The Needs and Provision Complexity Scale: a multicentre prospective cohort analysis of met and unmet needs and their cost implications for patients with complex neurological disability

BMJ Open, 2013 · DOI: 10.1136/bmjopen-2012-002353 · Published: March 1, 2013

Simple Explanation

This study introduces the Needs and Provision Complexity Scale (NPCS), a tool designed to assess the alignment between healthcare needs and the services provided to individuals with complex neurological disabilities. The NPCS was used to evaluate service provision in comparison with the needs of patients with complex neurological disability. The research highlights shortfalls in rehabilitation, social support, and equipment provision, alongside excessive personal care often provided by families.

Study Duration

12 months

Participants

211 patients with complex neurological disability

Evidence Level

Not specified

Key Findings

1
Significant shortfalls were identified in the provision of rehabilitation, social support and equipment.
2
Provision of personal care (mainly provided by families) exceeded the predicted needs.
3
The underprovision of community-based rehabilitation and support services may contribute directly to excess care burden and costs to family carers.

Research Summary

The study focuses on the epidemiology of healthcare and support needs, addressing the lack of a methodology for routine-costed evaluation of service provision in relation to individual needs. The Needs and Provision Complexity Scale (NPCS) is introduced as a pragmatic tool to describe the level of met and unmet needs for health and social care and estimate their cost. The study's findings highlight significant shortfalls in rehabilitation, social support, and equipment provision, with personal care, often provided by families, exceeding predicted needs, indicating a potential burden on family carers.

Practical Implications

Service Planning and Delivery

The NPCS can inform population-based service planning and delivery by identifying gaps in service provision.

Clinical Decision-Making

The NPCS can be used as a tool to inform clinical decision-making at the individual level, ensuring that patients receive appropriate care and support.

Cost Analysis

The NPCS provides insights into the cost implications of failing to provide adequate support, highlighting the potential for increased costs due to personal care and institutional care.

Study Limitations

1
The NPCS requires further validation and exploration in different settings before our findings may be considered generalisable.
2
The low rate of response (49%) to follow-up evaluation is a weakness. Although no significant differences were detected between respondents and non-respondents, the possibility of selection bias cannot be excluded.
3
The costing algorithm, in particular, requires further testing and reﬁnement.

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