Costing for long-term care: the development of Scottish health service resource utilization groups as a casemix instrument.
OBJECTIVE
to create a casemix measure with a limited number of categories which discriminate in terms of resource use and will assist in the development of a currency for contracting for the provision of health care.


METHODS
nursing staff completed a questionnaire providing clinical data and also gave estimates of relative patient resource use; ward-based costs were collected from appropriate unit managers.


METHODS
National Health Service continuing-care wards in 50 Scottish hospitals.


METHODS
2783 long-stay patients aged 65 years and over.


RESULTS
inter-rater reliability was assessed using 1402 patients; percentage agreement between raters for individual variables varied from 68% for feeding to 97% for clinically complex treatments. Nursing costs gave 62% agreement given categories of high, medium and low. The Scottish health service resource utilization groups (SHRUG) measure was developed using 606 cases, and 67% consistency was achieved for the five categories. The relative weights for the SHRUG categories ranged from 0.56 to 1.41. The five categories explain 35% of variance in costs.


CONCLUSIONS
the five SHRUG casemix categories show good discrimination in terms of costs. The SHRUG measure compares favourably with diagnosis-related groups in the acute sector and with other casemix instruments for long-term care previously piloted in the UK. SHRUG is a useful measurement instrument in assessing the resource needs of elderly people in long-term care.
Urquhart
J
J
Information and Statistics Division, Trinity Park House, Edinburgh, UK.
Kennie
D C
DC
Murdoch
P S
PS
Smith
R G
RG
Lennox
I
I
D000368:Aged; D006299:Health Services for the Aged; D017721:Hospital Costs; D006801:Humans; D008134:Long-Term Care / Q000191:economics*; D015895:Relative Value Scales; D012606:Scotland