[Modular nursing system in pediatric ambulatory care according to nursing insurance legislation XI]

In the compulsory nursing insurance according to German legislation, the assessed degree of disablement in children is dependent on their daily quantitative need for nursing care with respect to 19 distinctive items belonging to the four sectors "personal hygiene", "mobility", "nutrition", and "household duties", that exceeds normal age-dependent requirements. In ambulatory nursing, exactly that care is given to the clients.

Are there typical combinations of items scoring positively, delivering the basis for a simplified billing schedule?

4500 records from the expert assessment of children < 18 years underwent a hierarchical cluster analysis (SPSS, Ward's method).

The resulting dendrogram revealed distinct relationships between items. The items clustered into 4 main groups. Each cluster comprised items with a common thematic relationship (A = household duties, B = mobility, C = personal hygiene, D = nutrition/leaving one's home--scoring positively may indicate extra severe disablement).

Remarkably enough, the resulting four clusters are very similar to the four sectors as defined by legislation (see above), although each single item is assessed independently. Our results are similar to that found in adults (Michel et al., 1998). Here we deliver the statistical basis for a modularised system of ambulatory paediatric nursing care, or its costing.