Assessing the appropriateness of the level of care for morbidly obese subjects: validation of the CASCO-R scale

Ann Ig. 2014 May-Jun;26(3):195-204. doi: 10.7416/ai.2014.1977.


Aim: Aim of this study was to validate the Comprehensive Appropriateness Scale for the Care of Obesity in Rehabilitation (CASCO-R) and to determine the cut-off score for indicating the most appropriate health care setting for patients with obesity.

Methods: The CASCO-R scale was developed according to the available scientific literature and expertise of an expert panel working for a Consensus document endorsed by the Italian Society of Obesity (SIO) and the Italian Society for the Study of Eating Disorders (SISDCA). 16 Italian centres, specialized in the treatment of obesity, characterised by different settings of care (specialist outpatient service, day-hospital service, intensive inpatient rehabilitation), participated in the study.

Results: 449 obese subjects were enrolled in the study (30.5% males and 69.5% females): 38.3% from outpatient services, 20.7% from day-hospital services and 40.9% from intensive inpatient rehabilitation units. After 2-month of treatment, a workload summary sheet, including medical and nursing interventions, number of expert advices and diagnostic procedures, and adverse clinical events (ACEs) was fulfilled for each patient. Statistically significant correlation was found between the CASCO-R scale score, overall workload and ACEs. The CASCO-R scale demonstrated also an excellent performance in terms of internal validity and test-retest analysis. Three total score cut-off have been proposed: >25 for inpatient intensive rehabilitation; 20-25 for day-hospital service; <20 for outpatient treatment.

Conclusions: In conclusion, the CASCO-R scale was demonstrated to be a valid tool for assessing the appropriateness of the choice of the level of care. Hence, it can be used to verify the proper allocation of patients, as it was well correlated with measures of workload and the incidence of ACEs.

Publication types

  • Multicenter Study
  • Validation Study

MeSH terms

  • Adult
  • Aged
  • Ambulatory Care / organization & administration
  • Ambulatory Care / standards
  • Delivery of Health Care / organization & administration
  • Delivery of Health Care / standards*
  • Female
  • Hospitalization
  • Humans
  • Incidence
  • Italy
  • Male
  • Middle Aged
  • Obesity, Morbid / therapy*
  • Outcome Assessment, Health Care / methods*
  • Quality of Health Care*
  • Workload / statistics & numerical data