Comparing the case-mix of frail older people at home and of those being admitted into residential care: a longitudinal study.
Case-mix
Health services optimization
Home care
Long-term care
RUG-III/HC
Resource utilization
Journal
BMC geriatrics
ISSN: 1471-2318
Titre abrégé: BMC Geriatr
Pays: England
ID NLM: 100968548
Informations de publication
Date de publication:
05 06 2020
05 06 2020
Historique:
received:
20
09
2019
accepted:
21
05
2020
entrez:
7
6
2020
pubmed:
7
6
2020
medline:
22
12
2020
Statut:
epublish
Résumé
In order to optimize interventions and services in the community, it is important to identify the profile of persons who are able to stay at home and of those who are being admitted into residential care. Understanding their needs and their use of resources is essential. The main objective of the study is to identify persons who are likely to enter residential care based upon their needs and resource utilization, so that care providers can plan interventions effectively and optimize services and resources to meet the persons' needs. This is a longitudinal quasi-experimental study. The data consists of primary data from the community setting collected every six months during the period of 2010-2016. Interventions had the goal of keeping older people longer at home. Participants were at least 65 years old and were living in the community. The interRAI Resource Utilization Group system (RUG-III) was used to calculate the case-mix indexes (CMI) of all participants. Comparisons were made between the case-mix of those who were still living at home and those who were admitted into residential care at follow-up. A total of 10,289 older persons participated in the study (81.2 ± 7.1 yrs., 69.1% female). From this population, 853 participants (8.3%) were admitted into residential care. The CMI of the persons receiving night care at home were the highest (1.6 at baseline and 1.7 at the entry point of residential care), followed by persons receiving occupational therapy (1.5 at baseline and 1.6 at the entry point of residential care) and persons enrolled in case management interventions with rehabilitation (1.4 at baseline and 1.6 at the entry point of residential care). The CMIs at follow-up were significantly higher than at baseline and the linear regression model showed that admission to residential care was a significant factor in the model. The study showed that the RUG-III system offers possibilities for identifying persons at risk of institutionalization. Interventions designed to avoid early nursing home admission can make use of the RUG-III system to optimize care planning and the allocation of services and resources. Based on the RUG-III case-mix, resources can be allocated to keep older persons at home longer, bearing in mind the complexity of care and the availability of services in the community.
Sections du résumé
BACKGROUND
In order to optimize interventions and services in the community, it is important to identify the profile of persons who are able to stay at home and of those who are being admitted into residential care. Understanding their needs and their use of resources is essential. The main objective of the study is to identify persons who are likely to enter residential care based upon their needs and resource utilization, so that care providers can plan interventions effectively and optimize services and resources to meet the persons' needs.
METHODS
This is a longitudinal quasi-experimental study. The data consists of primary data from the community setting collected every six months during the period of 2010-2016. Interventions had the goal of keeping older people longer at home. Participants were at least 65 years old and were living in the community. The interRAI Resource Utilization Group system (RUG-III) was used to calculate the case-mix indexes (CMI) of all participants. Comparisons were made between the case-mix of those who were still living at home and those who were admitted into residential care at follow-up.
RESULTS
A total of 10,289 older persons participated in the study (81.2 ± 7.1 yrs., 69.1% female). From this population, 853 participants (8.3%) were admitted into residential care. The CMI of the persons receiving night care at home were the highest (1.6 at baseline and 1.7 at the entry point of residential care), followed by persons receiving occupational therapy (1.5 at baseline and 1.6 at the entry point of residential care) and persons enrolled in case management interventions with rehabilitation (1.4 at baseline and 1.6 at the entry point of residential care). The CMIs at follow-up were significantly higher than at baseline and the linear regression model showed that admission to residential care was a significant factor in the model.
CONCLUSIONS
The study showed that the RUG-III system offers possibilities for identifying persons at risk of institutionalization. Interventions designed to avoid early nursing home admission can make use of the RUG-III system to optimize care planning and the allocation of services and resources. Based on the RUG-III case-mix, resources can be allocated to keep older persons at home longer, bearing in mind the complexity of care and the availability of services in the community.
Identifiants
pubmed: 32503445
doi: 10.1186/s12877-020-01593-w
pii: 10.1186/s12877-020-01593-w
pmc: PMC7275336
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
195Références
BMJ. 2001 Aug 18;323(7309):391-3
pubmed: 11509435
Health Serv Res. 1998 Oct;33(4 Pt 1):835-65
pubmed: 9776939
BMC Med Inform Decis Mak. 2013 Feb 26;13:27
pubmed: 23442258
Can J Aging. 2008 Fall;27(3):233-9
pubmed: 19158040
J Gerontol A Biol Sci Med Sci. 1995 Mar;50(2):M128-33
pubmed: 7874589
Gerontologist. 2004 Jun;44(3):389-400
pubmed: 15197293
J Am Med Dir Assoc. 2016 Sep 1;17(9):862.e1-9
pubmed: 27473899
J Am Geriatr Soc. 2016 Nov;64(11):2251-2256
pubmed: 27676585
Healthc Manage Forum. 2015 Jan;28(1):12-15
pubmed: 25838565
Health Aff (Millwood). 2014 Sep;33(9):1549-58
pubmed: 25201659
Med Care. 2008 Apr;46(4):380-7
pubmed: 18362817
J Am Med Dir Assoc. 2017 Feb 1;18(2):105-110
pubmed: 28126135
J Gerontol B Psychol Sci Soc Sci. 2000 May;55(3):S152-62
pubmed: 11833983
J Gen Intern Med. 2020 Jan 2;:
pubmed: 31898134
J Am Geriatr Soc. 1996 Mar;44(3):305-9
pubmed: 8600202
Health Aff (Millwood). 2015 Dec;34(12):2138-46
pubmed: 26643635
BMC Public Health. 2012 Aug 06;12:615
pubmed: 22867442
J Gerontol A Biol Sci Med Sci. 1999 Nov;54(11):M546-53
pubmed: 10619316
Int J Geriatr Psychiatry. 2006 Mar;21(3):281-7
pubmed: 16477582
Int J Integr Care. 2014 Feb 26;14:e005
pubmed: 24605073
Gerontologist. 2012 Jun;52(3):357-66
pubmed: 21983126
Int Psychogeriatr. 2010 Nov;22(7):1161-71
pubmed: 20478100
Home Health Care Serv Q. 1999;18(1):25-45
pubmed: 10947561
Scand J Public Health. 1999 Sep;27(3):228-34
pubmed: 10482083
BMC Geriatr. 2013 Nov 21;13:128
pubmed: 24261417
Age Ageing. 2000 Mar;29(2):165-72
pubmed: 10791452
Med Care. 1994 Jul;32(7):668-85
pubmed: 8028403
Geriatr Nurs. 2006 May-Jun;27(3):160-5
pubmed: 16757387
Health Serv Res. 2007 Apr;42(2):827-46
pubmed: 17362220
Can J Aging. 2018 Dec;37(4):400-419
pubmed: 30176954
Drugs Aging. 2012 Sep;29(9):751-8
pubmed: 23018611