Le financement des soins infirmiers à domicile en Belgique - KCE

40 Financing of Home Nursing KCE reports 122
4.2.1.5 The Functional Autonomy Measurement System
Description
The SMAF (Système de Mesure de l’Autonomie Fonctionnelle) was developed in
Quebec in 1982. Data used to develop this system came from a sample of 1 977 old
people with autonomy troubles, in different contexts (at home and in long term
institutions). Clinical evaluations and cost evaluations were performed. The SMAF
creates groups of patients using their characteristics and not using care delivered. The
SMAF evaluates how the person performs 29 functions covering ADL (7 items), mobility
(6 items), communication (3 items), mental functions (5 items) and IADL (8 items). Each
function is scored on an ordinal way: 0 (independent), - 0.5 (with difficulty), -1 (with
supervision), -2 (with help), -3 (dependent). The items allow capturing disabilities
related to interaction between individuals and their environments and meet the
approach of ICF.
It takes about 20 to 30 minutes to assess the patient with the instrument. The scale
exists in different versions (English, French and Dutch). A combined Statistical analysis
(using Ward ascending classification and the K-means non-hierarchical partitioning
method) with advice from a panel of experts lead to the identification of 14
homogeneous disability profiles (iso-SMAF) characterised by a gradual progression in
severity of disabilities in IADL and ADL accompanied by predominant limitations either
in mobility or mental functions. These 14 profiles could be classified in 5 categories.
Category 1 classifies persons with IADL problems (iso-SMAF 1, 2 and 3). Category 2
classifies persons with predominant troubles for mobility (iso-SMAF 4, 6 and 9.)
Category 3 classifies persons with predominant mental disorder (iso-SMAF 5, 7, 8 and
10.) Category 4 classifies persons with mental and mobility disorders needing help for
mobility. Category 5 classifies bedridden persons with severe mental disorder.
The care time needed varies from 0.39 hour up to 4.07 hours a day. Some iso-SMAF
profiles need care time that are not statistically different (1-2, 3-4, 7-8, 9-10, 11-12) but
they differ in the type of services needed.
Validity
Dubuc et al. (2006) 44 described the method used to create and validate the Iso-SMAF
classification. Stability of the classification was assessed with the “split sample” cross
validation method. Reproducibility was assessed by using another cluster analysis
method. The predictive validity was assessed by the ability of the classification to predict
patients’ required hours of nursing care. Homogeneity was evaluated by the coefficient
of variation. Heterogeneity across profiles was assessed with t-test or Wilcoxon rank
test. Content validity was established by a combination of Delphi method and nominal
group technique.
The results showed a good stability and reproducibility with a good kappa coefficient
obtained with the cross-validation (K= 0.67) and same cluster structures identified
when using different methods. The 14 iso-SMAF classification explained 82% of the
variance in nursing care time and 80% of their costs. Coefficients of variation were all
less than 0.5 44 .