Le financement des soins infirmiers à domicile en Belgique - KCE

KCE Report 122 Financing of Home Nursing 39
Validity
Benaim (2005) 49 reports that the AGGIR scale was built in institutional setting and that
its use was later extended to assess dependency at home without specific validation.
Such extension is doubtful because some relevant issues are not solved, as the need of
supervision at home and because some productive disorders like restlessness and
running away from home are not taken into account. Moreover, this scale is not a tool
allowing a follow-up of the dependent person and the geriatrics generally do not
recommend integrating it in the medical file.
Using a principal components analysis, Roudier and Al-Aloucy (2004) 50 found five factors
explaining 90% of the variance. They concluded that the scale mainly takes the physical
dependency into account. Dependency related to dementia would require an adaptation
of the scale, integrating cognitive and behavioural troubles. Fanello et al. (2000) 51
observed a relationship between the AGGIR scale and the Mini Nutritional Assessment
(MNA), iso-resource groups 4, 3, 2 and 1 presenting a higher risk of malnutrition.
Lafont et al. (1999) 52 found a relationship between global cognitive performance and the
dependency evaluated by the AGGIR scale but concluded that the model seems to lack
sensitivity for taking in account functional impairment associated with dementia. IADL
should be considered in the classification.
Falez 40 assessed the content validity, and concluded that this scale assesses dependency
for activities in Daily Living (ADL) and for instrumental activities in daily living (IADL).
He concludes that the scale meets the International Classification of Functioning (ICF)
approach. Construct validity is good. Concurrent validity with the Belgian scale is high
(r²=0.89) and the scale is correlated with the time spent for care for ADL (r² = 0.63.)
Cronbach’s alpha coefficient is higher than 0.9. Test-retest and external reliability are
good (coefficient kappa >0.7). The mean time for care is significantly different in each
iso-resource group (ANOVA and Games-Howel post-hoc test).
Falez(2006) 38 found a high correlation between the weighted mean GIR and the
required time for ADL care (r²=0.86). He found that median required daily care time
for dependence for ADL is 236 minutes for iso-resource group 1, 194 minutes for isoresource
group 2, 158 minutes for iso-resource group 3, 99 minutes for iso-resource
group 4, 38 minutes for iso-resource group 5 and 21 minutes for iso-resource group 6.
The author concludes that the scale is valid and could allow a funding of home nursing
care by case-mix based on the AGGIR scale.
The Interface study reports face validity of the scale as used in nursing homes. For the
caregivers, this scale is evaluated as offering better insight in de condition of the patient
than the Belgian scale, but does not offer sufficient information for care planning.
Gervais et al. (2009) 53 compared AGGIR and SMAF. They found a good correlation
between the two scales (r 2 =0.86) but also discrepancies in the way the two scales
classify the patients.
Coutton (2009) 54 compared the dependency categories of the AGGIR scale and the
resources utilisation by dependent aged persons, but is not able to conclude neither
whether the scale is valid nor whether the resources utilisation is adequate.
Applicability for financing purposes
Colvez et al. (2009) 55 presided a scientific committee entrusted by a French law, to
adapt the dependency evaluation tools. This committee reported that the AGGIR scale
alone does not constitute a complete assessment of the problems of the person. The
hierarchy between discriminant and illustrative variables pushes the IADL variables, the
relational life and the capacity to manage the daily life into the background. Moreover,
the scale does not recognize the consequences of psychological disorders and the
discriminant variables “moving out and alerting” are underestimated because they are
not taken in account to calculate the iso-resource groups. Another problem reported
by the committee is the small number of scientific validations of the tool. The scientific
committee recommends that providers should be funded on a case-mix basis but
recommends AGGIR scale only if it is integrated in a multidimensional tool allowing to
develop a care plan.