Email updates

Keep up to date with the latest news and content from BMC Health Services Research and BioMed Central.

Open Access Research article

Development of a case-mix funding system for adults with combined vision and hearing loss

Dawn M Guthrie1* and Jeffrey W Poss2

Author Affiliations

1 Department of Kinesiology and Physical Education, Wilfrid Laurier University, 75 University Ave. W., Waterloo, ON, N2L 3C5, Canada

2 School of Public Health and Health Systems, University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L 3G1, Canada

For all author emails, please log on.

BMC Health Services Research 2013, 13:137  doi:10.1186/1472-6963-13-137

Published: 15 April 2013

Abstract

Background

Adults with vision and hearing loss, or dual sensory loss (DSL), present with a wide range of needs and abilities. This creates many challenges when attempting to set the most appropriate and equitable funding levels. Case-mix (CM) funding models represent one method for understanding client characteristics that correlate with resource intensity.

Methods

A CM model was developed based on a derivation sample (n = 182) and tested with a replication sample (n = 135) of adults aged 18+ with known DSL who were living in the community. All items within the CM model came from a standardized, multidimensional assessment, the interRAI Community Health Assessment and the Deafblind Supplement. The main outcome was a summary of formal and informal service costs which included intervenor and interpreter support, in-home nursing, personal support and rehabilitation services. Informal costs were estimated based on a wage rate of half that for a professional service provider ($10/hour). Decision-tree analysis was used to create groups with homogeneous resource utilization.

Results

The resulting CM model had 9 terminal nodes. The CM index (CMI) showed a 35-fold range for total costs. In both the derivation and replication sample, 4 groups (out of a total of 18 or 22.2%) had a coefficient of variation value that exceeded the overall level of variation. Explained variance in the derivation sample was 67.7% for total costs versus 28.2% in the replication sample. A strong correlation was observed between the CMI values in the two samples (r = 0.82; p = 0.006).

Conclusions

The derived CM funding model for adults with DSL differentiates resource intensity across 9 main groups and in both datasets there is evidence that these CM groups appropriately identify clients based on need for formal and informal support.

Keywords:
Case-mix systems; Dual sensory loss; Standardized assessment; Resource allocation