Using existing case-mix methodologies to fund trauma cases

Abstract

The purpose of this paper is to demonstrate how existing case-mix methodologies can be applied for funding of subpopulations of patients, taking as an example a suggested funding model for trauma. Currently, trauma funding in Ontario is based on a flat rate per case. However, the distribution of the measures of resource utilization, such as average length of stay, hours in intensive care, and resource intensity weights in Ontario Lead Trauma Hospitals, suggests that facilities differ in patient case mix. For instance, average hours in intensive care ranged from 62 to 153 across facilities, average resource intensity weight varied from 3.2 to 4.7, and average length of stay ranged from 11 to 18 days. The literature related to the development of a funding methodology for trauma is divided into two streams. Some studies suggested the need for the development of a new grouping methodology, specific for trauma cases, based on such factors as age, injury severity score (ISS), mechanism of injury, patient transfer, and the like. Other research was aimed at improvement of existing grouping methodologies and/or weights, such as diagnoses-related groups (DRG), case-mix groups (CMG), and resource intensity weights (RIWs) to better address characteristics of trauma patients.