Non-acute casemix in the Illawarra.
There are problems associated with the use of acute care diagnosis-related groups for prospective payment for rehabilitation medicine services. As a preliminary effort to assist in the development of the National Non-Acute Inpatient Casemix Project, a modified costing study was done in the rehabilitation and geriatrics ward of the Illawarra Regional Hospital; its aim was to assess the validity of the functional independence measure (FIM) and the resource utilization group (RUG) system as predictors of staff time involvement in inpatient rehabilitation services. Data collected on 51 patients over 3 months showed that in a standard Australian rehabilitation unit the costs of staff involvement varied depending on the type of functional impairment and severity of carer burden. The FIM alone was not predictive of rehabilitation costs and the RUG 2 instrument was not comprehensively predictive of cost. The RUG 3 instrument developed in the USA did not allocated weightings appropriate to Australian costs. If, however, functional impairment groups were combined with one of these measures of carer burden, then costs did fall into categories reflective of staff time involvement. An Australian system which incorporates an instrument measuring functional capacity may be useful for resource allocation in rehabilitation care.
Lee
L
L
Rehabilitation Service, Illawarra Area Health Service NSW, Warrawong, Australia.
Goor
E
E
Kennedy
C
C
Walters
S
S
Kirby
L
L
D000203:Activities of Daily Living; D000208:Acute Disease; D000368:Aged; D003362:Cost-Benefit Analysis; D003953:Diagnosis-Related Groups / Q000145:classification*; D005260:Female; D005853:Geriatrics / Q000191:economics*; D006295:Health Resources / Q000706:statistics & numerical data; D017721:Hospital Costs; D006757:Hospital Units / Q000191:economics*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008505:Medical Staff, Hospital / Q000191:economics; D009517:New South Wales; D009741:Nursing Staff, Hospital / Q000191:economics; D010343:Patient Admission; D010564:Personnel, Hospital / Q000191:economics; D012046:Rehabilitation / Q000145:classification* / Q000191:economics; D013997:Time Factors; D000078329:Workforce