Costing for long-term care: the development of Scottish health service resource utilization groups as a casemix...

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.

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.

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

2783 long-stay patients aged 65 years and over.

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.

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.