.6c
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发表时间：
2004-01-01
期刊：
影响因子：
3
通讯作者：
Jette, AM
中科院分区：
文献类型：
--
作者：
Haley, SM;Coster, WJ;Jette, AM
背景：由于缺乏概念上合理和全面的成果衡量标准，评估各种急性后护理服务的有效性的努力一直受到阻碍。目的：调查国际功能、残疾与健康分类(ICF)活动领域的因素结构、信度和量表属性，用于急性后护理结果测量。方法：我们开发了急性后护理(AM-PAC)的41项活动测量(AM-PAC)，根据ICF定义的主要内容领域，评估个体在其自身环境中执行离散日常任务的情况。本研究采用因子分析、条目量表测试、内部一致性信度分析、Rasch条目反应理论建模、残差成分分析和改进的平行分析等方法，对477名积极康复项目的受试者进行了AM-PAC原型的信度和判别效度检验。结果：初步探索性因素分析产生了3个可解释的因素：应用认知(44%)、个人护理和工具活动(19%)和身体和运动活动(9%)；验证性因素分析验证了这3个活动因素。总样本和诊断组中每个因素的比例假设都得到了满足。总体样本(Cronbach a 0.92至0.94)和特定诊断组(Cronbach a 0.90至0.95)的内部一致性可靠性较高。RASCH量表、剩余因素、不同项目功能和改进的平行分析支持每个独特活动领域的单维度和拟合优度。结论：AM-PAC的这个三因素模型可以形成共同项目等值和计算机自适应应用的概念基础，从而为急性后护理环境下的结果工具提供一个全面的系统。
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'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 a 0.92 to 0.94), and for specific diagnostic groups (Cronbach a 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.