Evaluation of a home health patient classification instrument

The purpose of this study was to assess reliability and validity of the Rev ised Easley-Storfjell Patient Classification Instrument (R-ESPCI). Content validity was assessed by expert home health nurses. Interrater reliability was assessed by staff nurse ratings of patients on home visits (N = 34) and by chart review by the investigators (N = 30). Concurrent validity was als o assessed. Percentage agreement for staff nurses was 36% (kappa = -. 15) a nd 52% (kappa =.04) in two phases and for investigators 90% (kappa =.63) an d 50% (kappa =.02) in two phases. Minimal support for concurrent validity w as found. Content validity was established, but revised reimbursement polic y eliminated less acutely ill patients, narrowing the acuity range. More di screte rating criteria or scoring changes may be needed, followed by furthe r assessment of the R-ESPCI. Agency stability and adequate resources for st aff training are required for additional testing of the instrument.