Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, McGill University, 2001 McGill College, Montreal, QC, Canada.
SE Research Centre, SE Health, 90 Allstate Parkway, Suite 800, Markham, ON, Canada.
BMC Health Serv Res. 2023 Nov 30;23(1):1324. doi: 10.1186/s12913-023-10150-1.
Transitional hospital-to-home care programs support safe and timely transition from acute care settings back into the community. Case-mix systems that classify transitional care clients into groups based on their resource utilization can assist with care planning, calculating reimbursement rates in bundled care funding models, and predicting health human resource needs. This study evaluated the fit and relevance of the Resource Utilization Groups version III for Home Care (RUG-III/HC) case-mix classification system in transitional care programs in Ontario, Canada.
We conducted a retrospective analysis of clinical assessment data and administrative billing records from a cohort of clients (n = 1,680 care episodes) in transitional home care programs in Ontario. We classified care episodes into established RUG-III/HC groups based on clients' clinical and functional characteristics and calculated four case-mix indices to describe care relative resource utilization in the study sample. Using these indices in linear regression models, we evaluated the degree to which the RUG-III/HC system can be used to predict care resource utilization.
A majority of transitional home care clients are classified as being Clinically complex (41.6%) and having Reduced physical functions (37.8%). The RUG-III/HC groups that account for the largest share of clients are those with the lowest hierarchical ranking, indicating low Activities of Daily Living limitations but a range of Instrumental Activities of Daily Living limitations. There is notable heterogeneity in the distribution of clients in RUG-III/HC groups across transitional care programs. The case-mix indices reflect decreasing hierarchical resource use within but not across RUG-III/HC categories. The RUG-III/HC predicts 23.34% of the variance in resource utilization of combined paid and unpaid care time.
The distribution of clients across RUG-III/HC groups in transitional home care programs is remarkably different from clients in long-stay home care settings. Transitional care programs have a higher proportion of Clinically complex clients and a lower proportion of clients with Reduced physical function. This study contributes to the development of a case-mix system for clients in transitional home care programs which can be used by care managers to inform planning, costing, and resource allocation in these programs.
过渡性医院到家庭护理计划支持安全和及时从急性护理环境过渡到社区。基于资源利用情况将过渡性护理客户分类为不同群体的病例组合系统可以协助护理计划、计算捆绑式护理资金模式的报销费率，并预测卫生人力资源需求。本研究评估了加拿大安大略省过渡性护理计划中资源利用情况分类系统第三版（RUG-III/HC）病例组合分类系统的适用性和相关性。
我们对安大略省过渡性家庭护理计划中的一组客户（n=1680 个护理期）的临床评估数据和行政计费记录进行了回顾性分析。我们根据客户的临床和功能特征将护理期归入既定的 RUG-III/HC 组，并计算了四个病例组合指数，以描述研究样本中的护理相对资源利用情况。我们在线性回归模型中使用这些指数，评估 RUG-III/HC 系统用于预测护理资源利用情况的程度。
大多数过渡性家庭护理客户被归类为临床复杂（41.6%）和身体功能降低（37.8%）。占客户比例最大的 RUG-III/HC 组是那些具有最低层次排名的组，表明日常生活活动限制较低，但存在一系列工具性日常生活活动限制。在过渡性护理计划中，RUG-III/HC 组中客户的分布存在显著的异质性。病例组合指数反映了在 RUG-III/HC 类别内而非跨类别资源使用的递减层次结构。RUG-III/HC 预测了付费和无偿护理时间综合资源利用的 23.34%的方差。
过渡性家庭护理计划中客户在 RUG-III/HC 组中的分布与长期家庭护理环境中的客户明显不同。过渡性护理计划中具有更高比例的临床复杂客户和较低比例的身体功能降低客户。本研究为过渡性家庭护理计划中的客户开发了一种病例组合系统，护理经理可以使用该系统为这些计划中的规划、成本核算和资源分配提供信息。
