Refining a case-mix measure for nursing homes: Resource Utilization Groups (RUG-III).
A case-mix classification system for nursing home residents is developed, based on a sample of 7,658 residents in seven states. Data included a broad assessment of resident characteristics, corresponding to items of the Minimum Data Set, and detailed measurement of nursing staff care time over a 24-hour period and therapy staff time over a 1-week period. The Resource Utilization Groups, Version III (RUG-III) system, with 44 distinct groups, achieves 55.5% variance explanation of total (nursing and therapy) per diem cost and meets goals of clinical validity and payment incentives. The mean resource use (case-mix index) of groups spans a nine-fold range. The RUG-III system improves on an earlier version not only by increasing the variance explanation (from 43%), but, more importantly, by identifying residents with "high tech" procedures (e.g., ventilators, respirators, and parenteral feeding) and those with cognitive impairments; by using better multiple activities of daily living; and by providing explicit qualifications for the Medicare nursing home benefit. RUG-III is being implemented for nursing home payment in 11 states (six as part of a federal multistate demonstration) and can be used in management, staffing level determination, and quality assurance.
Institute of Gerontology, University of Michigan, Ann Arbor 48109-2007.
B E
BE
Fries
D P
DP
Schneider
W J
WJ
Foley
M
M
Gavazzi
R
R
Burke
E
E
Cornelius
D003365:Costs and Cost Analysis; D003953:Diagnosis-Related Groups / Q000145:classification* / Q000191:economics / Q000706:statistics & numerical data; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008134:Long-Term Care / Q000145:classification*; D009735:Nursing Homes / Q000191:economics / Q000706:statistics & numerical data*; D011897:Random Allocation; D012047:Rehabilitation Centers / Q000191:economics / Q000706:statistics & numerical data; D013647:Task Performance and Analysis; D014481:United States