title: Predicting the need for institutional care shortly after admission to rehabilitation: Rasch analysis and predictive validity of the BRASS Index.
abstract: BACKGROUND
  Effective discharge planning is increasingly recognised as a critical component of hospital-based Rehabilitation. The BRASS index is a risk screening tool for identification, shortly after hospital admission, of patients who are at risk of post-discharge problems.
  
  
  OBJECTIVE
  To evaluate the internal construct validity and reliability of the Blaylock Risk Assessment Screening Score (BRASS) within the rehabilitation setting.
  
  
  METHODS
  Observational prospective study.
  
  
  METHODS
  Rehabilitation ward of an Italian district hospital.
  
  
  METHODS
  One hundred and four consecutively admitted patients.
  
  
  METHODS
  Using classical psychometric methods and Rasch analysis (RA), the internal construct validity and reliability of the BRASS were examined. Also, external and predictive validity of the Rasch-modified BRASS (RMB) score were determined.
  
  
  RESULTS
  Reliability of the original BRASS was low (Cronbach's alpha=0.595) and factor analyses showed that it was clearly multidimensional. A RA, based on a reduced 7-BRASS item set (RMB), satisfied model's expectations. Reliability was 0.777. The RMB scores strongly correlated with the original BRASS (rho=0.952; P<0.000) and with FIM™ admission scores (rho=-0.853; P<0.000). A RMB score of 12 was associated with an increased risk of nursing home admission (RR=2.1, 95%CI=1.7-2.5), whereas a score of 17 was associated to a higher risk of length of stay >28 days (RR=7.6, 95%CI=1.8-31.9).
  
  
  CONCLUSIONS
  This study demonstrated that the original BRASS was multidimensional and unreliable. However, the RMB holds adequate internal construct validity and is sufficiently reliable as a predictor of discharge problems for group, but not individual use.
  
  
  CONCLUSIONS
  The application of tools and methods (such as the BRASS Index) developed under the biomedical paradigm in a Physical and Rehabilitation Medicine setting may have limitations. Further research is needed to develop, within the rehabilitation setting, a valid measuring tool of risk of post-discharge problems at the individual level.
authors.affiliation: Department of Rehabilitation Medicine, ASL Vercelli, Vercelli, Italy. lorenzo.panella@aslvc.piemonte.it
authors.forename: L
authors.initials: L
authors.lastname: Panella
authors.forename: F
authors.initials: F
authors.lastname: La Porta
authors.forename: S
authors.initials: S
authors.lastname: Caselli
authors.forename: S
authors.initials: S
authors.lastname: Marchisio
authors.forename: A
authors.initials: A
authors.lastname: Tennant
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000534:rehabilitation*; D005260:Female; D005544:Forecasting; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D011446:Prospective Studies; D011594:Psychometrics / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012720:Severity of Illness Index