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

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 NPCN A 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 discha rge. Two subsets of patients were also assessed (a) at three-month follow-u p in the community (n = 15), and (b) both in hospital and in the home envir onments at the discharge time point (n = 28), Data were compared with FIM s cores on admission and discharge. Results: The median total weekly care hours fell from 52 hours interquartil e range (IQR) 2-66) 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 pound 600 (IQR pound 224-824) to pound 168 (IQR pound 56-280) (p<0.001). Th ese benefits were sustained at follow-up, and the NPCNA measured in hospita l 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 signifi cant 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.