Biomaterial Database

Resource utilization groups. DRGs move to long-term care. 1988

E L Mitty

Jewish Institute for Geriatric Care, New Hyde Park, New York.

The costs associated with a growing population of elderly persons in the United States combined with a need to restrain escalating acute care costs led to the development of a prospective payment system (PPS) for institutional long-term care in New York State. Although similar types of PPS exist in several other states, it is expected that RUGs will become the model for the nation. The price paid is based on a formula that combines the direct care components of care with allocated medical and ancillary costs per patient. Based on a patient classification case-mix system, the Resource Utilization Group (RUG) relies on specific nursing documentation of patient care delivered, that is, resource used. Implemented at the same time as diagnostic-related groups (DRGs), the RUGs system is not based on length of stay, diagnosis, or age. Activities of daily living (ADL) drive the system and, in that sense, RUGs has some similarities to severity of illness models. There are 16 RUGs (that is, 16 case-mix indexes and 16 prices), ranging from skilled rehabilitation and intensive skilled nursing care to light custodial care. Patients assessed at the low end of the spectrum--light care, lowest price--may be denied admission to nursing homes as well as prepared for discharge to the community or a lighter level of care. Discharge planning and patient teaching for less dependent living are recent phenomena in nursing homes. Nurses have to learn how to manage the complex, technologically dependent patient as well as learn aspects of preparing the patient--and family--for discharge. The challenge to nursing is to protect the patient from negative incentives inherent in the RUGs system; analyze the nursing process and productivity; and contribute to research that should be observing the effect of the reimbursement system on the quality of care.

UI	MeSH Term	Description	Entries
D008134	Long-Term Care	Care over an extended period, usually for a chronic condition or disability, requiring periodic, intermittent, or continuous care.	Care, Long-Term,Long Term Care
D009518	New York	State bounded on the north by Lake Ontario and Canada, on the east by Vermont, Massachusetts, and Connecticut, on the south by the Atlantic Ocean, New Jersey, and Pennsylvania, and on the west by Pennsylvania, Lake Erie, and Canada.
D009739	Nursing Services	A general concept referring to the organization and administration of nursing activities.	Services, Nursing,Nursing Service,Service, Nursing
D010351	Patient Discharge	The administrative process of discharging the patient, alive or dead, from hospitals or other health facilities.	Discharge Planning,Discharge Plannings,Discharge, Patient,Discharges, Patient,Patient Discharges,Planning, Discharge,Plannings, Discharge
D011445	Prospective Payment System	A system wherein reimbursement rates are set, for a given period of time, prior to the circumstances giving rise to actual reimbursement claims.	Discretionary Adjustment Factor,Prospective Pricing,Prospective Reimbursement,Reimbursement, Prospective,Adjustment, Discretionary,Adjustment Factor, Discretionary,Adjustment Factors, Discretionary,Adjustments, Discretionary,Discretionary Adjustment,Discretionary Adjustment Factors,Discretionary Adjustments,Factor, Discretionary Adjustment,Factors, Discretionary Adjustment,Payment System, Prospective,Payment Systems, Prospective,Pricing, Prospective,Prospective Payment Systems,Prospective Reimbursements,Reimbursements, Prospective,System, Prospective Payment,Systems, Prospective Payment
D011785	Quality Assurance, Health Care	Activities and programs intended to assure or improve the quality of care in either a defined medical setting or a program. The concept includes the assessment or evaluation of the quality of care; identification of problems or shortcomings in the delivery of care; designing activities to overcome these deficiencies; and follow-up monitoring to ensure effectiveness of corrective steps.	Quality Assessment, Health Care,Health Care Quality Assessment,Health Care Quality Assurance,Healthcare Quality Assessment,Healthcare Quality Assurance,Quality Assessment, Healthcare,Quality Assurance, Healthcare,Assessment, Healthcare Quality,Assessments, Healthcare Quality,Assurance, Healthcare Quality,Assurances, Healthcare Quality,Healthcare Quality Assessments,Healthcare Quality Assurances,Quality Assessments, Healthcare,Quality Assurances, Healthcare
D002908	Chronic Disease	Diseases which have one or more of the following characteristics: they are permanent, leave residual disability, are caused by nonreversible pathological alteration, require special training of the patient for rehabilitation, or may be expected to require a long period of supervision, observation, or care (Dictionary of Health Services Management, 2d ed). For epidemiological studies chronic disease often includes HEART DISEASES; STROKE; CANCER; and diabetes (DIABETES MELLITUS, TYPE 2).	Chronic Condition,Chronic Illness,Chronically Ill,Chronic Conditions,Chronic Diseases,Chronic Illnesses,Condition, Chronic,Disease, Chronic,Illness, Chronic
D003710	Demography	Statistical interpretation and description of a population with reference to distribution, composition, or structure.	Demographer,Demographic,Demographic and Health Survey,Population Distribution,Accounting, Demographic,Analyses, Demographic,Analyses, Multiregional,Analysis, Period,Brass Technic,Brass Technique,Demographers,Demographic Accounting,Demographic Analysis,Demographic Factor,Demographic Factors,Demographic Impact,Demographic Impacts,Demographic Survey,Demographic Surveys,Demographic and Health Surveys,Demographics,Demography, Historical,Demography, Prehistoric,Factor, Demographic,Factors, Demographic,Family Reconstitution,Historical Demography,Impact, Demographic,Impacts, Demographic,Multiregional Analysis,Period Analysis,Population Spatial Distribution,Prehistoric Demography,Reverse Survival Method,Stable Population Method,Survey, Demographic,Surveys, Demographic,Analyses, Period,Analysis, Demographic,Analysis, Multiregional,Demographic Analyses,Demographies, Historical,Demographies, Prehistoric,Distribution, Population,Distribution, Population Spatial,Distributions, Population,Distributions, Population Spatial,Family Reconstitutions,Historical Demographies,Method, Reverse Survival,Method, Stable Population,Methods, Reverse Survival,Methods, Stable Population,Multiregional Analyses,Period Analyses,Population Distributions,Population Methods, Stable,Population Spatial Distributions,Prehistoric Demographies,Reconstitution, Family,Reconstitutions, Family,Reverse Survival Methods,Spatial Distribution, Population,Spatial Distributions, Population,Stable Population Methods,Technic, Brass,Technique, Brass
D003953	Diagnosis-Related Groups	A system for classifying patient care by relating common characteristics such as diagnosis, treatment, and age to an expected consumption of hospital resources and length of stay. Its purpose is to provide a framework for specifying case mix and to reduce hospital costs and reimbursements and it forms the cornerstone of the prospective payment system.	Case Mix,DRG,Diagnosis Related Group,Diagnosis-Related Group,Case Mixes,DRGs,Diagnostic-Related Group,Group, Diagnostic-Related,Groups, Diagnostic-Related,Diagnosis Related Groups,Diagnostic Related Group,Diagnostic-Related Groups,Group, Diagnosis Related,Group, Diagnosis-Related,Group, Diagnostic Related,Groups, Diagnosis Related,Groups, Diagnosis-Related,Groups, Diagnostic Related,Related Group, Diagnosis,Related Groups, Diagnosis
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man