Nursing home case mix in Wisconsin. Findings and policy implications.
Nursing home case mix in Wisconsin. Findings and policy implications.
复制标题
威斯康星州疗养院的病例组合。
DOI：
10.1097/00005650-198902000-00007
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发表时间：
1989
期刊：
影响因子：
3
通讯作者：
Updike,L
中科院分区：
文献类型：
--
作者：
Arling,G;Zimmerman,D;Updike,L
与许多其他州一样，威斯康星州正在考虑对医疗补助疗养院报销采用案例混合方法。为了支持这项工作，我们从威斯康星州 56 个机构的 410 名医疗补助疗养院居民的代表性样本中开发了一个疗养院案例混合模型。该模型将居民分为相互排斥的组，这些组在直接护理资源的使用方面是同质的，即在 7 天的时间内直接护理时间的分钟数（根据护士技能水平加权）。小组最初是根据强烈的、特殊的或常规的护理要求来定义的。在这些护理要求类别中，根据是否存在行为问题和日常生活活动 (ADL) 依赖性形成亚组。根据病例组合模型对威斯康星州当前的熟练/中级护理（SNF/ICF）分类系统进行了分析，发现该系统在通过资源使用区分居民方面效果较差。案例混合模型解释了资源使用差异的 48%，而 SNF/ICF 分类系统解释了 22%。与纽约州 (RUG-II) 和明尼苏达州的疗养院病例混合模型进行了比较。尽管疗养院案例组合的研究及其在报销改革中的应用取得了进展，但方法和政策问题仍然存在。其中包括护理要求和 ADL 依赖的不同操作定义、有关心理行为问题的研究结果的不一致，以及基于可能对住院医师条件随时间变化不敏感的模型促进积极的健康和功能结果的问题。
Along with many other states, Wisconsin is considering a case mix approach to Medicaid nursing home reimbursement. To support this effort, a nursing home case mix model was developed from a representative sample of 410 Medicaid nursing home residents from 56 facilities in Wisconsin. The model classified residents into mutually exclusive groups that were homogeneous in their use of direct care resources, ie, minutes of direct care time (weighted for nurse skill level) over a 7-day period. Groups were defined initially by intense, Special, or Routine nursing requirements. Within these nursing requirement categories, subgroups were formed by the presence/absence of behavioral problems and dependency in activities of daily living (ADL). Wisconsin's current Skilled/Intermediate Care (SNF/ICF) classification system was analyzed in light of the case mix model and found to be less effective in distinguishing residents by resource use. The case mix model accounted for 48% of the variance in resource use, whereas the SNF/ICF classification system explained 22%. Comparisons were drawn with nursing home case mix models in New York State (RUG-II) and Minnesota. Despite progress in the study of nursing home case mix and its application to reimbursement reform, methodologic and policy issues remain. These include the differing operational definitions for nursing requirements and ADL dependency, the inconsistency in findings concerning psychobehavioral problems, and the problem of promoting positive health and functional outcomes based on models that may be insensitive to change in resident conditions over time.