[Design and validation of a complex case evaluation index]

The aim was to develop and validate the Complex Case Assessment Index (CCAI), a specific instrument to identify complex patients.

Instrumental study in two phases: 1) Development of the scale: the variables extracted from the literature were firstly defined and operationalized, and then submitted for expert judgment. The CCAI included 14 variables divided into two dimensions: complexity of clinical management and complexity of community management. 2) Psychometric study: evaluation of the reliability and validity of the scale by equivalence between observers (Pearson's r), criterion validity with respect to the Clinical Risk Groups (CRG) classification system, and construct validity through known groups and study of hierarchical clusters were examined. The analyses were carried out with the SPSS version 17 statistical package.

Reliability by equivalence between observers was r?=?0.97 for the clinical subscale, r?=?0.74 for the community subscale, and r?=?0.89 for the total score. The CCAI identified 518 cases as complex; 458 of them (88.4%) were categorized by the CRG system in the categories of greatest clinical complexity (levels 6 to 9). The results support the construct validi-ty of the scale. The cluster analysis showed two different, although related, clusters.

The CCAI is a fast and easy-to-use index, with good conceptual adequacy and evidence of reliability and validity for screening patients with complex needs.