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Rehabilitation Research and Practice
Volume 2015, Article ID 841523, 7 pages
Research Article

Development and Initial Psychometric Evaluation of the Post-Acute Acuity Rating for Children

1Franciscan Hospital for Children, 30 Warren Street, Boston, MA 02135, USA
2Research Center for Children with Special Health Care Needs, Franciscan Hospital for Children, 30 Warren Street, Boston, MA 02135, USA

Received 17 July 2015; Revised 6 October 2015; Accepted 8 October 2015

Academic Editor: Ching-Yi Wu

Copyright © 2015 Jane E. O’Brien and Helene M. Dumas. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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, ), the Complexity Index (rho = .76, ), and APR-DRGs (rho = .349, ). Predictive validity was moderate (rho = .504, ) and returns to acute care within 30 days. Interrater reliability was excellent (ICC = 0.97; 95% CI = 0.92–0.90, ). 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.