Article

OBJECTIVE: To determine the feasibility of tracking stroke patients' functional
outcomes in an integrated health system across a care continuum using the
computer version of the Activity Measure of Post-Acute Care
(AM-PAC). SETTING: A
large integrated health care system in northern California. PARTICIPANTS: A total
of 222 stroke patients (aged >/=18 years) who were hospitalized after an acute
cerebrovascular accident. METHODS: An AM-PAC assessment was made at discharge
from sites of care, including acute hospital, inpatient rehabilitation hospital,
skilled nursing facility, home during home care, and outpatient settings.
Assessments also were completed in the patient's home at 6 months. Data from the
AM-PAC program were integrated with the health care system's databases. MAIN
OUTCOME MEASUREMENTS: (1) AM-PAC administration time at the various sites of
care; (2) assessment of a floor or a ceiling effect; and (3) administrative
burden of tracking participants. RESULTS: AM-PAC assessment sessions averaged 7.9
minutes for data acquisition in 3 domains: Basic Mobility, Activities of Daily
Living, and Applied Cognition. Participants answered, on average, 27 AM-PAC
questions per session. A small ceiling effect was observed at 6 months, and there
was a larger ceiling effect when the instrument was administered in an
institution, ie, when the AM-PAC institutional item bank was used rather than the
community item bank. It was feasible to track patients and to assess their
function using the AM-PAC instrument from institutional to community settings.
Implementation of the AM-PAC in clinical environments, and the success of the
project, were influenced by instrumental, technological, operational, resource,
and cultural factors. CONCLUSIONS: This study demonstrates the feasibility of
implementing a single functional outcome instrument in clinical and community
settings to measure rehabilitation functional outcomes of stroke patients.
Integrating the AM-PAC measurement system into clinical workflows and the
electronic medical record could provide assistance to clinicians for medical
decision making, functional prognostication, and discharge planning.
CI - Copyright (c) 2013 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS