The patient categorisation tool: psychometric evaluation of a tool to measure complexity of needs for rehabilitation in a large multicentre dataset from the United Kingdom

Abstract

Purpose: This first psychometric evaluation of the Patient Categorisation Tool examined its properties as an instrument to measure complexity of needs in a mixed population of patients presenting for specialist neurorehabilitation. Materials/methods: Analysis of a large multicentre cohort of patients (n ¼ 5396) from the national clinical dataset representing 63 specialist rehabilitation services across England. Structural validity was examined using exploratory and confirmatory factor analysis. Concurrent and criterion-validity were tested through a priori hypothesized relationships with other validated measures of resource requirements and dependency. Results: All but two items loaded strongly onto a single principal component with Cronbach's alpha 0.88. A total score of !30 identified patients with complex (category A) needs with sensitivity 76% and specificity 75%. However, confirmatory factor analysis provided a better fit when the scale was split into two subscales -a 'Cognitive/psychosocial' and a 'Physical' sub-scale (alpha 0.83 and 0.84, respectively). Moderate convergent and discriminant correlations were consistent with hypothesized relationships. Conclusions: The findings provide some overall support for the Patient Categorisation Tool as a unidimensional tool for measuring complexity of needs for neurorehabilitation, but the subscales may be more suitable for certain groups of patients. Further analysis is now required to evaluate its performance in different conditions. ä IMPLICATIONS FOR REHABILITATIONA psychometrically robust tool for measuring the complexity of rehabilitation needs has potential value, both at an individual level for treatment planning, and at a population level for planning and commissioning rehabilitation services. The Patient Categorisation Tool now forms part of the United Kingdom national clinical dataset mandated by the National Health Service in England This psychometric analysis from a large national multicentre cohort representing a diverse range of conditions, provides evidence for its validity as a means to identity patients with complex rehabilitation needs requiring specialist rehabilitation. ARTICLE HISTORY

Medical Rehabilitation Need, Case Complexity, and Related Issues among Patients in an Acute Stroke Rehabilitation Setting

“…In neurological rehabilitation, including for patients after stroke, however, the actual supply of rehabilitation services depends on case-related characteristics such as comorbidities, cognitive impairment, behavioral disorders, and longer length of stay, rather than physical dependency alone. For efficient service provision, rehabilitation inputs should be matched as closely as possible to individual patient needs 12) . The following are some examples of measures used to capture case complexity (Table 2).…”

“…The PCAT was initially developed as a checklist to identify patients with complex needs, and has since been validating methods of identifying patients with complex needs requiring specialist rehabilitation 12) . This tool comprises four domains (specialist medical/neuropsychiatric needs, clinical needs, additional needs, and expected duration of admission) with 18 items, each containing a level of need.…”

Protecting the Health Service and Managing the COVID-19 Pandemic Surge: The Unintended Impact of Service Reconfiguration on the Specialist Rehabilitation Service at a Regional Teaching Hospital

“…This helps inform the level of rehabilitation service designated as levels1, 2 or 3 in order of decreasing specialization required based on the British Society of Rehabilitation Medicine (BSRM) service standards [6]. PCAT was originally designed to provide a descriptive measure of patient needs, it has since been refined for use as an ordinal tool in associating rehabilitation needs to patient pathology [7].…”

Rehabilitation prioritization: Development of expert consensus on essential rehabilitation during pandemics

“…The need for rehabilitation specialization skills was considered a lower priority domain. Various authorities advocate for instruments such as the Patient Categorization Tool to stratify patients with more complex needs [4] , [8] . These criteria include the number of disciplines required, medical stability, and patients with behavioral/emotional needs [4] , [8] .…”

“…Various authorities advocate for instruments such as the Patient Categorization Tool to stratify patients with more complex needs [4] , [8] . These criteria include the number of disciplines required, medical stability, and patients with behavioral/emotional needs [4] , [8] . However, these instruments are often deployed for right-siting rehabilitation rather than prioritization of rehabilitation.…”