Examination of the measurement equivalence of the Functional Assessment in Acute Care MCAT (FAMCAT) mobility item bank using differential item functioning analyses

Factors associated with self-reports of limitations in activities of daily living among Medicare Fee-for-Service recipients

BACKGROUND

Physical function is an important indicator of physical health and predicts mortality. This study identified characteristics associated with limitations in Medicare recipients' activities of daily living.

METHODS

2019 Consumer Assessment of Healthcare Providers and Systems Fee-for-Service Medicare Survey data: 79,725 respondents (34% response rate) who were 65 and older and 53% female; 7% Black, 5% Hispanic, 4% Asian American, Native Hawaiian, or other Pacific Islander, 2% Multiracial, 1% American Indian/Alaskan Native; 35% with high school education or less. Walking, getting in and out of chairs, bathing, dressing, toileting, and eating (scored as having no difficulty versus being able to do with difficulty or unable to do) and a scale of these items were regressed on patient characteristics.

RESULTS

After adjustment for all characteristics, function limitations were found for those who smoked (effect sizes of significant associations range .04-.13), had chronic health conditions (.02-.33), were 85 years or older (.09-.46), needed assistance completing the survey (.32-1.29), were female (.05-.07), and had low income and assets (.15-.47).

CONCLUSIONS

These nationally representative U.S. estimates of physical function characteristics are useful for interventions for vulnerable population subgroups.

Correlation and Crosswalks between Patient-Reported Functional Outcomes and PROMIS Physical Function among Medically Ill Patients

OBJECTIVES

To develop scoring crosswalks between a new multi-domain patient-reported outcome measure, the Functional Assessment in Acute Care (FAMCAT) with a PROMIS measure of physical function and examine correlations with existing legacy instruments.

DESIGN

Cross-sectional, single-group design study Setting: Large Midwestern academic teaching hospital Participants: A sample of 1,885 patients (53% men, average age 62 (SD 16)) hospitalized on the general medical services between May 2016 - June 2017.

INTERVENTION

Not applicable.

MAIN OUTCOME MEASURES

Scores from the FAMCAT administered via computerized adaptive testing were compared to scores on the 8-item PROMIS Physical Function short form.

RESULTS

Correlations with the FAMCAT and the PROMIS PF were strong for initial scores (MCAT_Mobilty r=0.78, p<.0001; MCAT_DailyAct r=0.81, p<.0001). The Applied Cognition scale did not demonstrate adequate correlations, thus was not a candidate for crosswalk scores. While the MCAT_Mobility scale could be initially linked, subsequent analysis did not support a valid crosswalk. Linking criteria were applied with the Daily Activity scale to developing a final concordance table.

CONCLUSIONS

The FAMCAT Daily Activity scale yielded robust correlations to develop crosswalk scores with the PROMIS PF. The resulting crosswalk conversion metric may be useful to compare outcomes across these constructs for assessing functional abilities among patients on general medical services. The Applied Cognition and Basic Mobility scales did not meet criteria; therefore, alternate legacy instruments are needed to develop additional crosswalks.

A View of the Development of Patient Reported Outcomes Measures, their Clinical Integration, Electronification, and Potential Impact on Rehabilitation Service Delivery

Recognition of the importance of a patient's perception of their status and experience has become central to medical care and its evaluation. This recognition has led to a growing reliance on the use of patient reported outcome measures (PROMs). Nevertheless, while awareness of PROMs and acceptance of their utility has increased markedly, few of us have a good insight into their development; their utility relative to clinician-rated and performance measures such as the FIM and 6-Minute Walk Test or how their "electronification" and incorporation into electronic health records (EHRs) may improve the individualization, value, and quality of medical care. In all, the goal of this commentary is to provide some insight into historical factors and technology developments that we believe have shaped modern clinical PROMs as they relate to medicine in general and to rehabilitation in particular. In addition, we speculate that while the growth of PROM use may have been triggered by an increased emphasis on the centrality of the patient in their care, future uptake will be shaped by their embedding in EHRs and use to improve clinical decision support though their integration with other sources of clinical and sociodemographic data.