Activity Measure for Post Acute Care (AM-PAC

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This document discusses the Activity Measure for Post-Acute Care (AM-PAC) assessment tool for occupational therapy. The AM-PAC provides a standardized way to assess patient function and predict discharge needs. It measures basic mobility, daily activities, and cognitive function. Evidence shows the AM-PAC "6-Clicks" scores accurately predict a patient's destination after hospital discharge and assess activity limitations in acute care settings. The presentation provides details on the tool's design, intended populations, domains, scoring system, and results of a trial using the AM-PAC at Swedish Medical Center, First Hill.

Activity Measure for Post Acute
Care (AM-PAC) for Occupational
Therapy
Suzie Kwon, MOTS
Swedish Medical Center, First Hill
September 7th
, 2016

∗ Important in discharge planning
∗ Standardized assessment of patient’s function
Need for an Objective Outcome Measure

∗ Evidence of the accuracy of “6-Clicks” scores for
predicting destination after discharge from an acute
care hospital (Jette et al., 2014).
∗ Evidence for the validity of “6-Clicks” scores for
assessing patients' activity limitations in acute care
settings (Jette et al., 2014).
Supporting Evidence

∗ Provides a quantitative score
∗ Can be used across patient diagnoses, conditions, and
settings
∗ Can predict level of care at discharge
http://pac-metrix.com/am-pac-resources/am-pac_short-form/
AM-PAC Design

$• Acute hospital • Inpatient rehabilitation • Post-acute care • Hip fracture • Stroke • Cancer • Geriatric • Orthopedic impairments • Medically complex cases http://am-pac.com/category/population/ Intended Population$

Three functional domains:
•Basic Mobility- Physical Therapy
•Daily Activity- Occupational Therapy
•Applied Cognitive- Speech & Language Pathology
http://am-pac.com/category/domains/
Inpatient “6-Clicks” Short Forms

∗ Grooming & Hygiene
∗ Feeding and Meal Preparation
∗ Personal Care
http://am-pac.com/category/domains/
Daily Activity Domain

∗ Unable-1 (total assistance or dependent)
∗ A Lot-2 (moderate to maximum assistance)
∗ A Little-3 (minimal/contact guard/supervision)
∗ None-4 (independent/modified independent)
“6-Clicks” Scoring

∗ How much help from another person does the patient currently
need . . .
1. Putting on and taking off regular lower body clothing?
2. Bathing (including washing, rinsing and drying)?
3. Toileting, which includes using toilet, bedpan or urinal?
4. Putting on and taking off regular upper body clothing?
5. Taking care of personal grooming such as brushing teeth?
6. Eating meals?
∗ Total Raw Score can convert to G Code and % impairment
“6-Clicks”

∗ 80 patients in inpatient acute care at Swedish First Hill
∗ Time period: 8/10 /16– 9/2/16
∗ AM-PAC scores throughout their inpatient stay
Trial

∗ AM-PAC possible raw score range: 6-24
∗ Lowest raw score: 6
∗ Highest raw score: 23
∗ Average raw score at eval during our trial: 16.18
∗ Average raw score at discharge during our trial: 16.91
Data

∗ Considerations
∗ Next Steps:
∗ .ampacot for SmartPhrase
∗ Applied Cognitive domain for inpatient Speech &
Language Pathology team
Trial Outcomes

∗ The patients at Swedish Medical Center, First Hill
∗ Lauren Anderson-Connolly, OTR/L
Thank You!

∗ Jette, D. U., Stilphen, M., Ranganathan, V. K., Passek, S. D.,
Frost, F. S., & Jette, A. M. (2014). AM-PAC “6-Clicks”
Functional Assessment Scores Predict Acute Care Hospital
Discharge Destination. Physical Therapy, 94(9), 1252-1261.
Accessed September 01, 2016.
http://dx.doi.org/10.2522/ptj.20130359.
∗ Jette, D. U., Stilphen, M., Ranganathan, V. K., Passek, S. D.,
Frost, F. S., & Jette, A. M. (2014). Validity of the AM-PAC “6-
Clicks” Inpatient Daily Activity and Basic Mobility Short
Forms. Physical Therapy, 94(3), 379-391. Accessed
September 01, 2016.
http://dx.doi.org/10.2522/ptj.20130199.
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Activity Measure for Post Acute Care (AM-PAC

1. Activity Measure for Post Acute Care (AM-PAC) for Occupational Therapy Suzie Kwon, MOTS Swedish Medical Center, First Hill September 7th , 2016

2. ∗ Important in discharge planning ∗ Standardized assessment of patient’s function Need for an Objective Outcome Measure

3. ∗ Evidence of the accuracy of “6-Clicks” scores for predicting destination after discharge from an acute care hospital (Jette et al., 2014). ∗ Evidence for the validity of “6-Clicks” scores for assessing patients' activity limitations in acute care settings (Jette et al., 2014). Supporting Evidence

4. ∗ Provides a quantitative score ∗ Can be used across patient diagnoses, conditions, and settings ∗ Can predict level of care at discharge http://pac-metrix.com/am-pac-resources/am-pac_short-form/ AM-PAC Design

5. • Acute hospital • Inpatient rehabilitation • Post-acute care • Hip fracture • Stroke • Cancer • Geriatric • Orthopedic impairments • Medically complex cases http://am-pac.com/category/population/ Intended Population

6. Three functional domains: •Basic Mobility- Physical Therapy •Daily Activity- Occupational Therapy •Applied Cognitive- Speech & Language Pathology http://am-pac.com/category/domains/ Inpatient “6-Clicks” Short Forms

7. ∗ Grooming & Hygiene ∗ Feeding and Meal Preparation ∗ Personal Care http://am-pac.com/category/domains/ Daily Activity Domain

8. ∗ Unable-1 (total assistance or dependent) ∗ A Lot-2 (moderate to maximum assistance) ∗ A Little-3 (minimal/contact guard/supervision) ∗ None-4 (independent/modified independent) “6-Clicks” Scoring

9. ∗ How much help from another person does the patient currently need . . . 1. Putting on and taking off regular lower body clothing? 2. Bathing (including washing, rinsing and drying)? 3. Toileting, which includes using toilet, bedpan or urinal? 4. Putting on and taking off regular upper body clothing? 5. Taking care of personal grooming such as brushing teeth? 6. Eating meals? ∗ Total Raw Score can convert to G Code and % impairment “6-Clicks”

10. ∗ 80 patients in inpatient acute care at Swedish First Hill ∗ Time period: 8/10 /16– 9/2/16 ∗ AM-PAC scores throughout their inpatient stay Trial

11. ∗ AM-PAC possible raw score range: 6-24 ∗ Lowest raw score: 6 ∗ Highest raw score: 23 ∗ Average raw score at eval during our trial: 16.18 ∗ Average raw score at discharge during our trial: 16.91 Data

12. ∗ Considerations ∗ Next Steps: ∗ .ampacot for SmartPhrase ∗ Applied Cognitive domain for inpatient Speech & Language Pathology team Trial Outcomes

13. ∗ The patients at Swedish Medical Center, First Hill ∗ Lauren Anderson-Connolly, OTR/L Thank You!

14. ∗ Jette, D. U., Stilphen, M., Ranganathan, V. K., Passek, S. D., Frost, F. S., & Jette, A. M. (2014). AM-PAC “6-Clicks” Functional Assessment Scores Predict Acute Care Hospital Discharge Destination. Physical Therapy, 94(9), 1252-1261. Accessed September 01, 2016. http://dx.doi.org/10.2522/ptj.20130359. ∗ Jette, D. U., Stilphen, M., Ranganathan, V. K., Passek, S. D., Frost, F. S., & Jette, A. M. (2014). Validity of the AM-PAC “6- Clicks” Inpatient Daily Activity and Basic Mobility Short Forms. Physical Therapy, 94(3), 379-391. Accessed September 01, 2016. http://dx.doi.org/10.2522/ptj.20130199. References

15. Questions?

Editor's Notes

I will be talking about Activity Measure for Post Acute Care, or AM-PAC for use in inpatient OT at SMC.
Acute care OTs and PTs play an important role in discharge planning Having a standardized assessment of a patient’s function is useful for discharge recommendations, so that it’s in a way easily understood by other members of the team such as doctors, nurses, social workers, etc.
The first study’s objective was to determine the accuracy of “6-Clicks” basic mobility and daily activity measures for predicting discharge from an acute care hospital to a home or institutional setting. The aim of the second study was to provide evidence for validity of scores on Activity Measure for Post-Acute Care (AM-PAC) “6-Clicks” measures of basic mobility and daily activity in acute care. Validity was analyzed by examining differences in “6-Clicks” scores across categories of patient characteristics; the ability of “6-Clicks” scores to predict patients&apos; having more than one therapy visit; correlation of “6-Clicks” scores with Functional Independence Measure (FIM) scores; and internal responsiveness over the episode of care.
The AM-PAC design provides a quantitative score easily understood by other professions, and Unlike traditional functional outcome measures which are disease, condition, or setting specific, the AM-PAC can be used across pt dignoses, conditions, and settings in acute care and measures functional outcomes. It is designed for examining functional outcomes over an episode of post acute care, as patients move across institutional and community-based care settings. It can also predict discharge level of care from an acute care hospital to a home or facility
The AM-PAC is validated for use with post acute care patients with major medical, orthopedic, and neurologic impairments. It has been tested in many mixed populations as shown in this slide.
Functional activity is multidimensional
Important aspects of daily occupations for self-care that can determine the level of care the pts may need at discharge
You can use your clinical judgment
Some considerations: We were not always able to see the same patients from eval all the way through d/c. This would have been interesting to see the whole treatment course. Some patients declined at first, then improved in function and discharged from the C rotation. It would have been useful and interesting to see if the AM-PAC could have been used across the rotations by all therapists to see his trend. Providence extending license to Swedish. Supervisor discretion to share the SmartPhrase from here on. Cognitive/SLP- future considerations for Swedish?
http://am-pac.com/category/domains/ http://am-pac.com/category/population/ http://pac-metrix.com/am-pac-resources/am-pac_short-form/

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Activity Measure for Post Acute Care (AM-PAC

Editor's Notes