Cicely Saunders Institute for Palliative Care and Rehabilitation King’s College London

www.csi.kcl.ac.uk

THE NEEDS AND PROVISION COMPLEXITY SCALE: Factor structure and repeatability

Lynne Turner-Stokes DM FRCP1, 2 and Richard J Siegert PhD1,3 1 Department of Palliative Care, Policy and Rehabilitation, King’s College London 2 Regional Rehabilitation Unit, Northwick Park Hospital, London 3 School of Public Health and Psychosocial Studies and School of Rehabilitation and Occupational Studies, Auckland University of Technology

Background The Needs and Provision Complexity Scale (NPCS) is a brief practical tool designed to evaluate: a)  An individual’s needs for community care and rehabilitation b)  Service provision against these needs. The NPCS comprises two principal domains:

1. Health/Care •  3 subscales: Healthcare, Personal care and Rehabilitation

2. Social Support •  3 subscales: Social/family support, Equipment and

Accommodation ‘Needs’ are normally rated by health professionals. ‘Provision’ is rated by patients (and/or family/carer), based on services received in a given period. An example of an NPCS score highlighting unmet need is given in Poster no 49. Aims To examine the psychometric properties of the NPCS in a cohort of patients with complex neurological disability. Design and Setting •  A multicentre cohort study •  Nine specialist neurorehabilitation units in London, UK. Methods Clinicians rated the NPCS: •  for 423 consecutive patients •  shortly before discharge to the community.

Internal structure and reliability was examined using: •  Cronbach’s alpha •  Principal Components Analysis (PCA) with varimax rotation.

Four weeks post-discharge, in a sub-sample of 45 patients: •  Self-report assessment of the NPCS was completed •  on two occasions, approximately 1 week apart.

Test-retest repeatability was examined using: •  Quadratic-weighted Cohen’s kappa efficients •  interpreted according to Landis and Koch.

Conclusions From this preliminary psychometric analysis, the NPCS is a promising measure of requirements for health and social care services with: •  A clear two factor structure •  Good internal consistency •  Acceptable test-retest reliability. Acknowledgements We would like to acknowledge the clinicians and patients who provided these data. This poster presents independent research commissioned by the National Institute for Health Research (NIHR) under its Services Development and Organisation funding scheme (SDO 08/1809/235). The views expressed in this poster are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. Financial support for the preparation of this manuscript was also provided by the Dunhill Medical Trust, the Luff Foundation.

NPCS Subscale

PCA Rotated Component

Corrected Item-total

correlation

Cronbach’s α if item deleted

1 2 Medical care 0.58 0.69 0.94 Skilled Nursing 0.74 0.70 0.94 No of carers 0.74 0.78 0.93 Care frequency 0.71 0.61 0.94 Personal enabler 0.67 0.75 0.94 No of therapy disciplines 0.81 0.68 0.94 Therapy intensit 0.73 0.59 0.94 Vocational /educational 0.71 0.70 0.93 Social worker/case manager 0.78 0.75 0.93 Family carer support 0.77 0.72 0.93 Residential respite 0.38 0.86 0.94 Daycare 0.83 0.48 0.93 Advocacy support 0.57 0.79 0.93 Equipment 0.65 (0.52) 0.80 0.93 Accommodation 0.53 (0.67) 0.74 0.93

Results Internal structure and reliability (see Table 1) •  Cronbach’s alpha for the full scale was 0.94. •  A scree plot showed two factors with Eigen values >1. •  Together these accounted for 66% of the variance.

Table 1: Principal Components Analysis and Cronbach’s alpha

Test-retest repeatability (see Table 2) •  ICCs for the subscales ranged from 0.66-0.84. •  Quadratic weighted kappa coefficients ranged from 0.47-0.93

Subscales ICC Items Kappa ±95% CI

Interpretation

Healthcare 0.67 Medical care Skilled Nursing

0.68 ±0.25 0.63 ±0.25

Substantial Substantial

Personal care 0.83 No of carers Care frequency Personal enabler

0.79 ±0.25 0.85 ±0.25 0.49 ±0.25

Substantial Substantial Moderate

Rehabilitation 0.83 No of therapy disciplines Therapy intensity Vocational /educational

0.55 ±0.25 0.57 ±0.25 0.68 ±0.25

Moderate Moderate Moderate

Social /family support

0.66 Social worker/case manager Family carer support Residential respite Daycare Advocacy support

0.47 ±0.24 0.47 ±0.25 0.93 ±0.25 0.85 ±0.27 0.53 ±0.24

Moderate

Moderate Substantial Substantial Moderate

Equipment 0.66 Specialist Equipment 0.67 ±0.25 Substantial

Accommodation 0.84 Accommodation 0.82 ±0.25 Substantial