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Applying Resource Utilization Groups (RUG-III) in Hong Kong Nursing Homes*

  • Kee-Lee Chou (a1), Iris Chi (a2) and Joe C.B. Leung (a1)


Resource Utilization Groups III (RUG-III) is a case-mix system developed in the United States for categorization of nursing home residents and the financing of residential care services. In Hong Kong, RUG-III is based on several board groups of residents. The aim of this study was to examine the reliability and validity of the RUG-III in Hong Kong nursing homes. A cross-sectional survey was conducted in seven residential facilities operated by one agency. Residents (N=1,127) were assessed by the Minimum Data Set (MDS) and nursing as well as auxiliary staff care times were recorded within 2 weeks before or after the completion of MDS assessment. Forty-five out 1,127 residents were re-interviewed by an independent assessor to assess the inter-rater reliability. The inter-rater reliability of MDS assessment was excellent (κ=0.76) and the original RUG-III accounted for about 30 per cent of nursing staff time. Results provide preliminary evidence to support that RUG-III is a reliable and valid case-mix system for Hong Kong nursing homes, but future studies must be explored to reduce the variance of resource use explained by this case-mix system.

Le système de classification des malades Resource Utilization Groups III (RUG-III) est un indice de composition de la clientèle élaboré aux États-unis pour classer les pensionnaires des maisons de soins infirmiers et le financement des services de soins en établissement. À Hong Kong, RUG III est basé sur plusieurs groupes de pensionnaires. Le but de la présente étude était d'examiner la fiabilité et la validité de RUG III dans les maisons de soins infirmiers de Hong Kong. Une enquête transversale a été effectuée dans sept établissements de soins de longue durée exploités par une seule agence. Les pensionnaires (n=1 127) ont été évalués selon un ensemble minimal de données et aussi de soins, et le temps passé par le personnel auxiliaire à la dispense des soins a été consigné durant deux semaines avant ou après la fin de l'évaluation de l'ensemble minimal des données. Un évaluateur indépendant a rencontré de nouveau 45 des 1 127 résidents afin d'évaluer le coefficient d'objectivité. Le coefficient d'objectivité de l'évaluation de l'ensemble minimal des données était excellent (Kappa=0,76) et le RUG III initial a compté pour quelque 30 pour cent du temps du personnel infirmier. Les résultats apportent une preuve préliminaire permettant d'étayer que RUG III est un indice fiable et valide de la composition de la clientèle des maisons de soins infirmiers de Hong Kong, mais il faudra effectuer d'autres études afin de réduire la variance de l'utilisation des ressources expliquée par cet indice de composition de la clientèle.


Corresponding author

Requests for offprints should be sent to:/Les demandes de tirés-à-part doivent être adressées à: Kee-Lee Chou, Department of Social Work and Social Administration, University of Hong Kong, Pokfulam Road, Hong Kong, (


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The authors wish to thank our collaborator, Hong Kong Sheng Kung Hui Welfare Council, a research assistant for her assistance in data collection, and those who kindly volunteered to participate in the study. We also acknowledge the work of the project group including Esther Hui, Rebecca Wong, Mee Tim Chow, Kit Yuen, Regina Ting, Joe Sham, Danny Chow, and Harmony Wong and the administration and staff of the facilities participating in this effort. Support for this research was provided by the Research Grant Council (HKU 7295/04H).



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Björkgren, M.A., Fries, B.E., Häkkinen, U., & Brommels, M. (2004). Case-mix adjustment and efficiency measurement. Scandinavian Journal of Public Health, 32, 464471.
Björkgren, M.A., Häkkinen, U., Finne-Soveri, U.H., & Fries, B.E. (1999). Validity and reliability of Resource Utilization Groups (RUG-III) in Finnish long-term care facilities. Scand Journal of Public Health, 27, 228234.
Brizioli, E., Bernabei, R., Grechi, F., Masera, F., Landi, F., Bandinelli, S., Cavazzini, C., Gangemi, S., & Ferrucci, L. (2003). Nursing home case-mix instruments: Validation of the RUG-III system in Italy. Aging Clinical and Experimental Research, 15, 243253.
Carpenter, I.G., Main, A., & Turner, G.F. (1995). Casemix for the elderly inpatient: Resource Utilization Groups (RUGs) validation project. Age and Ageing, 24, 513.
Carpenter, I.G., Perry, M., Challis, D., & Hope, K. (2002). Identification of registered nursing care of residents in England nursing homes using the Minimum Data Set Resident Assessment Instrument (MDS/RAI) and Resource Utilization Groups version III (RUG-III). Age and Ageing, 32, 279285.
Carrillo, E., Garcia-Altes, A., Peiro, S., & Portella, E. (1996). System for the classification of patients in mid- and long-term care facilities: Resource Utilization Groups, version III. Validation in Spain (original in Spanish). Revista de Gerontologia, 6, 276284.
Census and Statistics Department (2006). Hong Kong population by-census. Hong Kong: Hong Kong Special Administration Region Government Printer.
Census and Statistics Department (2007). Hong Kong population projections 2007–2036. Hong Kong: Hong Kong Special Administration Region Government Printer.
Chou, K.L., Chi, I., Leung, A.C.T., Wu, Y.M., & Liu, B.C.P. (2001). Validation of minimum data set for nursing home for Hong Kong Chinese elders. Clinical Gerontologist, 23, 4354.
Chou, K.L., Chow, N.W.S., & Chi, I. (2005). A proposal for a voucher system for long-term care in Hong Kong. Journal of Aging and Social Policy, 17, 85106.
Fleiss, J.L. (1981). Statistical methods for rates and proportions. (2nd ed.). New York: Wiley.
Fleiss, J.L., & Cohen, J. (1973). The equivalence of Weighted Kappa and the intraclass correlation coefficient as measures of reliability. Educational and Psychological Measurement, 33, 613619.
Francesconi, P., Cantini, E., Bavazzano, E., Lauretani, F., Bandinelli, S., Buiatti, E., & Ferrucci, L. (2006). Classification of residents in nursing homes in Tuscany (Italy) using Resource Utilization Groups Version III (RUG-III). Aging Clinical and Experimental Research, 18, 133140.
Fries, B.E., & Cooney, L.M. (1985). Resource Utilization Groups: A patient classification for long-term care. Medical Care, 23, 110122.
Fries, B.E., Schneider, D.P., Foley, W.J., Gavazzi, M., Burke, R., & Cornelius, E. (1994). Refining a case mix measure for nursing homes: Resource Utilization Groups (RUG-III). Medical Care, 32, 668685.
Frijters, D., & Van der Kooij, C. (1991). Resource Utilization Groups for nursing home patients in the Netherlands. Utrecht: Dutch Centre for Health Care Information.
Ikegami, N., Fries, B.E., Takagi, Y., Ikeda, S., & Ibe, T. (1994). Applying RUG-III in Japanese long-term care facilities. Gerontologist, 34, 628639.
Kim, E.K., Park, H.Y., & Kim, C.Y. (2004). On the feasibility of a RUG-III based payment system for long-term care facilities in Korea. Taehan Kanho Hakhoe chi, 34, 278289.
Laine, J. (2006). RUG-III for exploring the association between staffing levels and cost-efficiency in nursing facility care in Finland. Health Care Management Review, 31, 7377.
Leung, E.M.F. (2001). Changing needs and changing service delivery for long-term care in Hong Kong. Journal of Aging and Social Policy, 13, 155168.
Ljunggren, G., Fries, B.E., & Winbald, U. (1992). International validation and reliability testing of a patient classification system for long-term care. European Journal of Gerontology, 1, 4859.
Schneider, D.P., Fries, B.E., Foley, W.J., Desmond, M., & Gormley, W. (1988). Case mix for nursing home payment: Resource Utilization Groups, version II. Health Care and Financial Review, 9, 3952.
Topinkova, E., Neuwirth, J., Mellanova, A., Stankova, N., & Haas, T. (2000). Case-mix classification in post-acute and long-term care. Validation of Resource Utilization Groups III (RUG-III) in the Czech Republic. Cas Lek Cesk, 139, 4248.


Applying Resource Utilization Groups (RUG-III) in Hong Kong Nursing Homes*

  • Kee-Lee Chou (a1), Iris Chi (a2) and Joe C.B. Leung (a1)


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