title: The Needs and Provision Complexity Scale: a multicentre prospective cohort analysis of met and unmet needs and their cost implications for patients with complex neurological disability.
abstract: OBJECTIVE
  To provide a brief overview of the Needs and Provision Complexity Scale (NPCS) and report its first application to describe the level of 'met' and 'unmet' health/social care needs, and to estimate their costs in community-based patients with complex neurological disability.
  
  
  METHODS
  A multicentre prospective cohort analysis.
  
  
  METHODS
  Consecutive discharges to the community from the nine tertiary specialist inpatient neurorehabilitation units in London over 12 months (2010/2011).
  
  
  METHODS
  Patients responding at follow-up (n=211). Mean age 50.2(SD14) years, males:females 127/84. Diagnosis 157(74%) brain injury, 27(13%) spinal cord injury/peripheral neuropathy; 27(13%) other.
  
  
  METHODS
  The NPCS is a brief, pragmatic, directly costable instrument for measuring both an individual's needs for rehabilitation and support (NPCS-Needs) and the levels of service provided (NPCS-Gets) within a given period.
  
  
  METHODS
  The 'NPCS-Needs' was completed by the treating clinical team at discharge. Patients and/or their carers self-reported 'NPCS-Gets' after 6 months by a postal/online questionnaire supported by a follow-up telephone interview.
  
  
  RESULTS
  Needs for medical/nursing care and accommodation were generally well met. Significant shortfalls in provision were identified in the subscales of Rehabilitation (paired t test: t -9.7, p<0.001, effect size (ES)=-0.85), Social support (t -5.8, p<0.001, ES=-0.48) and Equipment (t -5.6, p<0.001, ES=-0.44). Item-level analysis demonstrated that the frequency of Personal care received exceeded predicted needs (Wilcoxon z=-3.3, p<0.001). In 80% of cases, this care was provided/paid for by families. Translated into mean costs/patient/year, the estimated underspends on Rehabilitation (-£2320) and Social support (-£1790) were exceeded >3.5-fold by excess costs of Personal care (£10 313) and Accommodation (£4296).
  
  
  CONCLUSIONS
  The results identify underprovision of community-based rehabilitation and support services compared with needs, which may contribute directly to excess care burden and costs to family carers. The NPCS requires further evaluation but has potential use as a simple, directly costable tool to inform both clinical decision-making and population-based service planning and delivery.
authors: Department of Palliative Care, Policy and Rehabilitation,  Cicely Saunders Institute, King's College London, School of Medicine, London,  UK.
authors: Lynne
authors: L
authors: Turner-Stokes
authors: Paul
authors: P
authors: McCrone
authors: Diana M
authors: DM
authors: Jackson
authors: Richard John
authors: RJ
authors: Siegert