Resource Intensity Weights Research Articles

Comparison of Acute Health Care Utilization Between Patients Receiving In-Center Hemodialysis and the General Population: A Population-Based Matched Cohort Study From Ontario, Canada.

Patients receiving maintenance hemodialysis have multiple comorbidities and are at high risk of presenting to the hospital. However, the incidence and cost of acute health care utilization in the in-center hemodialysis population and how this compares with other populations is poorly understood. To determine the rate, pattern, and cost of emergency department visits and hospitalizations in patients receiving in-center hemodialysis compared with a matched general population. Population-based matched cohort study. We used linked administrative health care databases from Ontario, Canada. We included 25 379 patients (incident and prevalent) receiving in-center hemodialysis between January 1, 2010, and December 31, 2018. Patients were matched on birth date (±2 years), sex, and cohort entry date using a 1:4 ratio to 101 516 individuals from the general population. Our primary outcomes were emergency department visits (allowing for multiple visits per individual) and hospital admissions from the emergency department. We also assessed all-cause hospitalizations, all-cause readmissions within 30 days of discharge from the original hospitalization, length of stay for hospital admissions (including multiple visits per individual), and the financial cost of these admissions. We presented the rate, percentage, median (25th, 75th percentiles), and incidence rate per 1000 person-years for emergency department visits and hospitalizations. Individual-level health care costs for emergency department visits and all-cause hospitalization were estimated using resource intensity weights multiplied by the cost per weighted case. Patients receiving in-center hemodialysis had substantially more comorbidities (eg, diabetes) than the matched general population. Eighty percent (n = 20 309) of patients receiving in-center hemodialysis had at least 1 emergency department visit compared with 56% (n = 56 452) of individuals in the matched general population, over a median follow-up of 1.8 years (25th, 75th percentiles: 0.7, 3.6) and 5.2 (2.5, 8.4) years, respectively. The incidence rate of emergency department visits, allowing for multiple visits per individual, was 2274 per 1000 person-years (95% confidence interval [CI]: 2263, 2286) for patients receiving in-center hemodialysis, which was almost 5 times as high as the matched general population (471 per 1000 person-years; 95% CI: 469, 473). The rate of hospital admissions from the emergency department and the rate of all-cause hospital admissions in the in-center hemodialysis population was more than 7 times as high as the matched general population (hospital admissions from the emergency department: 786 vs 101 per 1000 person-years; all-cause hospital admissions: 1056 vs 139 per 1000 person-years). The median number of all-cause hospitalization days per patient year was 4.0 (0, 16.5) in the in-center hemodialysis population compared with 0 (0, 0.5) in the matched general population. The cost per patient-year for emergency department visits in the in-center hemodialysis population was approximately 5.5 times as high as the matched general population while the cost of hospitalizations in the in-center hemodialysis population was approximately 11 times as high as the matched general population (emergency department visits: CAN$ 1153 vs CAN$ 209; hospitalizations: CAN$ 21 151 vs CAN$ 1873 [all costs in 2023 CAN$]). External generalizability and we could not determine whether emergency department visits and hospitalizations were preventable. Patients receiving in-center hemodialysis have high acute health care utilization. These results improve our understanding of the burden of disease and the associated costs in the in-center hemodialysis population, highlight the need to improve acute outcomes, and can aid health care capacity planning. Additional research is needed to address the risk of hospitalization after controlling for patient comorbidities. This is not applicable as this is a population-based matched cohort study and not a clinical trial.

The association between varying levels of palliative care involvement on costs during terminal hospitalizations in Canada from 2012 to 2015

BackgroundInpatient palliative care is associated with lower inpatient costs; however, this has yet to be studied using a more nuanced, multi-tiered measure of inpatient palliative care and a national population-representative dataset. Using a population-based cohort of Canadians who died in hospital, our objectives were to: describe patients’ receipt of palliative care and active interventions in their terminal hospitalization; and examine the relationship between inpatient palliative care and hospitalization costs.MethodsRetrospective cohort study using data from the Discharge Database in Canada between fiscal years 2012 and 2015. The cohort were Canadian adults (age ≥ 18 years) who died in hospital between April 1st, 2012 and March 31st, 2015 (N = 250,640). The exposure was level of palliative care involvement defined as: medium-high, low, or no palliative care. The main measure was acute care costs calculated using resource intensity weights multiplied by the cost of standard hospital stay, represented in 2014 Canadian dollars (CAD). Descriptive statistics were represented as median (IQR), and n(%). We modelled cost as a function of palliative care using a gamma generalized estimating equation (GEE) model, accounting for clustering by hospital.ResultsThere were 250,640 adults who died in hospital. Mean age was 76 (SD 14), 47% were female. The most common comorbidities were: metastatic cancer (21%), heart failure (21%), and chronic obstructive pulmonary disease (16%). Of the decedents, 95,450 (38%) had no palliative care involvement, 98,849 (38%) received low involvement, and 60,341 (24%) received medium to high involvement. Controlling for age, sex, province and predicted hospital mortality risk at admission, the cost per day of a terminal hospitalization was: $1359 (95% CI 1323: 1397) (no involvement), $1175 (95% CI 1146: 1206) (low involvement), and $744 (95% CI 728: 760) (medium-high involvement).ConclusionsIncreased involvement of palliative care was associated with lower costs. Future research should explore whether this relationship holds for non-terminal hospitalizations, and whether palliative care in other settings impacts inpatient costs.

The Association Between Varying Levels of Palliative Care Involvement on Costs During Terminal Hospitalizations in Canada from 2012–2015 (F405C)

1.Assess the association between inpatient palliative care and costs during a terminal hospitalization.2.Determine the relationship between inpatient palliative care and costs, stratified by disease trajectory, and Canadian province.3.Discuss the value of using varied levels of palliative care to assess relationship with costs rather than dichotomous predictors of receiving palliative care vs. not. Inpatient palliative care is associated with lower inpatient costs; however, this has yet to be studied using a more nuanced, multi-tiered measure of inpatient palliative care and a national population-representative dataset. Using a population-based cohort of Canadians who died in hospital, our objectives were to: describe patients’ receipt of palliative care and active interventions in their terminal hospitalization; and examine the relationship between inpatient palliative care and hospitalization costs. Retrospective cohort study using data from the Discharge Abstract Database in Canada between fiscal years 2012 and 2015. Canadian adults (age ≥18 years) who died in hospital between April 1, 2012, and March 31, 2015 (N=250,640). Level of palliative care involvement defined as: medium-high, low, or no palliative care. Acute care costs calculated using resource intensity weights multiplied by the cost of standard hospital stay, represented in 2014 Canadian dollars (CAD). Descriptive statistics were represented as median (IQR), and n (%). We modelled cost as a function of palliative care using a gamma generalized estimating equation (GEE) model, accounting for clustering by hospital. There were 250,640 adults who died in hospital. Mean age was 76 (SD 14), 47% were female. Of the decedents, 95,450 (38%) had no palliative care involvement, 98,849 (38%) received low involvement, and 60,341 (24%) received medium to high involvement. Controlling for age, sex, province and predicted hospital mortality risk at admission, the cost per day of a terminal hospitalization was: $1,359 (95% CI 1,323: 1,397) (no involvement), $1,175 (95% CI 1,146: 1,206) (low involvement), and $744 (95% CI 728: 760) (medium-high involvement). We observed an inverse dose-response relationship between palliative care involvement and costs.

Trends in prevalence of chronic disease and multimorbidity in Ontario, Canada.

BACKGROUND:New case-mix tools from the Canadian Institute for Health Information offer a novel way of exploring the prevalence of chronic disease and multimorbidity using diagnostic data. We took a comprehensive approach to determine whether the prevalence of chronic disease and multimorbidity has been rising in Ontario, Canada.METHODS:In this observational study, we applied case-mix methodology to a population-based cohort. We used 10 years of patient-level data (fiscal years 2008/09 to 2017/18) from multiple care settings to compute the rolling 5-year prevalence of 85 chronic diseases and multimorbidity (i.e., the co-occurrence of 2 or more diagnoses). Diseases were further classified based on type and severity. We report both crude and age- and sex-standardized trends.RESULTS:The number of patients with chronic disease increased by 11.0% over the 10-year study period to 9.8 million in 2017/18, and the number with multimorbidity increased 12.2% to 6.5 million. Overall increases from 2008/09 to 2017/18 in the crude prevalence of chronic conditions and multimorbidity were driven by population aging. After adjustments for age and sex, the prevalence of patients with ≥ 1 chronic conditions decreased from 70.2% to 69.1%, and the prevalence of multimorbidity decreased from 47.1% to 45.6%. This downward trend was concentrated in minor and moderate diseases, whereas the prevalence of many major chronic diseases rose, along with instances of extreme multimorbidity (≥ 8 conditions). Age- and sex-standardized resource intensity weights, which reflect relative expected costs associated with patient diagnostic profiles, increased 4.6%.INTERPRETATION:Evidence of an upward trend in the prevalence of chronic disease was mixed. However, the change in case mix toward more serious conditions, along with increasing patient resource intensity weights overall, may portend a future need for population health management and increased health system spending above that predicted by population aging.

Implementing the patient care collaborative model in three general internal medicine units: a mixed-methods healthcare improvement initiative

BackgroundAs part of the scale-up of the Patient Care Collaborative (PCC) at our institution, we explored staff perceptions and patient outcomes at different levels of model implementation in three general...

Surgical Approaches in Total Hip Arthroplasty Cost Per Case Analysis: A Retrospective, Matched, Micro-costing Analysis in a Socialised Healthcare System.

Total hip arthroplasty (THA) offers an effective method of pain relief and restoration of function for patients with end-stage arthritis. The anterior approach (AA) claims to benefit patients with decreased pain, increased mobilisation and decreasing length of hospital stay (LOS). In a socialised healthcare platform we questioned whether the AA, compared to posterior (PA) and lateral (LA) approaches, can decrease the cost burden. Using a retrospective matched cohort study, we matched 69 AA patients to 69 LA and 69 PA patients for age (p = 0.99), gender (p = 0.99) and number of pre-surgical risk factors (p = 0.99). First, we used the Resource Intensity Weights (RIW) using the Health Services agreed on method of calculating cost. Secondly, micro-costing analysis was performed using the financial services data for each patient's hospital stay. Using the RIW based cost analysis and 2-day reduction (95% CI 1.8-2.4) in LOS, the AA offers an estimated savings per case of $4099 (p < 0.001) compared to the LA and PA. Using micro-costing analysis, we found a total saving of $1858.00 per case (95% CI 1391-2324) when comparing the AA to the PA and LA. There was a statistically significant cost savings using every category: Net Direct Salary ($901.00, p < 0.001), Net Drug ($8.00, p = 0.003), Patient Supply ($454.00, p = 0.001), Patient Drug ($15.00, p = 0.008), Indirect Cost ($385.00, p < 0.001), Patient Care Administration ($106.00, p < 0.001). Furthermore, the AA saved 142 minutes of in-hospital rehabilitation time. The AA THA provides statistically significant reductions in cost compared to PA and LA while releasing rehabilitation resources.

Identifying Knowledge Gaps with Administrative Health Data: A Cohort Study of Traumatic and Non-Traumatic Spinal Cord Injury in Alberta

IntroductionThe Spinal Cord Injury (SCI) population consists of two main sub-groups: traumatic (TSCI) and non-traumatic (NTSCI). TSCI has been studied; however less attention has been given to NTSCI. It is important to understand both SCI sub-groups for identification of knowledge gaps and subsequent health service planning.&#x0D; Objectives and ApproachThe goal is to study the SCI population (both TSCI and NTSCI) in Alberta, Canada, leveraging recent administrative health data. It is difficult to identify NTSCI patients for their heterogeneous conditions, and relatively low prevalence. Consequently, we followed a validated algorithm using particular ICD-10-CA codes, to identify (and index) adult SCI patients from Ambulatory and Inpatient records between April 1, 2006 and March 31, 2016.&#x0D; Indexed patients were linked to various databases (inpatient, ambulatory, physician claims, provincial insurance registry), and analyzed in multiple perspectives such as demographics patterns, deaths, resource and cost utilization, geographic distribution, and care equity between groups.&#x0D; ResultsThrough 10 years of data we have identified 5217 SCI patients (3309 TSCI; 1908 NTSCI). 68.7% TSCI and 58.6% NTSCI are male. NTSCI patients are approximately 10 years older (46.3 TSCI; 54.5 NTSCI), and have a 3-point higher Charlson score. 1-year mortality in NTSCI is approximately 2.4 times the TSCI group.&#x0D; Hospitalizations, ER visits, critical care time have also been examined. Patients with NTSCI had a higher median index LOS (14 days IQR (4-51)) compared to the traumatic group who had much higher variability (11 days IQR (11-65.5)). Noted 13.7% NTSCI patients and 19.5% TSCI do not have hospitalizations after index (a diverse characteristic of SCI). Resource Intensity Weights, physician billing, rural-urban area utilization have also been compared between the sub-groups.&#x0D; Conclusion/ImplicationsWith the use of administrative databases and a validated algorithm, we described a diverse patient cohort with two main sub-groups (TSCI/NTSCI). Both groups were analyzed upon multiple topics and showed variations. Our results have provided updated knowledge of a comprehensive SCI population in Alberta, Canada, and may lead to improvements on care-giving model.

Hospital-associated Costs of Chronic Pelvic Pain in Canada: A Population-based Descriptive Study.

To determine the hospital-related costs incurred by women requiring surgery or inpatient admission for chronic pelvic pain in Canada. We conducted a population-based, cross-sectional study, focusing on women ages 15-59 with a most responsible International Classification of Diseases diagnosis of pelvic and perineal pain, dysmenorrhea, or dyspareunia who had surgery or inpatient admission with a discharge date between April 1, 2008 and March 31, 2012. This study was based on the Canadian Institute for Health Information Discharge Abstract database and the National Ambulatory Care Reporting System. Clinical diagnoses and interventions and resource intensity weights (RIW) were extracted. Hospital costs were estimated by multiplying cost per weighted case (CPWC) calculated at the national level with respective RIWs. Over four years, there were 34 346 cases of surgery or inpatient admission for chronic pelvic pain amounting to $100.5 million with an average cost of $25 million per year. Pelvic and perineal pain accounted for 61.5% (n= 21 127) of the cases, while dysmenorrhea accounted for 31.8% (n= 10 936), and dyspareunia accounted for 6.6% (n= 2283). The vast majority of the cases (92.9%, n= 31 923) were associated with surgical interventions, with the most common surgeries being hysterectomy (47.1%, n=16 189), followed by laparoscopy (25.8%, n= 8850), adnexal surgery (6.8%, n= 2349), and other procedures (11.6%, n= 3968). While these estimates do not take into account non-hospital related costs, such as outpatient treatment, loss of productivity, and impact on quality of life, this study demonstrates that chronic pelvic pain represents a considerable economic burden to Canada's health care system.

Preliminary Results of the Adoption and Application of the Integrated Comprehensive Care Bundle Care Program When Treating Patients with Chronic Obstructive Pulmonary Disease.

Background St. Joseph's Health System has implemented an integrated comprehensive care bundle care (ICC) program with the hopes that it would improve patients' care while reducing overall costs. The aim of this analysis was to evaluate the performance of the ICC program within patients admitted with chronic pulmonary obstructive disease (COPD). Methods We conducted a retrospective observational cohort study comparing ICC patients to non-ICC patients admitted to St. Joseph's Healthcare Hamilton for COPD being discharged with support services between June 2012 and March 2015, using administrative data. Confounding adjustment was achieved through the use of propensity score matching. Medical resource utilizations during the initial hospitalization and within the 60 days following discharge were compared using regression models. Results All 76 patients who entered the ICC program (100.0%) were matched 1 : 1 to 76 eligible non-ICC patients (28.4%). Length of stay (6.47 [7.29] versus 9.55 [10.21] days) and resource intensity weights (1.16 [0.80] versus 1.64 [1.69]) were lower in the ICC group within the initial hospitalization but, while favoring the ICC program, healthcare resource use tended not to differ statistically following discharge. Interpretation The ICC program was able to reduce initial medical resource utilization without increasing subsequent medical resource use.

The Role of Hospital Funding in Albania: A Situational Analysis

This abstract is to provide a concise description of the role of hospital funding in Albania. For many years, hospitals in Albania been funded on an historical and line-by-line basis. From year to year, the budgets has based on the previous year’s funding with adjustments based on inflation and political factors. The Health Insurance Fund of Albania is preparing to take over funding decisions with respect to hospitals in January 2017, in the event they are requested to do so. This abstract proposes a fives year program in which Health Insurance Fund of Albania could begin immediately with changes to hospital funding which would generate greater equity among hospitals in terms of funding based on population served. The additional data collected will also enable the Health Insurance Fund of Albania to move toward implementation of a case mix model, which be used for funding but is recommended to be used only as a method to improve the allocation process by putting cost values to cases treated including resource intensity weights reflecting the cost of services. In brief, the current situation in Albania includes the following problems as isufficiency in health financing; the national health insurance scheme is still not consolidated; planning and budgeting are not coordinated; inefficient management of financial resources and lack of transparency and accountability. These reform proposals are ambitious and require detailed planning for their implementation. Significant efforts will be required from key players in the health sector. DOI: 10.5901/ajis.2016.v5n3s1p525

LO031: The epidemiology of emergency department visits for dog-related injuries in Alberta

Introduction: Injuries due to interactions with dogs (e.g. bites, collisions, etc) are an important public health concern from both a health and an economic perspective. The consequences of these injuries can be both physical (injury, pain, infection, disfiguration) and psychological. The purpose of this study is to understand the prevalence and characteristics of dog-related injuries among patients presenting to Alberta emergency departments (EDs). Further, this study describes the burden of these injuries on ED economic health care resources. Methods: This retrospective, administrative database cohort study utilised the National Ambulatory Care Reporting System (NACRS) to identify all visits made to Alberta EDs in fiscal years 2010/11 through 2014/15 for dog-related injuries. ED visits where the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Canada (ICD-10-CA) code “W54-Bitten or Struck by Dog” appeared in the first four diagnosis fields were captured. The Canadian Institute for Health Information costing model utilising the Comprehensive Ambulatory Classification System and Resource Intensity Weights was employed to calculate average unit health care costs for ED visits excluding physician fees. Data were analyzed using descriptive statistics. Results: During the 5 year study period, Albertans made 21,821 ED visits for dog-related injuries. The ED visit rate was highest in children under 2 years of age, namely 234 per 100,000 for males and 206 per 100,000 for females. ED visit rates were highest for patients residing in the northern health region of the province (220/100,000) compared to metropolitan areas (90/100,000 and 64/100,000 for Edmonton and Calgary zones respectively). One third of visits occurred in the summer months, with a greater proportion of visits occurring on the weekend (34.4%). The predominant areas of injury were wrist/hand/fingers (n=7756 visits; 35.5%) and head/face/neck (n=5152 visits; 23.6%). In 287 visits (1.3%), the patient was admitted to hospital. ED visit costs were highest for children 4 years of age and younger ($243.86/visit; p&lt;0.001). Conclusion: Dog-related injuries result in a substantial number of ED visits and significant costs in Alberta. Understanding the characteristics of these injuries provides an opportunity for prevention, including strategies focussed on higher risk groups involving children and residents of rural areas.

Falls in hospital increase length of stay regardless of degree of harm.

Acute inpatient falls are common and serious adverse events that lead to injury, prolonged hospitalization and increased cost of care. To determine the difference in total acute hospital care length of stay (LOS) for patients with and without an in-hospital fall (IHF), regardless of degree of harm. This was a retrospective observational study at a 728-bed acute care teaching hospital. We used propensity scores to match 292 patients with 330 controls by case mix group, sex, Resource Intensity Weights and week of admission. We used two administrative databases: hospital fall incident reporting system and Discharge Abstract Database. We reviewed all IHF incidents for patients 18 years and older, admitted to inpatient acute care hospital units/programs between 1 November 2009 and 31 August 2011. The average LOS for IHF cases was 37.2 days [median 26.5 days; interquartile range (IQR) 14, 54] and 25.7 days (median 13 days; IQR 5, 33) for matched control patients. Survival analysis results indicated that patients who did not have an IHF were 2.4 times (95% CI 2.1, 2.7; P < 0.001) more likely to be discharged earlier from acute care than patients who had an IHF. Experiencing either an injurious or a non-injurious fall during an acute care hospitalization was associated with prolonged LOS.

Deriving expenditures by disease under the System of Health Accounts (SHA) 2011 framework: a systematic analysis

BackgroundConsistent and internationally comparable data on spending by disease can help answer important policy questions related to technical efficiency, sustainability, and equity, as well as tracking and examining the relation between disease-specific targeted expenditures (eg, reproductive, child, and maternal health, HIV/AIDS) and outcomes. The recently released global standard, A System of Health Accounts 2011, provides a framework to develop such estimates. A significant input came from an Organisation for Economic Cooperation and Development project that developed and successfully tested guidelines under differing health-care system characteristics. The current project seeks to develop efficient methodologies to expand the availability of comparable health expenditure by disease in the absence of explicit expenditure data. MethodsThe absence of detailed expenditure data can hinder the production of disease accounts. In this case, the development of allocation keys in a top–down approach is proposed. In an initial step, the focus has been on acute hospital care, where reliable administrative data (discharge data and average length of stay data by diagnostic category) are available for a majority of countries. Econometric models have been developed to determine if administrative data can be used to derive reliable expenditure by disease data for countries that do not produce explicit expenditure by disease data. FindingsInitial results have been promising. Data from countries that are able to produce reliable hospital expenditure data can be further employed to derive average resource intensity weights that can be applied to hospital utilisation data in order to estimate the expenditures by disease. InterpretationThe regular and expanded collection of expenditure by disease data will be extremely useful in the development of future disease-specific expenditure and cost-of-illness studies. Research is ongoing to derive disease-specific expenditures also in the areas of pharmaceutical spending and primary care. FundingEuropean Union.

Determining resource intensity weights in ambulatory chemotherapy related to nursing workload

Ontario cancer programs aim to deliver high-quality nursing care and treatment that is safe for patients and staff. The reality of health care is that financial constraints, inherent in the delivery of care, require that funding mechanisms count not only the cost of drugs, but factors such as pharmacy and nursing human resource costs. While some organizations have developed patient classification systems to measure nursing intensity and workload, these systems apply primarily to inpatient populations, and are fraught with numerous challenges, such as the need for nurses to document to justify the workload required for care. The purpose of this paper is to outline the methodology and engagement of nurses to develop regimen-based resource intensity weights that can be applied to ambulatory chemotherapy suites. The methodology included determination of workload related to nursing time to prepare, teach, counsel and assess patients, as well as time to gather supplies, access lines, monitor, manage adverse reactions, manage symptoms and document care. Resource intensity weights provide better measures of the complexity of care required by cancer patients in ambulatory settings.

Multilevel Modeling to Predict Factors Influencing the Length of Stay for An Inpatient Malignant Hematology Service

AbstractAbstract 4733 Purpose:Inpatient care represents a significant cost and resource allocation issue for hospitals. The purpose of this study was to examine factors in an administrative dataset that might predict the length of stay (LOS) for inpatients with a variety of hematological malignancies and to create a simple predictive model. There is a lack of published models for this in malignant hematology patients. Methods:Data was obtained from the Discharge Abstract Database (DAD) maintained by Canadian Institute for Health Information (CIHI) for the years 2002–2005. The data abstracted included patient demographics, type and route of admission, length of stay, resource intensity weights (RIW) and a complexity code. The disease category/diagnosis is based on the case mix group (CMG) which is a simplified grouping of diseases based on the International Classification of Diseases (ICD) system. The Juravinski Hospital and Cancer Centre is a tertiary referral center dealing with all varieties of adult hematological malignancies including stem cell transplantation. The data for this study did not include patients who were treated with an allogeneic stem cell transplant. Potential factors collected on admission were modeled to be nested among individual patients using longitudinal multi-level modeling. Factors entered in the model included: age and age2, route of entry to the hospital (direct vs. emergency room vs. other), area of residence, gender, day of the admission (weekday vs. weekend) and diagnosis (CMG). We also added the number of previous admissions as a baseline variable. Institutional research ethics board approval was granted for this study. Results:Data was collected on 713 patients representing 1,739 admissions and 17,661 days of in-patient services. The number of admissions ranged from 1 to 15 with a mean of 2.5 and median 2.0 admissions per patient. The range for LOS was 1 to 155 days with mean of 10.6 days (SD 13.8) and median of 64 days. The median age of patients was 62.6 years with a range of 17–95 years, and 45% of patients were female. Thirty-nine percent of patients had a diagnosis related to a lymphoproliferative disorder or a chronic leukemia and 19 percent related to the administration of chemotherapy.Factors with non-significant B (slope) value were omitted from the model. Age is centered around the mean. Errors and residuals (μ, r) have a mean of zero and a normal distribution. Age and previous number of admissions were the most important factors in predicting LOS. The final model for estimated LOS is as follows:LOS = 3.9658+μ 0+(0.2068+μ 1)(age-65)+(4.508+μ 2)(number of previous admissions) +rThe variances for the different residuals have been estimated from the model as: μ 0=73.82, μ 1=0.2436, μ 2=0.2436 and r=69.47. For each increment by 5 years above the average age, the LOS increases by 1 day and for each previous admission the LOS increases by 4.5 days. The Pseudo-R squared is approximately 0.50. Conclusion:Of the factors considered in this administrative database, age and the number of previous admissions were the only relevant factors at the time of admission which could predict LOS. This model represents a relatively simple method to estimate the LOS for patients with hematological malignancies admitted to a dedicated hematological unit. Such a model highlights patients at risk of prolonged LOS and may allow health care practitioners to focus on interventions geared towards shortening length of stay. Disclosures:No relevant conflicts of interest to declare.

Using existing case-mix methodologies to fund trauma cases

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.

Discordance between physicians and coders in assignment of diagnoses.

To measure concordance between physicians and medical record coders in their assignment of diagnoses. Prospective cohort series. Five hundred and fifty-bed, tertiary-care, university teaching hospital. Study participants. In-patients who were discharged from either the Cardiac Sciences Program (n=125), the Renal Program (n=43), or the HIV-AIDS Program (n=25) during the period May 18-July 1, 1995. None. Physicians and coders assigned diagnoses for individual in-patients based on their independent interpretations of the patient chart and discharge summary sheet. All assigned diagnoses were coded using the ICD-9-CM classification system. Concordance was measured for the most responsible diagnosis and for all assigned diagnoses. Difference in calculated resource intensity weights based on physicians' and coders' assignment of diagnoses was also calculated. Concordance rates for the most responsible diagnosis in each program were: Cardiac Sciences [27%; 95% confidence interval (CI)=20-36%], Renal Program (35%; 95% CI=21-53%), and HIV-AIDS Program (20%; 95% CI, 6-41%). Concordance rates for all diagnoses per chart were similar: Cardiac Sciences (20%; 95% CI, 14-25%), Renal Program (25%; 95% CI, 20-33%), and HIV-AIDS Program (29%; 95% CI, 25-44%). Resource intensity weights assigned by coders for the Cardiac Sciences and HIV-AIDS Program were significantly higher than those assigned by the physicians.

Quarterly Index: Evaluating Changes in Practice with Resource Intensity Weights

Quarterly Index: Evaluating Changes in Practice with Resource Intensity Weights

Resource Intensity Weighing and Case Mix Grouping: Assumptions and Implications for Health Service Performance Evaluation

The use of Resource Intensity Weights (RIWs*) for equity funding and utilization management assumes validity of the cost estimates, reliability of the patient categorization scheme, equivalence of the bases for cost comparison, and equity of the subsequent resource distribution. This paper examines these assumptions, and concludes that caution must be taken when using the current RIWs and Case Mix Groups (CMGs*) for resource allocation and performance evaluation purposes. RIW has represented a milestone in the history of Canadian health care product costing and management. It would be prudent for health care professionals at the operational level to provide structured and continuing feedback that can contribute to the validation and refinement of these valuable management tools.

Principles for Funding on a Case Mix Basis: Construction of Case Weights (RIWs)

The construct of Resource Intensity Weights (RIWs) contains implicit financial incentives if they are used for hospital funding purposes. This paper compares the RIW (funding) credit to the expected average per diem cost for each of the new subcategories (typicals, deaths, transfers, signouts and outliers) of Case Mix Groups (CMGs). RIW construction, and inherent incentives for a hospital to reduce costs or length of stay (LOS), differ significantly for each subcategory. At some point or points in a patient's LOS, when RIW credit equals case cost, RIWs are incentive neutral. However, it can also be demonstrated that RIW credit is not generally congruent with average costs on each day of a patient's stay. Financial incentives (both positive and negative) arise when RIW credit and costs differ. Only by being fully aware of these differences can hospitals determine how to respond to the introduction of case mix funding to maintain financial viability. Funding agencies, too, need to appreciate the sometimes subtle policy implications that come with the adoption of RIWs for funding purposes.