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

The two major purposes of this study were: (1) to evaluate Resource Utilization Groups (RUGs III) as a unified method for classifying all residential, chronic care and rehabilitation patients at the St. Joseph's Health Centre, London, and (2) to compare the potential funding implications of RUGs and other patient/resident classification systems. RUGs were used to classify a total of 336 patients/residents in residential, extended care, chronic care and rehabilitation beds at the Health Centre. Patients were also concurrently classified according to the Alberta Long Term Care Classification System and the Medicus Long Term Care System. Results show that RUGs provide relatively more credit for higher acuity patients than do the Alberta or Medicus systems. If used as a basis for funding, chronic care and rehabilitation hospitals would be entitled to more funding (relative to residential/nursing homes) under RUGs than under the other two patient classification mechanisms.

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Visual Analytics of Long-Term Care Resource Utilization in Taiwan

International Journal of Multimedia Data Engineering and Management ◽

10.4018/ijmdem.2018040104 ◽

2018 ◽

Vol 9 (2) ◽

pp. 57-68

Author(s):

Kuo-Chung Chu ◽

Hsin-Ke Lu ◽

Peng-Hua Jiang

Keyword(s):

Resource Utilization ◽

Visual Analytics ◽

Long Term Care ◽

Care Service ◽

Institutional Care ◽

The Elderly ◽

Term Care ◽

Open Government Data ◽

Government Data

This article describes how the phenomenon of an aging population in Taiwan has become increasingly evident in recent years as the elderly population dependency ratio has gradually risen. Therefore, a study on long-term care (LTC) resources has been a key issue that had needed discussion. Currently, Taiwan's government has enacted legislation and policies related to LTC, but most of them involved institutional care. The traditional idea of most elderly is aging in place, so this study has become very necessary. The study analyzed the Open Government Data of LTC to discuss the home care service resource utilization with regard to LTC.

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Health Care Resource Utilization and Costs Among Diabetes Patients Residing in long-Term Care Facilities

Value in Health ◽

10.1016/j.jval.2015.03.351 ◽

2015 ◽

Vol 18 (3) ◽

pp. A60

Author(s):

A. Huang ◽

S. Shrestha ◽

O. Baser ◽

H. Yuce ◽

L. Wang

Keyword(s):

Health Care ◽

Resource Utilization ◽

Long Term Care ◽

Health Care Resource ◽

Term Care ◽

Health Care Resource Utilization ◽

Care Facilities ◽

Diabetes Patients

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LO65: Frailty and associated outcomes among emergency department patients requiring endotracheal intubation

CJEM ◽

10.1017/cem.2019.108 ◽

2019 ◽

Vol 21 (S1) ◽

pp. S31

Author(s):

S. Fernando ◽

D. McIsaac ◽

B. Rochwerg ◽

S. Bagshaw ◽

A. Seely ◽

...

Keyword(s):

Emergency Department ◽

Mechanical Ventilation ◽

Hospital Mortality ◽

Endotracheal Intubation ◽

Resource Utilization ◽

Long Term Care ◽

Clinical State ◽

Term Care ◽

The Impact

Introduction: Risk-stratification of patients requiring endotracheal intubation and mechanical ventilation in the Emergency Department (ED) is necessary for informed discussions with patients regarding goals-of-care. Frailty is a clinical state characterized by reduced physiologic reserve, and resulting from accumulation of physiological stresses and comorbid disease. Frailty is increasingly being identified as an important independent predictor of outcome among critically ill patients. Our objective was to identify the impact of clinical frailty (defined by the Clinical Frailty Scale [CFS]) on in-hospital mortality and resource utilization of ED patients requiring endotracheal intubation and mechanical ventilation. Methods: We analyzed a prospectively collected registry (2011-2016) of patients requiring endotracheal intubation in the ED at two academic hospitals and six community hospitals. We included all patients ≥18 years of age, who survived to the point of ICU admission. All patient information, outcomes, and resource utilization were stored in the registry. CFS scores were obtained through chart abstraction by two blinded reviewers. The primary outcome, in-hospital mortality, was analyzed using a multivariable logistic regression model, controlling for confounding variables (including patient sex, comorbidities, and illness severity). We defined “frailty” as a CFS ≥ 5. Results: 4,622 patients were included. Mean age was 61.2 years (SD: 17.5), and 2,614 (56.6%) were male. Frailty was associated with increased risk of in-hospital mortality, as compared to those who were not frail (adjusted odds ratio [OR] 2.21 [1.98-2.51]). Frailty was also associated with higher likelihood of discharge to long-term care (adjusted OR 1.78 [1.56-2.01]) among patients initially from a home setting. Frail patients were more likely to fail extubation during their hospitalization (adjusted OR 1.81 [1.67-1.95]) and were more likely to require tracheostomy (adjusted OR 1.41 [1.34-1.49]). Conclusion: Presence of frailty among ED patients requiring endotracheal intubation and mechanical ventilation was associated with increased in-hospital mortality, discharge to long-term care, extubation failure, and tracheostomy. ED physicians should consider the impact of frailty on patient outcomes, and discuss associated prognosis with patients prior to intubation.

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Groupes d'utilisation des ressources: Définir un groupe mixte composant la clientèle des centres d'hébergement, de réadaptation et de soins infirmiers au Canada

Healthcare Management Forum ◽

10.1016/s0840-4704(10)61130-1 ◽

1993 ◽

Vol 6 (4) ◽

pp. 12-19

Author(s):

Chas. K. Botz ◽

Susan Bestard ◽

Mary Demaray ◽

Gail Molloy

Keyword(s):

Resource Utilization ◽

Long Term Care ◽

Term Care ◽

Soins Infirmiers

Les deux objectifs principaux de cette étude étaient: (1) d'évaluer les Resource Utilization Groups (RUG-III) en tant que méthode unifiée de classification de la clientèle du Centre de santé St. Joseph's de London qui bénéficie de soins d'hébergement, de soins chroniques ou de soins de réadaptation, et (2) de comparer les implications potentielles des RUG et d'autres systèmes de classification patient/résident sur le plan du financement. Les RUG ont été utilisés pour la classification de 336 patients/résidents dans des lits d'hébergement, de soins prolongés, de soins chroniques et de soins de réadaptation de l'établissement. De façon concomitante, les patients ont été classés selon la Long-Term Care Classification de l'Alberta et le système Medicus. Les résultats montrent que, par rapport au système albertain et à Medicus, les RUG permettent l'obtention de crédits relativement plus importants pour les patients traités pour des maladies plus sévères. En adoptant le système de financement fondé sur les groupes d'utilisation des ressources, les hôpitaux de soins chroniques et de réadaptation auraient droit à un financement supérieur (par rapports aux centres d'hébergement et aux maisons de repos) qu'en vertu des deux autres mécanismes de classification de la clientèle.

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Mental health service delivery in long-term care homes

International Psychogeriatrics ◽

10.1017/s1041610210000773 ◽

2010 ◽

Vol 22 (7) ◽

pp. 1063-1071 ◽

Cited By ~ 14

Author(s):

John Snowdon

Keyword(s):

Mental Health ◽

Mental Health Service ◽

Health Service ◽

Service Delivery ◽

Long Term Care ◽

Mental Health Problems ◽

Health Service Delivery ◽

Term Care ◽

Mental Health Service Delivery

ABSTRACTBackground:The prevalence of mental disorders in long-term care (LTC) homes is high, but quality and availability of mental health services to assess and help in management of cases have been criticized.Method:Literature concerning mental health problems in LTC homes was reviewed, especially regarding models of mental health service delivery and factors that affect development, persistence and reduction of symptoms and distress.Results:The advantages of consultation-liaison arrangements and of telepsychiatry were noted. Discussions led to development of recommendations aimed at improving mental health expertise and provision of assessment and intervention services in LTC homes in diverse countries. Prompt recognition of mental health problems among residents is required, with availability of a team working within the facility to deal with these problems. Commonly such multidisciplinary teams are formed by facility staff linking with visiting mental health professionals or services. Quality of care is also affected by the organization, attitudes and education within LTC facilities.Conclusion:Provision of optimal mental health care in LTC settings is dependent on adequate funding, availability of expertise and education, positive and caring attitudes, recognition of needs, and supportive teamwork. The latter should include cooperative links between well-resourced and under-resourced regions.

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Can Asia provide models for tax-based European health systems? A comparative study of Singapore and Sweden

Health Economics Policy and Law ◽

10.1017/s1744133120000390 ◽

2020 ◽

pp. 1-18

Author(s):

Richard B. Saltman ◽

Ming-Jui Yeh ◽

Yu Liu

Keyword(s):

Health Service ◽

Health System ◽

Health Systems ◽

Long Term Care ◽

Health Sector ◽

Chronically Ill ◽

Term Care ◽

Care Services ◽

Case Comparison

Abstract Singapore's health system generates similar levels of health outcomes as does Sweden's but for only 4.4% rather than 11.0% of gross domestic product, with Singapore's resulting health sector savings being re-directed to help fund both long-term care and retirement pensions for its elderly citizens. This paper contrasts the framework of financial risk-sharing and the configuration and management of health service providers in these two high-income, small-population countries. Two main institutional distinctions emerge from this country case comparison: (1) Key differences exist in the practical configuration of solidarity for payment of health care services, reflecting differing cultural roots and social expectations, which in turn carry substantial implications for financing long-term care and pensions. (2) Differing arrangements exist in the organization of health service institutions, in particular balancing public as against private sector responsibilities for owning, operating and managing these two countries' respective hospitals. These different structural characteristics generate fundamental differences in health sector financial and delivery outcomes in one developed country in Far East Asia as compared with a well-respected tax-funded health system in Western Europe. In the post-COVID era, as Western European policymakers find themselves forced to adjust their publicly funded health systems to (further) reductions in economic growth rates and overall tax receipts, and as the cost of the information revolution continues to rise while efforts to fund better coordinated social and home care services for growing numbers of chronically ill elderly remain inadequate, this two-country case comparison highlights a series of health system design questions that could potentially provide alternative health sector financing and service delivery strategies.

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Developing and Managing Health Systems and Organizations for an Aging Society

Research Anthology on Nursing Education and Overcoming Challenges in the Workplace ◽

10.4018/978-1-7998-9161-1.ch015 ◽

2021 ◽

pp. 244-250

Author(s):

Ana Filipa Ramos ◽

César Fonseca ◽

Adriana Henriques

Keyword(s):

Public Health ◽

Mortality Rate ◽

Health Service ◽

Long Term Care ◽

Nursing Profession ◽

Central Issue ◽

Care Needs ◽

Term Care ◽

Aging Society

With the worldwide trend towards aging and increasing numbers of chronic diseases, the promotion of self-care as a central issue in public health is a necessity. Recently, several international entities recommend that the nursing profession rethink its focus of intervention and maximize the relevance attributed to fundamental and long-term care. The implementation of fundamental care has been associated with improved of health service security, reduced mortality rate, and hospital readmission. At the same time, for an appropriate response of the health system, it is crucial to know the care needs of people aged 65 and over, which can be met by the analysis of electronic health records.

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