A resident classification system that is based on data collected from resident assessments

Case mix supports a number of different grouping methodologies for populations, areas of care and assessment data.

Population grouping methodology

• The Population Grouping Methodology (POP Grouper) builds clinical and demographic profiles for each person in a population. These profiles help predict the population’s health care needs and costs. The methodology uses input data on hospital care, ambulatory care, residential care and community care services.
  • Population Grouping Methodology video
  • Population Grouping Methodology overview (PDF)
  • Population Grouping Methodology clinical and predictive outputs (PDF)
• Health system planners at the provincial, regional and facility levels can use the methodology to gather valuable insights about their population in terms of resource needs and morbidity, as well as about how the health of their population compares with that of others and has changed over time.
  • Population Grouping Methodology in Action (PDF)
• The Population Grouping Methodology will be updated as needed. For more information, including how to access the methodology and client support, please write to . 

Acute inpatient grouping methodology

• CMG+
  A refinement of the Case Mix Groups methodology. It aggregates acute care inpatients with similar clinical and resource utilization characteristics.
  • CMG+
• Resource Intensity Weights (RIWs) and Expected Length of Stay (ELOS)
  ELOS is the average acute length of stay in hospital for patients with the same Case Mix Group (CMG), age category, comorbidity level and intervention factors. RIW is a relative value measuring total patient resource use compared with average typical acute inpatients.
  • Resource Intensity Weights (RIWs) and Expected Length of Stay (ELOS)
• Case Mix Decision-Support Guide: CMG+
  A summary of the CMG+ grouping and indicator methodology. It also includes guidelines for using case-mix information for decision support as well as analytical techniques for using case-mix data.
  • Case Mix Decision-Support Guide: CMG+
• Assigning HIG Weights and ELOS Values to Ontario Inpatient DAD Cases
  Provides an explanation of the ELOS calculation and the Health Based Allocation Model (HBAM) Inpatient Group (HIG) Weight calculation for typical and atypical acute care inpatient cases.
  • Assigning HIG Weights and ELOS Values to Ontario Inpatient DAD Cases
  • Health Based Allocation Model: HBAM Inpatient Group Methodology and Reports at CIHI (PDF)

Acute ambulatory care grouping methodology

• Comprehensive Ambulatory Classification System (CACS)
  A national grouping methodology for ambulatory care patients.
  • Comprehensive Ambulatory Classification System

Continuing and specialized care grouping methodologies

Case mix also supports grouping methodologies for continuing and specialized care.

Continuing Care Reporting System (CCRS)

• Resource Utilization Groups version Ill (RUG-Ill) Grouping Methodology (June 2017) (PDF)

• Differences Between RUG-III 44-Group and 34-Group Methodologies (information sheet) (Aug. 2017) (PDF)

Resource Utilization Groups version III Plus

The RUG-III Plus case-mix system is applicable to both the Continuing Care Reporting System (CCRS) and the Integrated interRAI Reporting System (IRRS).

• RUG-III Plus case-mix system

Resource Utilization Groups, version III (RUG-III)

This grouping methodology is applied to RAI-MDS 2.0 Canadian version assessment data submitted to CCRS. Effective 2011, the CCRS RUG-III (44-group) Case Mix Index (CMI) values will no longer be a separate product; they are available only with the complete CCRS RUG-III grouper product.

• CCRS RUG-III (44-Group) Grouping Methodology
• CCRS RUG-III (34-Group) Grouping Methodology

Resource Utilization Groups Weighted Patient Day (RWPD) reports

Resource summary reports produced for complex continuing care and long-term care at the resident level.

• CCRS Technical Document: RUG Weighted Patient Day (RWPD) Methodology, 2017–2018 (Sept. 2017) (PDF)
• Continuing Care Reporting System: Interpreting RUG Weighted Patient Day Reports (Sept. 2017) (PDF)
• RUG Weighted Patient Day (RWPD) Reports Quick Reference Guide (Aug. 2017) (PDF)

Resource Utilization Groups version III, Home Care (RUG-III-HC)
This grouping methodology is applied to Resident Assessment Instrument–Home Care (RAI-HC) Canadian version assessment data submitted to the Home Care Reporting System.

• Resource Utilization Groups III Home Care (RUG-III-HC) Job Aid (Sept. 2017) (PDF)
• RUG-III-HC Grouping Methodology (Sept. 2017) (PDF)
• HCRS RUG-III-HC Grouping Methodology Flowcharts and SAS Code

Rehabilitation Patient Groups (RPGs)

A grouping methodology applied to episodes based on the FIM® instrument data submitted to the National Rehabilitation Reporting System (NRS).

• Rehabilitation Patient Group (RPG) Grouping Methodology and Weights
• RPG Grouping Methodology and Rehabilitation Cost Weights (PDF)

System for Classification of In-Patient Psychiatry (SCIPP)

A grouping methodology applied to Minimum Data Set–Mental Health (MDS-MH) assessments.

• System for Classification of In-Patient Psychiatry (SCIPP) Grouping and Weighting Methodology (June 2017) (PDF)
• SCIPP Grouping Methodology and CMI Values for SWPD Methodology

Databases related to case mix

Canadian MIS Database 
The Canadian MIS Database (CMDB) is the national data source for financial and statistical information about hospitals and health regions. The day-to-day health service operations data is collected according to a standardized framework known as the Standards for Management Information Systems in Canadian Health Service Organizations (MIS Standards). Using CMDB data, CIHI calculates the indicator Cost of a Standard Hospital Stay, which is often used in combination with case-mix tools to estimate costs for hospital services.

• Canadian MIS Database

Canadian Patient Cost Database
The Canadian Patient Cost Database (CPCD) contains patient-level costs submitted in accordance with the MIS Standards and the CPCD Patient Costing Methodology. The CPCD data is used to recalculate RIWs and recalibrate the case-mix groups in the acute inpatient and ambulatory case-mix grouping methodologies.

• Canadian Patient Cost Database

Continuing Care Reporting System 
The Continuing Care Reporting System (CCRS) contains demographic, clinical, functional and resource utilization information on individuals receiving continuing care services in hospitals or long-term care homes in Canada. Participating organizations also provide information on facility characteristics to support comparative reporting and benchmarking.

• Continuing Care Reporting System

Discharge Abstract Database 
The Discharge Abstract Database (DAD) contains demographic, administrative and clinical data on inpatient hospital discharges. Facilities in all provinces and territories except Quebec are required to report to the DAD. Quebec acute inpatient records are submitted to CIHI through a different process and are included in the Hospital Morbidity Database.

• Discharge Abstract Database

Home Care Reporting System 
The Home Care Reporting System (HCRS) contains demographic, clinical, functional and resource utilization information on clients served by publicly funded home care programs in Canada.

• Home Care Reporting System 

National Ambulatory Care Reporting System 
The National Ambulatory Care Reporting System (NACRS) contains data for all hospital-based and community-based ambulatory care: day surgery, outpatient clinics and emergency departments. Client visit data is collected at the time of service in participating facilities.

• National Ambulatory Care Reporting System 

National Rehabilitation Reporting System 
The National Rehabilitation Reporting System (NRS) contains client data collected from participating adult inpatient rehabilitation facilities and programs across Canada, including specialized facilities and hospital rehabilitation units, programs and designated rehabilitation beds.

•  National Rehabilitation Reporting System

Ontario Mental Health Reporting System 
The Ontario Mental Health Reporting System (OMHRS) contains data about individuals admitted to adult mental health beds in the province of Ontario. It includes information about their mental and physical health, as well as which social supports and services they use. The data is collected at admission, discharge and every 3 months for patients with extended stays.

• Ontario Mental Health Reporting System

Related resources on case mix

Listed below you’ll find a sample of CIHI’s education courses on case mix. Check out the job aid (PDF) on how to access these courses. You can register for any of these, or learn more about CIHI’s other courses, by visiting our Learning Centre.

• Case Mix Education job aid (PDF)
• Learning Centre

Acute

• Introduction to Case Mix for DAD and NACRS
• Introduction to CMG+
• Introduction to Resource Indicators (RIW and ELOS) for DAD and NACRS
• An Introduction to Comprehensive Ambulatory Classification System (CACS)

Continuing and specialized care

• CCRS Case Mix Fundamentals of RUG-III and RWPD
• Calculating RUG-III (44-Group)
• Introduction to the Rehabilitation Patient Group (RPG) Methodology for NRS
• Introduction to RUG Weighted Patient Days for Ontario CCRS
• OMHRS SCIPP Methodology and SCIPP Weighted Patient Day (SWPD) Report Interpretation

Regrouping historical data

Regrouping historical data is the process of assigning the most recent grouping methodology and resource indicators to historical data. Regrouped Historical Data — CIHI Reference Document provides information about this process.

Regrouping historical data is important in order to be able to monitor changes over time in resource utilization and cost.

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