Nursing home case-mix instruments: Validation of the RUG-III system in Italy

Brizioli, Enrico; Bernabei, Roberto; Grechi, Francesca; Masera, Filippo; Landi, Francesco; Bandinelli, Stefania; Cavazzini, Chiara; Gangemi, Sebastiano; Ferrucci, Luigi

doi:10.1007/bf03324505

Cited by 11 publications

(24 citation statements)

References 10 publications

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“…The RUG-III explained 55 percent of the variance in direct care staff time cost in the original 1990 CMS time study , while it accounted for 40 percent of the variance in staff time cost of all residents and 21 percent of the variance for residents with Medicare stays in the 1995-1997 CMS time study (White et al 2002). RUG-III studies conducted in other countries have yielded comparable results (Ikegami et al 1994;Carpenter et al 1997;Brizioli et al 2003;Bjorkgren et al 2004).…”

Section: Rug-iii Classification and Cmismentioning

confidence: 79%

Explaining Direct Care Resource Use of Nursing Home Residents: Findings from Time Studies in Four States

Kane

Mueller

Lewis

2006

Health Services Research

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Objective. To explain variation in direct care resource use (RU) of nursing home residents based on the Resource Utilization Groups III (RUG-III) classification system and other resident-and unit-level explanatory variables. Data Sources/Study Setting. Primary data were collected on 5,314 nursing home residents in 156 nursing units in 105 facilities from four states (CO, IN, MN, MS) from 1998 to 2004. Study Design. Nurses and other direct care staff recorded resident-specific and other time caring for all residents on sampled nursing units. Care time was linked to resident data from the Minimum Data Set assessment instrument. Major variables were: RUG-III group (34-group), other health and functional conditions, licensed and other professional minutes per day, unlicensed minutes per day, and direct care RU (wage-weighted minutes). Resident-and unit-level relationships were examined through hierarchical linear modeling. Data Collection/Extraction Methods. Time study data were recorded with handheld computers, verified for accuracy by project staff at the data collection sites and then merged into resident and unit-level data sets. Principal Findings. Resident care time and RU varied between and within nursing units. RUG-III group was related to RU; variables such as length of stay and unit percentage of high acuity residents also were significantly related. Case-mix indices (CMIs) constructed from study data displayed much less variation across RUG-III groups than CMIs from earlier time studies. Conclusions. Results from earlier time studies may not be representative of care patterns of Medicaid and private pay residents. New RUG-III CMIs should be developed to better reflect the relative costs of caring for these residents.

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Section: Rug-iii Classification and Cmismentioning

confidence: 79%

Explaining Direct Care Resource Use of Nursing Home Residents: Findings from Time Studies in Four States

Kane

Mueller

Lewis

2006

Health Services Research

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“…Dealing with non-individual time is a common obstacle in most time study in nursing home. This obstacle is often overcome by dividing the non-individual time equally between all of the patients [23]. Increasing the amount of hours each patient receives will not alter the results for individual need variables.…”

Section: Discussionmentioning

confidence: 99%

Variations in levels of care between nursing home patients in a public health care system

Døhl

Garåsen

Kalseth

et al. 2014

BMC Health Serv Res

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BackgroundWithin the setting of a public health service we analyse the distribution of resources between individuals in nursing homes funded by global budgets. Three questions are pursued. Firstly, whether there are systematic variations between nursing homes in the level of care given to patients. Secondly, whether such variations can be explained by nursing home characteristics. And thirdly, how individual need-related variables are associated with differences in the level of care given.MethodsThe study included 1204 residents in 35 nursing homes and extra care sheltered housing facilities. Direct time spent with patients was recorded. In average each patient received 14.8 hours direct care each week. Multilevel regression analysis is used to analyse the relationship between individual characteristics, nursing home characteristics and time spent with patients in nursing homes. The study setting is the city of Trondheim, with a population of approximately 180 000.ResultsThere are large variations between nursing homes in the total amount of individual care given to patients. As much as 24 percent of the variation of individual care between patients could be explained by variation between nursing homes. Adjusting for structural nursing home characteristics did not substantially reduce the variation between nursing homes. As expected a negative association was found between individual care and case-mix, implying that at nursing home level a more resource demanding case-mix is compensated by lowering the average amount of care. At individual level ADL-disability is the strongest predictor for use of resources in nursing homes. For the average user one point increase in ADL-disability increases the use of resources with 27 percent.ConclusionIn a financial reimbursement model for nursing homes with no adjustment for case-mix, the amount of care patients receive does not solely depend on the patients’ own needs, but also on the needs of all the other residents.

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“…At the organization level are case mix systems like the Resource Utilization Groups (RUG-III) (Björkgren et al, 1999 ;Björkgren & Fries, 2006 ;Björkgren, Fries, & Shugarman, 2000 ;Brizioli et al, 2003 ;Carpenter, Perry, & Challis, 2003 ;Clauser & Fries, 1992 ;Fries et al, 1994 ;Hirdes, 2001 ;Hirdes, Botz, Kozak, & Lepp, 1996 ;Ikegami, Fries, Takagi, Ikeda, & Ibe, 1994 ;Poss, Hirdes, Fries, McKillop, & Chase, 2008 ). These systems are being used to (a) support nursing home payment systems, (b) risk-adjust quality indicators, (c) plan for service restructuring, and (d) manage staffi ng levels.…”

Section: Interrai Family Of Assessment Instrumentsmentioning

confidence: 99%

Beyond the ‘Iron Lungs of Gerontology’: Using Evidence to Shape the Future of Nursing Homes in Canada

et al. 2011

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Institutionalization of the Elderly in Canada suggested that efforts to address the underlying causes of age-related declines in health might negate the need for nursing homes. However, the prevalence of chronic disease has increased, and conditions like dementia mean that nursing homes are likely to remain important features of the Canadian health care system. A fundamental problem limiting the ability to understand how nursing homes may change to better meet the needs of an aging population was the lack of person-level clinical information. The introduction of interRAI assessment instruments to most Canadian provinces/territories and the establishment of the national Continuing Care Reporting System represent important steps in our capacity to understand nursing home care in Canada. Evidence from eight provinces and territories shows that the needs of persons in long-term care are highly complex, resource allocations do not always correspond to needs, and quality varies substantially between and within provinces.

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Nursing home case-mix instruments: Validation of the RUG-III system in Italy

Abstract: Our findings provide strong evidence that the RUG-III classification, applied to Italian intermediate- and long-term care institutions, provides a robust estimate of the amount of nursing and rehabilitation resources consumed by older residents.

Cited by 11 publications

References 10 publications

Explaining Direct Care Resource Use of Nursing Home Residents: Findings from Time Studies in Four States

Explaining Direct Care Resource Use of Nursing Home Residents: Findings from Time Studies in Four States

Variations in levels of care between nursing home patients in a public health care system

Beyond the ‘Iron Lungs of Gerontology’: Using Evidence to Shape the Future of Nursing Homes in Canada

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