[Is there equality of nursing care insurance coverage for ambulatory and non-ambulatory clients according to German law?].
In nursing insurance according to German legislation, the act of classifying the client into degrees of severity of disablement (0 = none, 1 to 3 = considerable, severe, most severe disablement) by expert assessment is based on legally defined distinct criteria (need for help items). Over and above these criteria, information with regard to the activities of daily life (ADL) is also documented routinely.


OBJECTIVE
Is there a fundamental difference between patients suitable for ambulatory or non-ambulatory nursing care, or are their positive pattern scores for needing help fundamentally different?


METHODS
Based on 7,000 electronic records of the assessments for ambulatory, and another 7,000 records for non-ambulatory nursing care, we fed artificial neural networks with all, or subsets, of the available items. Thereafter, in a crossover design, we evaluated the nets' classification competencies on independent validation data, using the ambulatory net for non-ambulatory classification, and vice versa. Weighted kappa (kw) was calculated as an index of performance.


RESULTS
The nets trained on ambulatory data uniformly performed slightly better on ambulatory than on non-ambulatory data (kw = 0.78 versus 0.65, all items; 0.68 versus 0.67, only ADL items), whereas the non-ambulatory nets showed no consistent difference in respect of the nature of the input data (kw = 0.76/0.77, and 0.71/0.66). Overall, the nets' classification competence was convincing.


CONCLUSIONS
There are inter-group differences regarding the need for care. The more severely disabled clients are mainly in the non-ambulatory group. But the principles governing the need for care are very similar in both groups. Thus, a uniform assessment procedure with regard to individual patient disability is justified. From the viewpoint of quality control, the results are reassuring.
Michel
E
E
Medizinischer Dienst der Krankenversicherung Westfalen-Lippe, Munster. Erik.Michel@t-online.de
Zernikow
B
B
D000553:Ambulatory Care / Q000331:legislation & jurisprudence* / Q000639:trends; D005858:Germany; D015276:Health Care Rationing / Q000331:legislation & jurisprudence / Q000639:trends; D006801:Humans; D007355:Insurance, Nursing Services / Q000331:legislation & jurisprudence* / Q000639:trends*; D020380:Needs Assessment / Q000331:legislation & jurisprudence* / Q000639:trends*