Validation of Resource Utilization Groups version III for Home Care (RUG-III/HC): evidence from a Canadian home care jurisdiction

TitleValidation of Resource Utilization Groups version III for Home Care (RUG-III/HC): evidence from a Canadian home care jurisdiction
Publication TypeJournal Article
Year of Publication2008
AuthorsPoss J.W, Hirdes J.P, Fries B.E, McKillop I., Chase M.
JournalMedical Care
Date PublishedApr
ISBN Number0025-7079
Accession Number18362817
Keywords*Diagnosis-Related Groups, *Health Care Rationing/og [Organization & Administration], *Home Care Services/og [Organization & Administration], Adolescent, Adult, Aged, Canada, Direct Service Costs, Female, Geriatric Assessment/mt [Methods], Health Care Rationing/ec [Economics], Home Care Services/ec [Economics], Humans, Insurance Claim Review, Male, Middle Aged

BACKGROUND: The case-mix system Resource Utilization Groups version III for Home Care (RUG-III/HC) was derived using a modest data sample from Michigan, but to date no comprehensive large scale validation has been done. OBJECTIVES: This work examines the performance of the RUG-III/HC classification using a large sample from Ontario, Canada. METHODS: Cost episodes over a 13-week period were aggregated from individual level client billing records and matched to assessment information collected using the Resident Assessment Instrument for Home Care, from which classification rules for RUG-III/HC are drawn. The dependent variable, service cost, was constructed using formal services plus informal care valued at approximately one-half that of a replacement worker. RESULTS: An analytic dataset of 29,921 episodes showed a skewed distribution with over 56% of cases falling into the lowest hierarchical level, reduced physical functions. Case-mix index values for formal and informal cost showed very close similarities to those found in the Michigan derivation. Explained variance for a function of combined formal and informal cost was 37.3% (20.5% for formal cost alone), with personal support services as well as informal care showing the strongest fit to the RUG-III/HC classification. CONCLUSIONS: RUG-III/HC validates well compared with the Michigan derivation work. Potential enhancements to the present classification should consider the large numbers of undifferentiated cases in the reduced physical function group, and the low explained variance for professional disciplines.

Short TitleMedical careMedical care
Alternate JournalMed Care