title: Weighing up the weighted case mix tool (WCMT): a psychometric investigation using confirmatory factor analysis.
abstract: OBJECTIVE
  To assess the use of the WCMT in two Scottish health boards and to consider the impact of simplifying the tool to improve efficient use.
  
  
  METHODS
  A retrospective analysis of routine WCMT data (47,276 cases).
  
  
  METHODS
  Public Dental Service (PDS) within NHS Lothian and Highland.
  
  
  METHODS
  The WCMT consists of six criteria. Each criterion is measured independently on a four-point scale to assess patient complexity and the dental care for the disabled/impaired patient. Psychometric analyses on the data-set were conducted. Conventional internal consistency coefficients were calculated. Latent variable modelling was performed to assess the 'fit' of the raw data to a pre-specified measurement model. A Confirmatory Factor Analysis (CFA) was used to test three potential changes to the existing WCMT that included, the removal of the oral risk factor question, the removal of original weightings for scoring the Tool, and collapsing the 4-point rating scale to three categories.
  
  
  RESULTS
  The removal of the oral risk factor question had little impact on the reliability of the proposed simplified CMT to discriminate between levels of patient complexity. The removal of weighting and collapsing each item's rating scale to three categories had limited impact on reliability of the revised tool. The CFA analysis provided strong evidence that a new, proposed simplified Case Mix Tool (sCMT) would operate closely to the pre-specified measurement model (the WMCT).
  
  
  CONCLUSIONS
  A modified sCMT can demonstrate, without reducing reliability, a useful measure of the complexity of patient care. The proposed sCMT may be implemented within primary care dentistry to record patient complexity as part of an oral health assessment.
authors: B G
authors: BG
authors: Duane
authors: G
authors: G
authors: Humphris
authors: D
authors: D
authors: Richards
authors: E J
authors: EJ
authors: Okeefe
authors: K
authors: K
authors: Gordon
authors: R
authors: R
authors: Freeman
mesh_terms: D003142:Communication; D003299:Cooperative Behavior; D003730:Dental Care for Persons with Disabilities / Q000706:statistics & numerical data*; D003953:Diagnosis-Related Groups / Q000706:statistics & numerical data*; D004990:Ethics, Dental; D005163:Factor Analysis, Statistical; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006304:Health Status; D006801:Humans; D007258:Informed Consent; D062072:Patient Acuity; D011320:Primary Health Care / Q000706:statistics & numerical data; D011594:Psychometrics / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D019035:Rural Health Services / Q000706:statistics & numerical data; D012606:Scotland; D013218:State Dentistry / Q000706:statistics & numerical data; D019037:Urban Health Services / Q000706:statistics & numerical data