Patient Categorisation Tool
The Patient Categorisation Tool (PCAT) is an ordinal score (total score range 16-50)
It comprises 18 domains, each domain has 3 columns containing the level of need for categories A, B and C/D. The areas covered are as follows:
- Specialist Medical/neuropsychiatric need – Medical/surgical/neuropsychiatric and intensity
- Clinical Needs – physical, tracheostomy/ventilatory, swallowing/nutrition, communication, cognitive, behavioural, mood/emotion, complex disability management, social/discharge planning, family support and emotional load on staff
- Vocational rehabilitation
- Medico-legal issues
- Specialist equipment/facilities
Anticipated Duration of stay is allocated a score of 0-2.
The total possible score range is 16-50.
Implementation of the Patient Categorisation Tool (PCAT)
The PCAT may be rated in the pre-admission stage to help determine the complexity of rehabilitation needs and thus direct referral to the appropriate setting for ongoing rehabilitation.
Within the mandated UK ROC dataset for inpatient specialist rehabilitation, the PCAT should be scored once at admission, preferably by the treating Consultant in Rehabilitation Medicine or their deputy.
- Each domain is rated on a score of 1-3 by “ticking” the relevant descriptions (if descriptors from more than one column are relevant – all should be ticked, but only the highest score is included in the total PCAT score).
- Only the highest of either medical/surgical or neuropsychiatric score is used (not both).
- The supplementary questions should also be completed which include:
- The category of need based on clinical impression
- The recommended level of service
- Anticipated duration of stay:
- Long stay = 2 (up to 6 months)
- Medium stay = 1 (usually 2-4 months),
- Short stay = 0 (e.g. 6-8 weeks/ or assessment only)
The PCAT was initially developed as a simple checklist to determine which of the specific criteria a given patient met for requiring a Level 1 neuro-rehabilitation service.
Version 2 (the current version that incorporates a scoring system) was subsequently developed to provide the more systematic identification of all the categories, and therefore to help direct patients to the correct level of rehabilitation service to meet their needs.
Psychometric evaluation has demonstrated that the tool satisfies the expectations of the Rasch model as a unidimensional tool, and therefore the total score has acceptable reliability for individual assessment of complexity. In broad numerical terms:
- A total PCAT score of 19-24 indicates Category C needs
- a score of 25-29 indicates Category B needs and
- scores of 30+ indicate Category A needs.
However, these cut-offs are not absolute.
- A total score of 30+ identified patients with complex (category A) needs with sensitivity 76% and specificity 75%.
- Confirmatory factor analysis provided a better fit when the scale was split into two subscales – a 'Cognitive/psychosocial' and a 'Physical' sub-scale, of 9 items each.
This is expected because rehabilitation needs following acquired brain injury can vary from severe physical disability to cognitive/behavioural problems.
For ambulant patients with severe cognitive/ behavioural problems it is best to rely on the cognitive subscale scores to determine the category of needs. In this case:
- Scores of 12-15 identify patients with category B needs
- Scores of >15 identify those with Category A needs requiring a Level 1c specialised cognitive/behavioural rehabilitation unit.
Source references
- Siegert RJ, Medvedev O, Turner-Stokes L. Dimensionality and scaling properties of the Patient Categorisation Tool in patients with complex rehabilitation needs following acquired brain injury. Journal of Rehabilitation 2018; 50 (5): 435-443
- Turner-Stokes L, Krägeloh CU, Siegert RJ. The Patient Categorisation Tool: psychometric evaluation of a tool to measure complexity of need for rehabilitation in a large multicentre dataset from the United Kingdom. Disability and Rehabilitation 2019; 41 (9): 1101-1109
The PCAT is used to assist in the clinical decision of category of need.
- Total PCAT scores (or subscale scores for the physical and/or cognitive domains) can provide a reasonable indication of the Level and type of rehabilitation service required.
- However, given the diversity of needs following acquired brain injury, we do not recommend relying solely on the numerical scores.
- The PCAT should also be applied as a checklist to support a clinical evaluation of rehabilitation needs.
Licensing and accreditation
- The PCAT does not require accreditation, but its application requires specialist knowledge of rehabilitation and so should ideally be completed by a consultant in rehabilitation medicine or their suitable experienced deputy (e.g. a consultant rehabilitation nurse or AHP)
- It is free to use and does not incur any licencing fee.
Guidelines
The PCAT includes all the descriptions required for the level of need as indicated in the NHS service specification.
Self-Learning
Please use the self-learning slides to assist with tool completion:
Training
There are no formal training sessions for PCAT, but if further guidance/advice is required please contact the UK ROC team – LNWH-tr.ukroc@nhs.net
Additional References
Find out more about the additional reference on PURE.
Using the PCAT to demonstrate unmet need
The Patient Categorisation Tool has been used to identify category of need following neurosurgery and comparison with the level of on-going rehabilitation received and the effect on the cost of on-going care.
Key publication
- Singh R, Sinha S, Bill A, Turner-Stokes L. Unmet need for specialised rehabilitation following neurosurgery: can we maximise the potential cost-benefits? British Journal of Neurosurgery. 2017; 31 (2): 249-253
The PCAT was designed for use within UK Specialist Neurorehabilitation Settings.
Further collaborative work is in progress with Western Australia to develop the PCAT-Oz.