Improving the Delivery of Function-Directed Care During Acute Hospitalizations: Methods to Develop and Validate the Functional Assessment in Acute Care Multidimensional Computerized Adaptive Test (FAMCAT)

Andrea L Cheville; Chun Wang; Kathleen J Yost; Jeanne A Teresi; Mildred Ramirez; Katja Ocepek-Welikson; Pengsheng Ni; Elizabeth Marfeo; Tamra Keeney; Jeffrey R Basford; David J Weiss

doi:10.1016/j.arrct.2021.100112

Improving the Delivery of Function-Directed Care During Acute Hospitalizations: Methods to Develop and Validate the Functional Assessment in Acute Care Multidimensional Computerized Adaptive Test (FAMCAT)

Arch Rehabil Res Clin Transl. 2021 Feb 16;3(2):100112. doi: 10.1016/j.arrct.2021.100112. eCollection 2021 Jun.

Authors

Affiliations

¹ Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota.
² College of Education, University of Washington, Seattle, Washington.
³ Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
⁴ Research Division, Hebrew Home at Riverdale, Riverdale, New York.
⁵ Columbia University Stroud Center at New York State Psychiatric Institute, New York, New York.
⁶ School of Public Health, Boston University, Boston, Massachusetts.
⁷ Tufts University, Department of Occupational Therapy, Medford, Massachusetts.
⁸ Division of Palliative Care and Geriatric Medicine, Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, Massachusetts.
⁹ Department of Psychology, University of Minnesota, Minneapolis, Minnesota.

Abstract

Objective: To (1) develop a patient-reported, multidomain functional assessment tool focused on medically ill patients in acute care settings; (2) characterize the measure's psychometric performance; and (3) establish clinically actionable score strata that link to easily implemented mobility preservation plans.

Design: This article describes the approach that our team pursued to develop and characterize this tool, the Functional Assessment in Acute Care Multidimensional Computer Adaptive Test (FAMCAT). Development involved a multistep process that included (1) expanding and refining existing item banks to optimize their salience for hospitalized patients; (2) administering candidate items to a calibration cohort; (3) estimating multidimensional item response theory models; (4) calibrating the item banks; (5) evaluating potential multidimensional computerized adaptive testing (MCAT) enhancements; (6) parameterizing the MCAT; (7) administering it to patients in a validation cohort; and (8) estimating its predictive and psychometric characteristics.

Setting: A large (2000-bed) Midwestern Medical Center.

Participants: The overall sample included 4495 adults (2341 in a calibration cohort, 2154 in a validation cohort) who were admitted either to medical services with at least 1 chronic condition or to surgical/medical services if they required readmission after a hospitalization for surgery (N=4495).

Intervention: Not applicable.

Main outcome measures: Not applicable.

Results: The FAMCAT is an instrument designed to permit the efficient, precise, low-burden, multidomain functional assessment of hospitalized patients. We tried to optimize the FAMCAT's efficiency and precision, as well as its ability to perform multiple assessments during a hospital stay, by applying cutting edge methods such as the adaptive measure of change (AMC), differential item functioning computerized adaptive testing, and integration of collateral test-taking information, particularly item response times. Evaluation of these candidate methods suggested that all may enhance MCAT performance, but none were integrated into initial MCAT parameterization.

Conclusions: The FAMCAT has the potential to address a longstanding need for structured, frequent, and accurate functional assessment among patients hospitalized with medical diagnoses and complications of surgery.

Keywords: AM-PAC, Activity Measure of Post-Acute Care; AMC, Adaptive Measurement of Change; Activities of daily living; CAT, computerized adaptive testing; Cognition; DIF, differential item functioning; EHR, electronic health record; FAM, Functional Assessment for Acute Care Multidimensional; FAMCAT, Functional Assessment in Acute Care Multidimensional Computer Adaptive Test; HIPAA, Health Insurance Portability and Accountability Act of 1996; IRT, item response theory; MCAT, multidimensional computerized adaptive testing; MGRM, multidimensional graded response model; MIRT, multidimensional item response theory; PAC, postacute care; PH, physical function; PROM, patient-reported outcome measure; PROMIS, Patient-Reported Outcomes Measurement Information System; Rehabilitation; SF, short form.

Abstract

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