Q&A: AOTA’s Endorsement of Outcomes Measurement Tool
AOTA is the national voice for occupational therapy, and as part of the Centennial Vision a project is underway to address several issues related to promoting understanding and use of occupational therapy. A key effort is to develop a database of occupational therapy outcomes that can be used to identify and promote what occupational therapy accomplishes. This project, conceived 3 years ago, is putting AOTA and the profession ahead of the curve of major policy and reimbursement questions being considered in the health care reform debate: comparative effectiveness and health information technology. This effort will solidify the future of recording appropriate occupational therapy and appreciation of its achievements for clients. It is a bridge to the future.
AOTA recently announced the endorsement of the AM-PAC™ as an outcomes measurement tool that identifies many of the critical areas of outcome for occupational therapy. This tool will become part of AOTA’s long-term efforts to develop health information technology tools and resources that are sensitive to the unique needs of occupational therapy. The following Q&A describes the endorsement, the future of the project, and the benefits of the AM-PAC for practitioners and clients, with answers from Deborah Lieberman, MHSA, OTR/L, FAOTA, AOTA’s program director of Evidence-Based Practice; and Chuck Willmarth, AOTA’s director of State Affairs, and Reimbursement and Regulatory Policy.
What is the AM-PAC?
Deborah Lieberman (DL): AM-PAC is the Boston University Activity Measure for Post Acute Care. A team of researchers at Boston University developed the AM-PAC as an instrument that looks at measuring client outcomes. It is a tool that practitioners can use with adults across outpatient settings. The AM-PAC is divided into three functional areas—basic mobility, daily activities, and applied cognition. AOTA will be using the results from the daily activities scale for the national database. Basically, it looks at a set of functional activities that most adults are likely to encounter during their daily routine in settings where postacute care is provided. It does not address other populations, such as pediatrics.
Chuck Willmarth (CW): The AM-PAC uses computer adaptive technology, which selects items appropriate for each client. For example, if a client reports that he is in a wheelchair, he will not be asked a question about walking up stairs. Each question builds on the previous response so it quickly narrows down the questions.
Why does AOTA endorse the AM-PAC?
DL: The project began with the AOTA Board of Directors identifying the development of an outcomes database as one of the priority projects for the Centennial Vision. The first step was to convene an ad-hoc group of experts to identify the constructs that were essential for occupational therapy practitioners to measure across the lifespan. They recommended that the Areas of Occupation identified in the Occupational Therapy Practice Framework: Domain and Process, 2nd Edition (Framework-II) were the appropriate constructs for an outcome measure.
CW: The group recommended that instead of creating our own tool, we should partner with an existing database management company.
DL: We did a very thorough search, researching many specific outcomes measures, systems, and database management companies. The AM-PAC was the outcomes measure identified by the ad hoc that most closely parallels the constructs included in the Areas of Occupation in the Framework-II. We talked with practitioners who were using the AM-PAC already. We also looked closely at what was going on with health information technology so we could be consistent with what was already being used.
How will clients benefit from the AM-PAC?
DL: The AM-PAC is a client self-report. The clients will go through the process themselves, answering the specific questions about activities and what they can do. If the client is not able to complete the instrument directly, it can be administered by the practitioner or by proxy report.
CW: On average, client registration and background information data are collected in 30 seconds, and it takes only 2 minutes to complete the assessment of each functional domain.
DL: The practitioner would then gear the treatment and intervention plan to maximize client performance, along with considering what the client deems as important in his or her daily activities. The system would also be able to generate reports that the practitioner could share with the client to show changes in status.
The AM-PAC is part of a larger electronic medical record project—what is that project?
DL: There are two projects: one is to create a national outcomes database; the second is to work with an existing patient record and documentation system company to develop documentation templates for occupational therapy practitioners.
One of the things we found is that the existing documentation systems were not specific to occupational therapy. We wanted to create a system to help occupational therapy practitioners with their workflow and to capture occupational therapy documentation, but also that allows them to gather outcomes data using the AM-PAC and report back to the national database.
The AM-PAC is the measure—to look at change in performance from admission to discharge of a client—and the documentation system will gather other data, such as the client’s demographic information, billing information, diagnostic information, specific interventions, other assessments, the intervention plan, and client goals.
CW: You can get to the AM-PAC from other vendors, but the documentation templates system we’re launching will be specific to occupational therapy and the AM-PAC—the component for measuring outcomes data—will be integrated into that system.
When can practitioners start using the AM-PAC?
DL: The AM-PAC is available already from a number of vendors. Practitioners can start using it now, and can start collecting data immediately. The Centers for Medicare & Medicaid Services (CMS) recognizes the AM-PAC as one of the tools that practitioners can use for documenting occupational therapy services under Medicare Part B.
CW: Once AOTA introduces the patient documentation system for practitioners, we hope that more practitioners will use it to record their outcomes. If this occurs, we anticipate having a set of data in the outcomes database by 2011. It is important to note that practitioners can start using the AM-PAC immediately; since that data will be reported to the national database in addition to data gathered through the AOTA patient record and documentation system. One of our goals is to get as much data as possible into the database, so we did not seek an exclusive relationship to gather the outcomes data.
What are AOTA’s next steps?
CW: The next steps are to promote the endorsement to AOTA members, encouraging them to use the AM-PAC and report to the national database, and to continue developing the occupational therapy documentation templates. After the documentation system is ready, it will be easy for practitioners to report outcomes while doing documentation.
How can practitioners learn more about AM-PAC and its development?
DL: There is a great wealth of published literature on the AM-PAC, including the development of the instrument (what it measures, why it was developed), validation testing, and the methods used—all of which are available on the CRE Care Web site. One of the researchers involved in the development of the AM-PAC was Wendy Coster, PhD, OTR/L, FAOTA, and both the “Applied Cognitive Activities” and “Personal Care and Instrumental Activities” sections are highly related to occupational therapy goals and services.