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Descrizione/Abstract:
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- Due to the current dimension and the estimated future increase of the elderly population, it is crucial to carefully plan health and social care for this population group. From this point of view, it is essential to develop a classification system able to accurately describe the care profile of the residents in different types of long-term care facilities.
- Among other classification systems, the RUGIII system has been preferred for several reasons: it has been widely applied in a number of countries; in Italy has been initially validated in a sample of facilities located in 6 regions; it has been subsequently adopted in a number of regions (Abruzzo, Friuli Venezia-Giulia, Marche, Umbria) and selected fro a local evaluation in other regions (Toscana, Basilicata, Calabria); it is one of the classification systems initially indicated by the Progetto Mattoni and, subsequently, included by the DM 17/12/2008 for the institution of a national information system in long-term care facilities (“Istituzione della banca dati finalizzata alla rilevazione delle prestazioni residenziali e semiresidenziali”).
- Between 2004 and 2007, in 10 subsequent occasions the residents of 27 facilities of four Local Health Authorities (LHAs) of the Emilia-Romagna Region (Forlì, Imola, Ravenna e Parma), were characterized according to the items of the Resource Utilization Group - RUG (version III) classification system, with the aim of evaluating the feasibility, validity, and capability to predict the use of resources of this system. RUG data and direct observation of minutes of care were simultaneously collected during two different data collection periods in the three LHAs located in the Romagna area (2004 e 2005), and once in the LHAs of Parma (2006).
- The RUG system was able to accurately describe the care profile of the residents in both residential homes (Case protette) and nursing homes (RSA). According to the RUG algorithm, residents were classified in highly homogenous groups according to time of care: the variation coefficient was low (on average equal to 30%), with only one exception (group 34).
- The model was able to explain globally 30% of the observed variance of the time of care. The proportion of variance explained increased to 40% (which is comparable to that explained by the Diagnoses Related Groups - DRG classification system in hospital), when the local weights were used instead of those developed by the Marche Region and when a facility, with a completely different staffing, was excluded.
- The average case-mix index in each facility changes over time, as well as the condition of individual residents: a system that follows-up over time the resident, recording possible improvements or worsening of his/her conditions, is much more able to accurately and meaningfully describe the case mix of each facility, when compared with one data collection during a calendar year.
- Some aspects need to be further explored: in particular, residents needing rehabilitation were scarcely represented in the studied facilities, also because belonging to this group is strongly influenced by the rehabilitation activities actually carried out in the facility. This support the hypothesis, as suggested by other Italian authors, of a new RUGIII classification system composed of 34 groups, with only 4 rehabilitation groups instead of 14, or in alternative composed of 30 groups, eliminating completely the “Rehabilitation” category, while recording the eventual rehabilitation programs among other clinical and care items of each resident.
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Data di pubblicazione:
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01/06/2009
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