Costing for long-term care: the development of Scottish health service resource utilization groups as a casemix instrument

Objective: to create a casemix measure with a limited number of categories which discriminate in terms of resource use and will assist in the developm ent of a currency for contracting for the provision of health care. Design: nursing staff completed a questionnaire providing clinical data and also gave estimates of relative patient resource use; ward-based costs wer e collected from appropriate unit managers. Setting: National Health Service continuing-care wards in 50 Scottish hospi tals. Subjects: 2783 long-stay patients aged 65 years and over. Results: inter-rater reliability was assessed using 1402 patients; percenta ge agreement between raters for individual variables varied from 68% for fe eding to 97% for clinically complex treatments. Nursing costs gave 62% agre ement given categories of high, medium and low. The Scottish health service resource utilization groups (SHRUG) measure was developed using 606 cases, and 67% consistency was achieved for the five categories. The relative wei ghts for the SHRUG categories ranged from 0.56 to 1.41. The five categories explain 35% of variance in costs. Conclusions: the five SHRUG casemix categories show good discrimination in terms of costs. The SHRUG measure compares favourably with diagnosis-relate d groups in the acute sector and with other casemix instruments for longter m care previously piloted in the UK. SHRUG is a useful measurement instrume nt in assessing the resource needs of elderly people in long-term care.