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Development and Initial Psychometric Evaluation of the Post-Acute Acuity Rating for Children
Jane E O'Brien1, Helene M Dumas2
1Franciscan Hospital for Children, 30 Warren Street, Boston, MA 02135, USA.
Insights
The Post-Acute Acuity Rating for Children (PAARC) is a new tool to measure medical severity in pediatric rehabilitation. It demonstrated strong validity and reliability, supporting its use in assessing children
Area of Science:
- Pediatric Rehabilitation
- Healthcare Quality Measurement
- Clinical Assessment Tools
Background:
- Post-acute care for children requires accurate medical severity assessment.
- Existing tools may not adequately capture pediatric-specific needs.
- The Post-Acute Acuity Rating for Children (PAARC) was developed to address this gap.
Purpose of the Study:
- To introduce and validate the Post-Acute Acuity Rating for Children (PAARC).
- To assess the PAARC's content validity, concurrent validity, predictive validity, and interrater reliability.
Main Methods:
- Content validity assessed via expert panel and Content Validity Index (CVI).
- Concurrent validity examined using clinician opinion, Complexity Index, and APR-DRG codes.
- Predictive validity evaluated against 30-day acute care readmissions.
- Interrater reliability tested using admission histories.
Main Results:
- Established content validity with expert agreement on relevance and representativeness.
- Demonstrated moderate to high concurrent validity with clinician opinion (rho = .76) and Complexity Index (rho = .76).
- Showed moderate predictive validity (rho = .504) for acute care readmissions.
- Achieved excellent interrater reliability (ICC = 0.97).
Conclusions:
- The PAARC is a valid and reliable measure of medical acuity for children in post-acute rehabilitation.
- The tool effectively assesses medical complexity and predicts readmissions.
- Further development and validation are supported by these findings.
Abstract:
The Post-Acute Acuity Rating for Children (PAARC) is the first known acuity rating intended to reflect medical severity based on age, reason for admission, diagnoses, dependence in activities of daily living, and technology reliance for children admitted to post-acute care rehabilitation hospitals. Content validity was tested using an expert panel scoring the Content Validity Index (CVI). Concurrent validity was examined using clinician's opinion of acuity at admission, the Complexity Index, and All Patient Refined Diagnosis Related Group (APR-DRG) codes. Predictive validity was examined with acute care readmission within 30 days. Interrater reliability was assessed using admission histories from closed cases. Content validity was established and concurrent validity was moderate to high with clinician opinion (rho = .76, p < .001), the Complexity Index (rho = .76, p < .001), and APR-DRGs (rho = .349, p = .001). Predictive validity was moderate (rho = .504, p = .005) and returns to acute care within 30 days. Interrater reliability was excellent (ICC = 0.97; 95% CI = 0.92-0.90, p < .001). Experts agreed that the PAARC's content is relevant, simple, and representative of the population. The PAARC measured well against indicators of medical complexity for pediatric outpatient care and medical record coding and was reliable between raters. This work supports proceeding with additional development and validity testing of the PAARC.
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