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A RUG-III Case-Mix System for Home Care

Published online by Cambridge University Press:  29 November 2010

Magnus A. Björkgren ,
Brant E. Fries  and
Lisa R. Shugarman
Magnus A. Björkgren
Affiliation:
Health Services Research Unit, Helsinki and Jyväskylä University
Brant E. Fries
Affiliation:
The University of Michigan and Ann Arbor VA Medical Center
Lisa R. Shugarman
Affiliation:
RAND Corporation
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Abstract

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The nursing home case-mix classification system, Resource Utilization Groups Version III (RUG-III), has been tested and refined for long-term home care clients. The study sample included 804 individuals seeking home care through the Michigan Care Management Program or the Home and Community Based Waiver for the Elderly and Disabled. Clients were classified, and RUG-III models were derived using the Minimum Data Set for Home Care (MDS-HC). A refined home care model, RUG-III/HC, was developed incorporating Instrumental Activities of Daily Living (IADLs) to the nursing home RUG-III classification. The model explained 33.7 per cent of the variance of per diem cost, using cost weighted formal and informal care as the dependent variable. Resource use within groups was relatively homogeneous. The case-mix index (CMI) of weighted formal and informal care time spanned an eight-fold range. Further analysis is suggested regarding the inclusion of informal care as a cost in case-mix classification for long-term home care clients.

Résumé

RÉSUMÉ

Le système de classification de la composition de la clientèle des maisons de soins infirmiers, Resource Utilization Groups Version III (RUG-III), a été éprouvé et raffiné pour les bénéficiaires de soins de longue durée à domicile. Lapos;échantillonnage étudié regroupe 804 personnes recevant des soins à domicile par l'entremise du Michigan Care Management Program ou du Home and Community Based Waiver for the Elderly and Disabled. On a catégorisé les clients et établi des modèles de RUG-III à partir du Minimum Data Set for Home Care (MDS-HC). On a établi un modèle raffiné de soins à domicile, RUG-III/HC, en incorporant les activités instrumentales de la vie quotidienne (AIVQ) à la classification RUG-EH des établissements de soins. Le modèle explique 33,7 pour cent de la variance des coûts quotidiens, à partir de la variable dépendante du coût pondéré des soins structurés ou non. L'utilisation des ressources à l'égard des différents groupes est relativement homogène. Le CMI (case-mix index) du temps pondéré des soins structurés ou non couvre une échelle de 8. Il faudra songer à effectuer des analyses plus poussées du coût de l'inclusion des soins non structurés à l'égard des patients recevant des soins à domicile de longue durée.

Keywords

Case-MixPatient ClassificationHome CareLong-Term CareResource UsePayment SystemsClientèleclassification des patientssoins à domicilesoins de longue duréeutilisation des ressourcessystèmes de paiement
Type
Research Article
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 19 , supplement S2 , Fall/Automne 2000 , pp. 106 - 125
Creative Commons
Creative Common License - CCCreative Common License - BYCreative Common License - NCCreative Common License - ND
This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work.
Copyright
Copyright © Canadian Association on Gerontology 2000

Footnotes

1

Institute of Gerontology, 300 N. Ingalls, Ann Arbor, MI, 48109-2009, ([email protected])

*

Supported in part by a grant from the Michigan Public Health Institute #33-33000-189-18 to the University of Michigan (B. Pries, Principal Investigator). The findings represent the opinions of the authors, and do not represent the official policy of the State of Michigan or the Michigan Public Health Institute. Magnus Björkgren was supported in part by grants from the Yrjö Jahnsson Foundation, The University of Kuopio, and The Jyväskylä University Chydenius Institute. The authors wish to thank John Hirdes of the University of Waterloo, Department of Health Studies and Gerontology, and Mary James, of the Michigan Department of Community Health, for their valuable comments on the paper.

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