Population-based Stratification Research Articles

Health risk assessment and stratification in an integrated care scenario

Background: Health risk assessment and stratification have proven highly relevant for large-scale implementation of integrated care by facilitating services design and case identification. Aim: The principal objective was to analyse five health-risk assessment strategies used in the five regions participating in the Advancing Care Coordination and TeleHealth Deployment (ACT) program (www.act-programme.eu): Scotland (UK), Basque Country (ES), Catalonia (ES), Lombardy (I) and Groningen (NL). A second aim was to explore the potential of population-based health risk predictive tools to contribute to risk prediction in the clinical setting. Method: We characterized and compared risk assessment strategies among ACT regions by analysing operational risk predictive modelling tools for population-based stratification, as well as available health indicators. The risk assessment tool deployed in Catalonia (GMA, Adjusted Morbidity Groups) was used as an example to explore how population-based analysis can contribute to clinical risk prediction. Results: The study indicated a high degree of conceptual agreement among the five ACT regions on the relevant role of population-based health risk assessment for regional deployment of integrated care. The entire ACT consortium shared its usefulness for service commission, case finding and screening. There was also consensus on the use of a population health approach as the optimal strategy for population-based risk assessment. However, the health risk predictive modelling tools in place displayed marked heterogeneities that precluded comparability of the risk pyramid distributions across regions. We identified a clear need for evolving toward risk predictive modelling tools allowing proper quantification of the estimations. Likewise, different well-identified problems mostly associated to data reporting precluded appropriate comparisons of the recommended health indicators. The current study identified transferability across regions and potential for evolving, that is flexibility, as two key requirements for any population-based health risk assessment tool. Factors such as: i) license binding constraints, ii) insufficient public availability; iii) lack of availability for inspection; and/or, iv) rigidity of some computational algorithms (i.e. due to inclusion of expert-based criteria in some morbidity groupers) are currently limiting transferability. These factors might also preclude adaptation of the current risk prediction tools toward evolving requirements such as: i) integration between healthcare and social services; and, ii) implementation of synergies between population-based and clinically oriented risk predictive modelling, as described in the study. We acknowledge some intrinsic limitations of population-based predictive modelling in terms of strength of estimations. However, their potential for allocation of individuals into the risk stratification pyramid facilitates both design and implementation of preventive strategies that have shown high potential to generate healthcare value. Moreover, the study reports on the conceptual steps required for development of innovative strategies for clinical risk predictive modelling with potential to enhance its supporting role for decision making in the clinical scenario. Conclusions : We acknowledge that further efforts should be devoted to improve both comparability and flexibility of current population-based health risk predictive modelling approaches. The novel strategy for enhanced clinical risk assessment requires prospective evaluation.

A novel approach to population-based risk stratification, comprising individualized lifestyle intervention in Danish general practice to prevent chronic diseases: Results from a feasibility study.

Early detection of patients at risk seems to be effective for reducing the prevalence of lifestyle-related chronic diseases. We aim to test the feasibility of a novel intervention for early detection of lifestyle-related chronic diseases based on a population-based stratification using a combination of questionnaire and electronic patient record data. The intervention comprises four elements: (1) collection of information on lifestyle risk factors using a short 15-item questionnaire, (2) electronic transfer of questionnaire data to the general practitioners' electronic patient records, (3) identification of patients already diagnosed with a lifestyle-related chronic disease, and (4) risk estimation and stratification of apparently healthy patients using questionnaire and electronic patient record data on validated risk estimation models. We show that it is feasible to implement a novel intervention that identifies and stratifies patients for further examinations in general practice or behaviour change interventions at the municipal level without any additional workload for the general practitioner.

199. Calcium metabolism, the renin-angiotension-aldosterone system, and the acute blood pressure response to calcium blockade

Hypertension (HTN) is an important risk factor for cardiovascular disease (CVD) but the association between HTN and CVD cannot be explained by average blood pressure (BP) alone. BP variability (BPV) is another important factor, along with the effects of HTN on the vasculature. The concept of systemic hemodynamic atherothrombotic syndrome (SHATS) has been proposed, describing an age-related and synergistic vicious cycle of hemodynamic stress and vascular disease. The importance of SHATS is based on the assumption that the assessment of BPV and arterial disease is likely to provide an effective opportunity to intervene early to reduce progression to HTN in younger patients or to CVD events and organ damage in older patients. In addition to providing an overview of current evidence for the mechanisms and clinical data related to SHATS, this article proposes a new SHATS score for use to diagnose and assess the severity of SHATS. The score includes two components – a BP score and a vascular score – which are multiplied to generate the SHATS score. This reflects the synergistic, rather than additive, effects of BP and vascular disease on target organ damage and CVD events. Although it requires refinement and validation in future studies, early detection of SHATS using tools such as the proposed score, combined with population-based stratification and technology-based anticipation medicine incorporating real-time individual data, has the potential to contribute to meaningful reductions in rates of CVD events and target organ damage.