G519(P) Creating a tool for measuring health complexity in uk community paediatric caseloads

Aims To develop a reliable, simple tool to objectively score health complexity in children known to community paediatric teams, supporting individual care plans, and health systems governance and structuring. Methods A scoring proforma was developed with multi-professional input from published eligibility criteria for paediatric hospice care- the health complexity in community paediatrics (HCCP) score. The HCCP scoring tool was then validated and assessed for use: Inter–rater reliability was assessed in two ways, both looking at whether different clinicians scored similarly for the same cases. Initially two clinicians scored 23 real cases for children with complex needs. Following this pilot, an on–line survey was completed by local paediatricians scoring devised/anonymised clinical+ letters. To assess breadth of relevance, the HCCP tool was used to score 214 children across four different community paediatric settings. HCCP score was correlated with health service use by retrospective collection of outpatient, inpatient and A+E review data for 99 special school pupils who had had HCCP scored. Results Inter–rater reliability: for both exercises good reliability was demonstrated. Online scoring tests yielded a Krippendorff’s alpha value of 0.79; for the 23 complex children alpha value was 0.93. (1 indicates perfect agreement and 0 the level of agreement expected by chance.) Community paediatric caseload scores; there were a wide range of scores across all subgroups apart from general referrals to community paediatrics, which had a low mean score of 0.12. There were higher mean scores in populations of anticipated increased complexity. Health service use; significant correlation existed between greater use of hospital services and higher HCCP score. A higher HCCP score was particularly significant as a predictor for a higher number of inpatient admissions days. Conclusions The HCCP scoring tool is reliable, and an individual’s score predicts the likelihood of acute health service use. This tool has value therefore for an individual by anticipating acute health needs and optimising local service use e.g for escalation to local intensive community support service where avilable. Other functions, such as using the tool to inform discussions with families about advanced planning, and use in overall health systems structuring and funding, could be explored.