Related Experiment Videos
Non-acute casemix in the Illawarra
1Rehabilitation Service, Illawarra Area Health Service NSW, Warrawong, Australia.
Abstract:
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.
Insights
The Functional Independence Measure (FIM) and Resource Utilization Group (RUG) system do not accurately predict rehabilitation costs alone. Combining functional impairment with carer burden offers a better approach for Australian rehabilitation cost allocation.
Area of Science:
- Rehabilitation Medicine
- Health Economics
- Inpatient Care Management
Background:
- Acute care diagnosis-related groups present challenges for prospective payment in rehabilitation medicine.
- Developing effective casemix systems is crucial for resource allocation in non-acute inpatient settings.
Purpose of the Study:
- To evaluate the Functional Independence Measure (FIM) and Resource Utilization Group (RUG) system's ability to predict staff time costs in Australian inpatient rehabilitation.
- To inform the development of the National Non-Acute Inpatient Casemix Project.
Main Methods:
- A modified costing study was conducted in a rehabilitation and geriatrics ward.
- Data from 51 patients over 3 months were analyzed.
- The study assessed the predictive validity of FIM and RUG (versions 2 and 3) for staff time costs.
Main Results:
- Staff time costs in Australian rehabilitation varied by functional impairment type and carer burden severity.
- The FIM alone was not a significant predictor of rehabilitation costs.
- RUG 2 did not comprehensively predict costs, and RUG 3 weightings were not suitable for Australian costs.
- Combining functional impairment groups with carer burden measures improved cost prediction.
Conclusions:
- Existing FIM and RUG systems require modification for accurate cost prediction in Australian rehabilitation settings.
- An Australian casemix system incorporating functional capacity and carer burden measures could enhance resource allocation.
- Further development is needed to create a tailored system for Australian rehabilitation services.