Interrater reliability and agreement of the Care Dependency Scale in the home care setting in the Netherlands

The care dependency scale (CDS) aims at determining nursing care needs in a holistic way, at providing standardized and meaningful descriptions of the type and intensity of nursing care needs and the degree of independence. Assessment results support appropriate care planning for individuals and they provide epidemiological data about care dependency. Although the CDS is used worldwide in various healthcare settings, data quality in the home care setting has not been examined yet. The interrater reliability and agreement of CDS scores were investigated within two large prevalence surveys of care problems in the Netherlands in the home care setting. Three hundred and thirty-five (year 2007) and 337 (year 2008) home care clients were independently assessed twice by trained nurses. Intraclass correlation coefficients [ICC(1,1)] for CDS sum scores were 0.94 (95% CI: 0.92-0.95) and 0.93 (95% CI: 0.92-0.95), and corresponding standard errors of measurement were 3.2 and 3.3. The items mobility, day/night pattern and learning ability contained the largest amounts of measurement error and the lowest interrater reliability. Results indicate that CDS sum scores are reproducible estimates characterizing the care dependency in the home care setting. Interrater agreement is too low to make clinical decisions on individual level.