DEVELOPMENT AND TESTING OF A COMMUNITY HEALTH NURSING INTENSITY RATING SCALE FOR PATIENT CLASSIFICATION
Donna Ambler Peters · Scholarly Commons (University of Pennsylvania) · 1987
There are several reasons why Federal expenditures for home care are rising. These include the "sicker and quicker" hospital discharges and rising technologic use. Policy makers want to temper growth. The current retrospective cost reimbursement system provides no incentives for cost containment. Therefore, policy makers are investigating a financial reform for home care similiar to the DRG approach for reimbursing hospitals. The method of classifying patients into payment groups will determine the equity of payment. Therefore, much consideration must be given to the development of a PCS. The purpose of this study was to develop a classification method which would identify the differences among patients' health problems within the context of their requirement for nursing care. The study was divided into three steps: tool development, pilot, and validation. Expert groups were formed to develop a four point ordinal scale tool using a prototype design. CHIRS is a result of these groups' efforts. The tool is divided into four domains which encompass community health nursing. These domains are subdivided into 15 community health parameters which are defined utilizing the nursing process as a framework. The tool considers patient characteristics, nursing interventions, and the intellectual aspects of nursing as well as the performance of discrete nursing tasks. Following development, the tool was pilot tested to assess validity and interrater reliability. The full study consisted of rating five hundred and sixty patient charts from two home health agencies. These ratings were correlated with other measures of nursing effort to validate the ability of the tool to measure resource consumption. The ratings were also correlated with two measures of hospital utilization to determine if there was any relationship. The findings of the study indicate that CHIRS is an initial, valuable step toward understanding community health patients' variable needs for nursing resources. CHIRS can be used to identify subgroups of patients with respect to their nursing resource requirements, and correlates significantly with the other measures of nursing resource consumption. The other findings in the study indicate that nursing resource consumption in the community is not explained by the severity of a patient's illness or by the amount of nursing care received in the hospital.