Evaluation of a home health patient classification instrument

The purpose of this study was to assess reliability and validity of the Revised 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 also assessed. Percentage agreement for staff nurses was 36% (kappa = -.15) and 52% (kappa = .04) in two phases and for investigators 90% (kappa = .63) and 50% (kappa = .02) in two phases. Minimal support for concurrent validity was found. Content validity was established, but revised reimbursement policy eliminated less acutely ill patients, narrowing the acuity range. More discrete rating criteria or scoring changes may be needed, followed by further assessment of the R-ESPCI. Agency stability and adequate resources for staff training are required for additional testing of the instrument.