Manton K G, Hausner T
Health Care Financ Rev. 1987 Summer;8(4):37-54.
Developing a case-mix methodology for home health services is more difficult than developing one for hospitalization and acute health services, because the determinants of need for home health care are more complex and because of the difficulty in defining episodes of care. To evaluate home health service case mix, a multivariate grouping methodology was applied to records from the 1982 National Long-Term Care Survey linked to Medicare records on home health reimbursements. Using this method, six distinct health and functional status dimensions were identified. These dimensions, combined with factors describing informal care resources and local market conditions, were used to explain significant proportions of the variance (r2 = .45) of individual differences in Medicare home health reimbursements and numbers of visits. Though the data were not collected for that purpose, the high level of prediction strongly suggests the feasibility of developing case-mix strategies for home health services.
开发家庭健康服务的病例组合方法比开发住院治疗和急性健康服务的病例组合方法更困难，这是因为家庭医疗保健需求的决定因素更为复杂，也因为确定护理期间存在困难。为了评估家庭健康服务病例组合，一种多变量分组方法被应用于1982年全国长期护理调查的记录，这些记录与医疗保险关于家庭健康报销的记录相关联。使用这种方法，确定了六个不同的健康和功能状态维度。这些维度，结合描述非正式护理资源和当地市场状况的因素，被用来解释医疗保险家庭健康报销和就诊次数个体差异的很大一部分方差（r2 = 0.45）。尽管数据并非为此目的收集，但较高的预测水平强烈表明开发家庭健康服务病例组合策略的可行性。
