"INTERMED": A method to assess health service needs - I. Development and reliability

The purpose of this paper is to describe the development and to test the re liability of a new method called INTERMED, for health service needs assessm ent. The INTERMED integrates the biopsychosocial aspects of disease and the relationship between patient and health care system in a comprehensive sch eme and reflects an operationalized conceptual approach to case mix or case complexity. The method is developed to enhance interdisciplinary communica tion between (para-) medical specialists and to provide a method to describ e case complexity for clinical, scientific, and educational pur poses. Firs t, a feasibility study (N = 21 patients) tons conducted which included doub le scoring and discussion of the results. This led to a version of the inst rument on which two interrater reliability studies were performed. In study 1, the INTERMED was double scored for 14 patients admitted to an internal ward by a psychiatrist and an internist on the basis of a joint interview c onducted by both. In study 2, on the basis of medical charts, two clinician s separately double scored the INTERMED in 16 patients referred to the outp atient psychiatric consultation service. Aver aged over both studies, in 94 .2% of all ratings there was no important difference between the raters (mo re than 1 point difference). As a research interview, it takes about 20 min utes; as part of the whole process of history taking it takes about 15 minu tes. In both studies, improvements were suggested by the results. Analyses of study I revealed that on most items there was considerable agreement; so me items were improved. Also, the reference point for the prognoses was cha nged so that it reflected both short- and long-term prognoses. Analyses of study 2 showed that in this setting, less agreement between the raters was obtained due to the fact that the raters were less experienced and the scor ing procedure was move susceptible to differences. Some improvements-mainly of the anchor points-were specified which may further enhance interrater r eliability The INTERMED proves to be it reliable method for classifying pat ients' care needs, especially when used by experienced raters scoring by pa tient interview. It can be a useful tool in assessing patients' cave needs, as well as the level of needed adjustment between general and mental healt h service delivery. The INTERMED is easily applicable in the clinical setti ng at low lime-costs. (C) 1999 Elsevier Science Inc.