Introduction: Increasing pressures on the health care system, particularly in emergency departments (EDs), make it critical to understand changing ED case-mix, patient demographics and care needs, and resource utilization. Our objective is to assess Alberta (AB) ED volumes, utilization and case mix, stratified by ED type. This knowledge will help identify opportunities for system change and quality improvement. Methods: Data from Alberta Health Services administrative databases, including the National Ambulatory Care Reporting System, ED Admission/Discharge/Transfer data, and Comprehensive Ambulatory Care Classification System codes, were linked for all ED visits from 2010-17. Data were stratified by seven facility categories: tertiary referral (TR), regional referral (RR), community<5,000 inpatient discharges (CL), community>600 inpatient discharges (CM), community <600 inpatient discharges (CS), community ambulatory care (CA), and free-standing EDs (FS). Results: We analyzed 11,327,258 adult patient visits: 13% at TR, 34 % at RR, 24% at CL, 16% at CM, 9% at CS, 1% at CA, and 3% at FS sites. Acuity was highest at TR and RR hospitals, with 76%, 63%, 25%, 26%, 22%, 12% and 55% of patients falling into CTAS levels 1-3, for TR, RR, CL, CM, CS, CA, and FS respectively. Admission rates were highest at TR and RR hospitals, (23%, 13%, 5%, 5%, 4%, 0% and 0%), as were left without being seen rates, (5%, 4%, 1%, 2%, 1%, 0% and 5%). The most common ICD-10 diagnoses were chest pain/abdominal pain in TR and RR centres, and IV (antibiotic) therapy in all levels of community and FS EDs. Conclusion: Acuity and case-mix are highly variable across ED categories. Acuity, admission rates and LWBS rates are highest in TR and RR centres. Administrative data can reveal opportunities for health system re-engineering, e.g. potentially avoidable IV antibiotic visits. Further investigation will clarify the type of ED care provided, variability in resource utilization by case-mix, and allocation, and will help identify the optimal metrics to describe ED case-mix.

The nursing home case-mix classification system, Resource Utilization Groups Version III (RUG-III), has been tested and refined for long-term home care clients. The study sample included 804 individuals seeking home care through the Michigan Care Management Program or the Home and Community Based Waiver for the Elderly and Disabled. Clients were classified, and RUG-III models were derived using the Minimum Data Set for Home Care (MDS-HC). A refined home care model, RUG-III/HC, was developed incorporating Instrumental Activities of Daily Living (IADLs) to the nursing home RUG-III classification. The model explained 33.7 per cent of the variance of per diem cost, using cost weighted formal and informal care as the dependent variable. Resource use within groups was relatively homogeneous. The case-mix index (CMI) of weighted formal and informal care time spanned an eight-fold range. Further analysis is suggested regarding the inclusion of informal care as a cost in case-mix classification for long-term home care clients.

This paper reports one component of an evaluation of the different forms, types and models of local authority social services' care-management for older people that have emerged in England since 1993. It was undertaken at a time of a growing debate about whether care-management differentiated those with simple from complex needs, and whether for the latter a multi-disciplinary approach was required. A sample representative of different approaches to care-management was selected from a national survey of local authorities to explore the associations between types of care-management and case-mix, the services received by the clients, and the use of staff time. The paper addresses the categorisation of the types of care-management and the differences associated with these. The care-management teams were distinguished by whether they used a ‘targeted approach’, had ‘specialist older people's teams’, or used other arrangements. It was found that those with a targeted approach undertook more multi-disciplinary assessments, provided more assistance to older people with mental health problems, and that their staff spent significantly less time in direct contact with users and carers. Conversely, those with specialist older people's teams had more users in receipt of occupational therapy services. Further research is required to explore the influence of these different arrangements on the wellbeing of service users and their carers.