Article

OBJECTIVE: To investigate validity and reliability of a new measure of case
complexity, the Oxford Case Complexity Assessment Measure (OCCAM). DESIGN: Data
collection on inpatients and outpatients attending for rehabilitation. In
subsets, repeat assessments were undertaken two weeks apart, by clinicians
unaware of initial data, and on admission and on discharge from inpatient
rehabilitation. SETTING: Specialist neurological rehabilitation service.
SUBJECTS: Patients receiving rehabilitation after acute onset disability.
Interventions: Assessment by clinical staff as part of routine care. MEASURES:
OCCAM, the INTERMED, Rehabilitation Complexity Scale - Extended (RCS-E), clinical
judgement of complexity (0-10 numerical rating scale), length of stay and
discharge destination (for inpatients). RESULTS: For the OCCAM, the Cronbach's
alpha coefficient was 0.69 and item-total correlations were moderate to high
except for pathology and time. The correlation coefficients with OCCAM were:
INTERMED (rho = 0.694), RCS-E (rho = 0.736), and team judgement (rho = 0.796).
Inter-rater agreement was excellent (Weighted kappa = 0.95). Correlation between
admission and discharge scores was rho = 0.917. Test-retest agreement was good
(intraclass correlation coefficient 0.86). Higher mean admission scores were
associated with prolonged stays (38.6 +/- 12.2 versus 32.9 +/- 13.7, P = 0.04)
and failure to return home (48.0 +/- 13.7 versus mean 32.1 +/- 10.7, P < 0.001).
The optimal cut-off of OCCAM to detect patients not discharged home was >/= 34,
with corresponding sensitivity and specificity of 84.6% and 62.8%, respectively.
CONCLUSIONS: This preliminary evidence suggests that the OCCAM may measure case
complexity reliably, and may predict rehabilitation resource used and outcome.
Further research is warranted.

Langue : ANGLAIS