The Northwick Park Care Needs Assessment (NPCNA): a directly costable outcome measure in rehabilitation

Abstract

Background: The Northwick Park Dependency Score (NPDS) has been shown to be valid, reliable and practical to use. It was designed to be used together with a short set of additional questions to inform care needs in the community and facilitate discharge planning.

Aim: To develop a conversion formula to translate information derived from the NPDS into a generic assessment of care needs in the community – the Northwick Park Care Needs Assessment (NPCNA) – and to evaluate its potential as a directly costable measure of outcome in rehabilitation. Setting: An inpatient neurorehabilitation unit for young patients with brain injury.

Method: Part 1, Development: For each task in the NPDS, a set of assumptions was developed to reflect the number of people, the time taken and the frequency of help required. Tasks were collected into a daily timetable and minimum and maximum allocations made for each time slot. From this the weekly care hours can be calculated. A range of care package categories and their approximate costs were identified, and a simple set of criteria developed with experienced community care planners to determine the circumstances under which each category is applied. Part 2, Evaluation: The assumptions and derived care package were evaluated in a prospective comparative study in 35 cases. Timetables of care needs were drawn up using (a) the NPDS-derived Care Needs Assessment (NPCNA) and (b) detailed structured interview with an independent assessor. The weekly hours of care, care package and approximate cost were then determined for each set of timetables, by a third independent assessor, applying the formula described according to strict rules.

Results: Assessment of the total weekly hours of care showed an excellent correlation between the two methods (rho 0.90, p<0.01) with no significant differences. There was also a high correlation in the category of care package allotted and thus the weekly cost of care (rho 0.73, p<0.01).

Conclusion: The NPCNA provides a simple measure of care needs in total care hours, as well as a timetable of care from which a care package can be directly planned and costed. It has potential use, therefore, as an instrument that can demonstrate directly the effectiveness of rehabilitation in reducing the cost of continuing care in the community.