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The Northwick Park Care Needs Assessment (NPCNA): a measure of community care needs: sensitivity to change during rehabilitation

Lynne Turner-Stokes

Regional Rehabilitation Unit, Northwick Park and St Mark's Hospital Trust, London

Ian Robinson

Centre for Study of Health, Sickness and Disablement, Brunel University, Isleworth, Middlesex, UK

Objectives: To determine whether the Northwick Park Care Needs Assessment (NPCNA) is sensitive to change occurring during rehabilitation and provides a reliable estimate of care needs in the community, and to compare the NPCNA with the Functional Independence Measure (FIM).

Design: Prospective cohort study.

Setting: Postacute neurorehabilitation unit for young patients with complex disabilities. Subjects: Thirty-nine consecutive patients with brain injury admitted over six months.

Measurements and methods: The NPCNA was assessed on admission and at discharge. Two subsets of patients were also assessed (a) at three-month follow-up in the community (n = 15), and (b) both in hospital and in the home environments at the discharge time point (n = 28). Data were compared with FIM scores on admission and discharge.

Results: The median total weekly care hours fell from 52 hours (interquartile range (IQR) 25–66) on admission, to 17 hours (IQR 6–46) on discharge (p<0.001). There was a median reduction of approximate weekly cost of care from £600 (IQR £224–824) to £168 (IQR £56–280) (p<0.001). These benefits were sustained at follow-up, and the NPCNA measured in hospital at discharge gave a good estimation of the care hours and weekly cost of care in the community at three months after discharge. There was no significant correlation with FIM gain.

Conclusions: In this study the NPCNA, measured while the patient was still in hospital, gave a good estimation of care needs in the community and was sensitive to change occurring during rehabilitation in patients with severe complex disabilities.

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