Improving casemix systems by integrating functioning information: 25.11.2018 Improving casemix systems by integrating functioning information: A systematic literature review and call for expert input Maren Hopfe1,2, Gerold Stucki1,2,3, Mirjam Brach1,2,3, Birgit Prodinger1,2,3 1)Swiss Paraplegic Research, Nottwil, Switzerland 2)Department of Health Sciences & Health Policy, University of Lucerne, Lucerne, Switzerland 3)ICF Research Branch in cooperation with the WHO Collaborating Centre for the Family of International Classifications in Germany (at DIMDI), Nottwil, Switzerland 25.11.2018 Thema

25.11.2018 Background Information about a disease and a person’s functioning are complimentary. Current reimbursement systems, especially casemix systems, still rely predominantly on disease-specific information. First screening of the literature showed some evidence that functioning information adds value to existing casemix systems, such as Diagnosis Related Groups (DRGs). Systematic examination of the evidence on the added value of functioning information in casemix systems is needed to inform the decision on whether to adapt current casemix systems. Thema

25.11.2018 Objective To identify the value of integrating functioning information into casemix systems to improve financing in current health systems. More specifically, the aims are to determine indicators of added value of casemix systems based on the existing literature, and examine potential areas of use for integrating functioning information into casemix systems Procedures Diagnosis Age Gender Comorbidities Functioning Grouper 25.11.2018 Thema

Systematic literature review 25.11.2018 Methods & Materials Systematic literature review Search terms: Functioning OR “Functional status” OR Function* OR ICF OR “International Classification of Functioning, Disability and Health” OR “Activities of Daily Living” OR ADL Casemix OR “case mix” OR “Diagnosis Related Groups” OR “Function Related Groups” OR “Resource Utilization Groups” OR “AN-SNAP” AND Inclusion criteria for studies: empirical, with a comparative component account for functioning information in casemix systems published in peer-reviewed international journals (English or German language) 25.11.2018 Thema

Preliminary Results (I) 25.11.2018 Preliminary Results (I) PRISMA Flow chart 25.11.2018 Thema

Preliminary Results (II) 25.11.2018 Preliminary Results (II) Preliminary grouping of studies Examining existing systems by adding functioning information Comparison of two existing casemix systems which include both functioning information Development of casemix systems including functioning information as essential component Most common settings Most common outcome parameters Acute care hospitals Inpatient rehabilitation facilities Long-term care facilities Nursing homes Psychiatry Costs Length of stay (LOS) Mortality Discharge destination Functional gain 25.11.2018 Thema

The authors acknowledge the support of Conal Twomey. 25.11.2018 Conclusion Functioning in casemix has been studied since the development of casemix systems. This review provides a systematic overview on the evidence on the integration of functioning information into casemix systems throughout various settings and along the continuum of care. The preliminary findings reveal great heterogeneity, including the assessment of functioning, which challenge synthesis of existing evidence and points to the need for standards in collecting and reporting functioning information. Acknowledgements The authors acknowledge the support of Conal Twomey. 25.11.2018 Thema

Thank you for your attention! Comments, thoughts, and questions? 25.11.2018 Thank you for your attention! Comments, thoughts, and questions? 25.11.2018 Thema