Reliability and validity testing of an acuity tool for use in the long-term acute care hospital setting

The new millennium will see increased health care costs coupled with increased need for services—all compounded by a nursing shortage. In addition, regulatory agencies are mandating that standards be used to benchmark the quality of care provided to today's consumer. Future success of health care organizations will be measured by their ability to effectively manage resources to provide quality care at the appropriate level with competent personnel.

Classification systems have been in existence for over 30 years. Different classification systems have been developed to meet the individual patient characteristics in a variety of hospital settings. The uniqueness of patient care needs prohibits generic classification systems. Formatting a system according to the characteristics of the patient population in which it will be used is essential.

The purpose of this study was to determine psychometric properties of an acuity tool for use in the long-term acute care population. Internal consistency reliability was tested with Cronbach's alpha; an expert panel using the diagnostic content validation model (DCV) determined content validity. Two hundred acuity tools from four patient care areas of a long-term acute care hospital were used for psychometric testing.

A one-way ANOVA indicated significant differences in acuity scores by location. The ICU had the highest overall scores, followed by the IMU and general medical-surgical areas. Differences were noted in number of activity points, which suggested that higher acuity is directly proportional to intensity of nursing care.

A Cronbach's alpha coefficient of 0.7538 indicated that the tool was a reliable measure of acuity in long-term acute care population. The DCV coefficient was 0.84, which supported the hypothesis that the instrument was a valid tool for evaluating acuity in this population. Factor analysis yielded four factor trends among the variables. Each subscale on the LTA-Care Acuity Index loaded on one or more factors with a minimum coefficient of 0.30.

This study's findings have demonstrated that reliability and validity of an acuity instrument can be tested to provide hospital personnel, regulatory agencies, and health care consumers with a system for measuring acuity in long-term care facilities.