Transcript
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<CIHI Presents>
<Sorting Out Case Mix>
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As providers of health care, we strive to deliver the right care at the right time in the right place.
To do this well, we need to understand the populations we’re caring for and what's required to meet their individual needs.
Once we understand this, we can allocate our limited resources accordingly across the health care system. Given that we help many different populations, how can we categorize them to care for them better? We do this by using case-mix grouping methodologies.
Case-mix refers to the type or mix of people treated by a hospital or other health care facility. It provides a consistent way for classifying or sorting individuals into groups that are homogeneous in their clinical characteristics and resources used, such as hours of nursing care, therapy times and physician visits. In this way, case-mix information supports decision-making on staffing, quality improvement, benchmarking and program planning. In some instances, it is also used as part of funding models. But what exactly is a case-mix grouping methodology? By sorting information about each person into similar categories based on their clinical information and resources consumed, we end up with a more manageable amount of information. And we can begin to see meaningful patterns emerge in the data. These patterns can then be used to predict future resource use for people with similar characteristics. In other words, case mix helps us achieve a balance between the large amount of information about these people and a way to categorize this data into a reasonable number of groups that share characteristics.
Across the health care system, we use different case-mix grouping methodologies for different services. For example, in acute care, case mix is based on diagnostic and treatment interventions and is referred to in Canada as Case Mix Groups or CMGs,
>> Case Mix Groups (CMGs)
and internationally as
>> Diagnosis-Related Groups (DRGs)
diagnosis-related groups or DRGs.
Within the community, case-mix methodologies are often based on clinical and functional information.
>> Resource Utilization Groups (RUGs)
For example, in long-term care, case mix is described as Resource Utilization Groups or (RUGs), whereas in rehabilitation it's known as…
>>Rehabilitation Patient Groups (RPGs)
…Rehabilitation Patient Groups or RPGs.
>> Population Grouping Methodology
At the population level, the Population Grouping Methodology examines diagnosis and patterns of health system use data with an emphasis on chronic conditions to form this case-mix method.
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Still, case mix is not always simple to understand. So we're going to use these blocks to illustrate some case-mix concepts. At first glance you might think these blocks are all different. But as you can see, we can group them by similar characteristics such as colour. We can also see that within a group of the same colour, the shapes are different.
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The same can be said about people. They can be grouped by their similar clinical characteristics and by their individual care needs. For example, in the Resource Utilization Group case-mix methodology used in long-term care, there are 7 clinical categories. A person in a long-term care home who suffered a stroke might be assigned to a different category than someone who has a less severe condition and needs less help with daily activities.
<Video of manipulating blocks>
The question remaining is how many resources are needed to meet their needs. And this brings us to another important concept when discussing case mix called Case Mix Index.
As you recall, we mentioned that each of the blocks, although the same in colour, were different in size. We can use this difference to further illustrate the types of resources an individual group might require.
>> Case Mix Index
>> Case Mix Index (CMI = 1)
Using our blocks, let's say this one with 4 dots represents the average resources required by an individual and therefore has a Case Mix Index of 1.
>> Case Mix Index (CMI >1)
This block with 6 dots represents an individual requiring more resources than the average,
>> Case Mix Index (CMI <1)
while this block with 2 dots requires fewer resources. Therefore, we can say that these 2 blocks have different resource weights even though they are categorized into the same clinical category of the Resource Utilization Group.
In this way, Case Mix Index values help us to further understand the characteristics and care needs of the individuals in each of these groups.
This brings us to the end of our demonstration. We hope this brief introduction has simplified some of the complexities around case mix.
By sorting information about each person into similar categories, we can understand the populations we’re caring for and better understand the requirements to meet their individual needs.
>> www.cihi.ca/casemix
But we know there is still much to learn. For more information and other training products, contact Case Mix at CIHI, or email casemix@cihi.ca.