Refining a case-mix measure for nursing homes: Resource Utilization Groups (RUG-III)

TitleRefining a case-mix measure for nursing homes: Resource Utilization Groups (RUG-III)
Publication TypeJournal Article
Year of Publication1994
AuthorsFries B.E, Schneider D.P, Foley W.J, Gavazzi M., Burke R., Cornelius E.
JournalMedical Care
Date PublishedJul
Accession Number8028403
Keywords*Diagnosis-Related Groups/cl [Classification], *Health Resources/ut [Utilization], *Long-Term Care/cl [Classification], *Nursing Homes/ut [Utilization], Costs and Cost Analysis, Diagnosis-Related Groups/ec [Economics], Diagnosis-Related Groups/sn [Statistics & Numerical Data], Health Resources/ec [Economics], Health Resources/sn [Statistics & Numerical Data], Human, Nursing Homes/ec [Economics], Nursing Homes/sn [Statistics & Numerical Data], Random Allocation, Rehabilitation Centers/ec [Economics], Rehabilitation Centers/sn [Statistics & Numerical Data], Rehabilitation Centers/ut [Utilization], Support, U.S. Gov't, P.H.S., Task Performance and Analysis, United States

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.

Short TitleMed CareMed Care
Alternate JournalMed Care