Department of Orthopaedics, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts; and Department of Physical Therapy, School of Health and Rehabilitation Sciences and Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, 100 Technology Drive Pittsburgh, PA 15219 (USA).
The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth.
Phys Ther. 2020 Sep 28;100(10):1862-1871. doi: 10.1093/ptj/pzaa117.
Although Medicare assessment files will include Standardized Patient Assessment Data Elements from 2016 forward, lack of uniformity of functional data prior to 2016 impedes longitudinal research. The purpose of this study was to create crosswalks for postacute care assessment measures and the basic mobility and daily activities scales of the Activity Measure for Post-Acute Care (AM-PAC) and to test their accuracy and validity in development and validation datasets.
This cross-sectional study is a secondary analysis of AM-PAC, the Inpatient Rehabilitation Facility Patient Assessment Instrument, the Minimum Data Set, and the Outcome and Assessment Information Set data from 300 adults receiving rehabilitation recruited from 6 health care networks in 1 metropolitan area. Rasch analysis was used to co-calibrate items from the 3 measures onto the AM-PAC metric and to create look-up tables to create estimated AM-PAC (eAM-PAC) scores. Mean scores and correlation and agreement between actual and estimated scores were examined in the development dataset. Scores were estimated in a cohort of Medicare beneficiaries with hip, humerus and radius fractures. Correlations between eAM-PAC and Functional Independence Measure motor scores were examined. Differences in mean eAM-PAC scores were evaluated across groups of known differences (age, fracture type, dementia).
Strong correlations were found between actual and eAM-PAC scores in the development dataset. Moderate to strong correlations were found between the eAM-PAC basic mobility and Functional Independence Measure motor scores in the validation dataset. Differences in basic mobility scores across known groups were statistically significant and appeared to be clinically important. Differences between mean daily activities scores were statistically significant but appeared not to be clinically important.
Although further testing is warranted, the basic mobility crosswalk appears to provide valid scores for aggregate analysis of Medicare postacute care data.
This study reports on a method to take data from different Medicare administrative data sources and estimate scores on 1 scale. This approach was applied separately for data related to basic mobility and to daily activities. This may allow researchers to overcome challenges with using Medicare administrative data from different sources.
尽管 2016 年起医疗保险评估文件将纳入标准化患者评估数据元素，但在此之前，功能数据缺乏一致性会阻碍纵向研究。本研究旨在为急性后护理评估措施和活动后急性护理评估（AM-PAC）的基本活动和日常活动量表创建交叉通道，并在开发和验证数据集测试其准确性和有效性。
本横断面研究是 AM-PAC、住院康复患者评估工具、最低数据集和结果和评估信息集数据的二次分析，纳入了来自 1 个大都市区 6 个医疗网络的 300 名接受康复治疗的成年人。使用 Rasch 分析将来自 3 个量表的项目与 AM-PAC 度量标准协同校准，并创建查找表以创建估计的 AM-PAC（eAM-PAC）分数。在开发数据集检查实际和估计分数的平均分数以及相关性和一致性。在一组患有髋部、肱骨和桡骨骨折的 Medicare 受益人中估计分数。检查 eAM-PAC 与功能独立性测量运动评分之间的相关性。在已知差异（年龄、骨折类型、痴呆）的组之间评估 eAM-PAC 平均得分的差异。
在开发数据集发现实际和 eAM-PAC 得分之间存在很强的相关性。在验证数据集发现 eAM-PAC 基本活动和功能独立性测量运动评分之间存在中度至强相关性。在已知组之间，基本活动评分的差异具有统计学意义，且似乎具有临床意义。日常活动评分之间的差异具有统计学意义，但似乎没有临床意义。
尽管需要进一步测试，但基本活动交叉通道似乎为 Medicare 急性后护理数据的综合分析提供了有效的分数。
本研究报告了一种方法，可以从不同的 Medicare 管理数据来源获取数据，并估计 1 个量表上的分数。此方法分别应用于与基本活动和日常活动相关的数据。这可能使研究人员能够克服使用来自不同来源的 Medicare 管理数据的挑战。
