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Fundamento: Desarrollar y validar un instrumento específico de identificación de pacientes complejos, elÍndice de Evaluación de Casos Complejos (IECC). Métodos: Estudio instrumental con dos fases: 1) Elaboración del instrumento: se definieron y operacionalizaronlas variables extraídas de la literatura que, posteriormente, fueron sometidas al juicio de expertos. El IECCincluyó catorce variables divididas en dos dimensiones:complejidad del manejo clínico y complejidad del manejo comunitario. 2) Estudio psicométrico: evaluaciónde la fiabilidad por equivalencia entre observadores (rPearson), de la validez de criterio respecto al sistema declasificación Clinical Risk Groups (CRG) y de la validezde constructo a través de grupos conocidos y a travésdel estudio de conglomerados jerárquicos. Los análisisse realizaron con el paquete estadístico SPSS.v.17. Resultados: La fiabilidad entre observadores para lasubescala clínica fue r = 0,97, para la subescala comunitaria r = 0,74 y para la puntuación total r = 0,89. El 88,4%(n = 458) de los 518 casos identificados como complejospor el IECC fueron categorizados por el sistema CRG enlas categorías de más complejidad clínica (niveles 6 a9). Los resultados sustentan la validez de constructode la escala. El análisis de conglomerados mostró dosclusters diferentes, aunque relacionados. Conclusión: El IECC es un índice breve y de fácil aplicación, con una buena adecuación conceptual y evidencias de su fiabilidad y validez dirigido a la detección depacientes con necesidades complejas.(AU)

Background: The aim was to develop and validate theComplex Case Assessment Index (CCAI), a specific instrument to identify complex patients. Methods: Instrumental study in two phases: 1) Development of the scale: the variables extracted from theliterature were firstly defined and operationalized, andthen submitted for expert judgment. The CCAI included14 variables divided into two dimensions: complexity ofclinical management and complexity of community management. 2) Psychometric study: evaluation of the reliability and validity of the scale by equivalence betweenobservers (Pearson’s r), criterion validity with respect tothe Clinical Risk Groups (CRG) classification system, andconstruct validity through known groups and study ofhierarchical clusters were examined. The analyses werecarried out with the SPSS version 17 statistical package. Results: Reliability by equivalence between observers was r = 0.97 for the clinical subscale, r = 0.74 for thecommunity 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 validity of the scale.The cluster analysis showed two different, although related, clusters. Conclusion: The CCAI is a fast and easy-to-use index,with good conceptual adequacy and evidence of reliability and validity for screening patients with complexneeds.(AU)

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OBJECTIVE: Non-professional care provided in domestic settings by a family member or someone from the close environment and without a connection to a professional care service, is increasingly assumed by older people, mainly the spouses of those requiring care. The aim of this study was to describe the experience of older people providing care at home to older dependents. METHODS: A qualitative study was carried out to describe and explore the experience of older people, caregivers of dependent older people in the home. RESULTS: Four themes emerged as a result of the analysis: interpersonal relationships established in the caregivers' immediate environment; the need and request for public and private resources; consequences of providing care during old age; and adaptation to the circumstance of being a caregiver during old age. Older people who provide home-based care, experience their situation as stressful, feel that it limits their daily life, deprives them of their freedom, and affects their interpersonal relationships and social activities. DISCUSSION: Older caregivers learn quickly and can manage the skills issues. The volume of work is their challenge. Interpersonal relationships are altered depending on the length of time spent together and the demand for care. Public services and benefits are not adapted to the demands of caregivers or dependent persons.

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

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