title: Measuring complexity in neurological rehabilitation: the Oxford Case Complexity Assessment Measure (OCCAM).
abstract: OBJECTIVE
  To investigate validity and reliability of a new measure of case complexity, the Oxford Case Complexity Assessment Measure (OCCAM).
  
  
  METHODS
  Data collection on inpatients and outpatients attending for rehabilitation. In subsets, repeat assessments were undertaken two weeks apart, by clinicians unaware of initial data, and on admission and on discharge from inpatient rehabilitation.
  
  
  METHODS
  Specialist neurological rehabilitation service.
  
  
  METHODS
  Patients receiving rehabilitation after acute onset disability.
  
  
  METHODS
  Assessment by clinical staff as part of routine care.
  
  
  METHODS
  OCCAM, the INTERMED, Rehabilitation Complexity Scale - Extended (RCS-E), clinical judgement of complexity (0-10 numerical rating scale), length of stay and discharge destination (for inpatients).
  
  
  RESULTS
  For the OCCAM, the Cronbach's α coefficient was 0.69 and item-total correlations were moderate to high except for pathology and time. The correlation coefficients with OCCAM were: INTERMED (ρ = 0.694), RCS-E (ρ = 0.736), and team judgement (ρ = 0.796). Inter-rater agreement was excellent (Weighted κ = 0.95). Correlation between admission and discharge scores was ρ = 0.917. Test-retest agreement was good (intraclass correlation coefficient 0.86). Higher mean admission scores were associated with prolonged stays (38.6 ± 12.2 versus 32.9 ± 13.7, P = 0.04) and failure to return home (48.0 ± 13.7 versus mean 32.1 ± 10.7, P < 0.001). The optimal cut-off of OCCAM to detect patients not discharged home was ≥ 34, with corresponding sensitivity and specificity of 84.6% and 62.8%, respectively.
  
  
  CONCLUSIONS
  This preliminary evidence suggests that the OCCAM may measure case complexity reliably, and may predict rehabilitation resource used and outcome. Further research is warranted.
authors.affiliation: 1University Hospital of Dijon, Dijon, France.
authors.forename: Odile
authors.initials: O
authors.lastname: Troigros
authors.forename: Yannick
authors.initials: Y
authors.lastname: Béjot
authors.forename: Patricia Marquez
authors.initials: PM
authors.lastname: Rodriguez
authors.forename: Farhat
authors.initials: F
authors.lastname: Shoaib
authors.forename: Henrietta
authors.initials: H
authors.lastname: Ellis
authors.forename: Derick
authors.initials: D
authors.lastname: Wade
mesh_terms: D003363:Cost Control / Q000379:methods; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D009422:Nervous System Diseases / Q000145:classification / Q000534:rehabilitation*; D015588:Observer Variation; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011379:Prognosis; D011594:Psychometrics; D012046:Rehabilitation / Q000145:classification* / Q000379:methods; D012047:Rehabilitation Centers / Q000191:economics / Q000592:standards / Q000639:trends; D012051:Reimbursement Mechanisms / Q000592:standards / Q000639:trends; D015203:Reproducibility of Results; D015599:Trauma Severity Indices
keywords: Case complexity; OCCAM; discharge location; neurorehabilitation; psychometrics; scale