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Profiling the different needs and expectations of patients for population-based medicine: a case study using segmentation analysis.

ABSTRACT: BACKGROUND: This study illustrates an evidence-based method for the segmentation analysis of patients that could greatly improve the approach to population-based medicine, by filling a gap in the empirical analysis of this topic. Segmentation facilitates individual patient care in the context of the culture, health status, and the health needs of the entire population to which that patient belongs. Because many health systems are engaged in developing better chronic care management initiatives, patient profiles are critical to understanding whether some patients can move toward effective self-management and can play a central role in determining their own care, which fosters a sense of responsibility for their own health. A review of the literature on patient segmentation provided the background for this research. METHOD: First, we conducted a literature review on patient satisfaction and segmentation to build a survey. Then, we performed 3,461 surveys of outpatient services users. The key structures on which the subjects' perception of outpatient services was based were extrapolated using principal component factor analysis with varimax rotation. After the factor analysis, segmentation was performed through cluster analysis to better analyze the influence of individual attitudes on the results. RESULTS: Four segments were identified through factor and cluster analysis: the "unpretentious," the "informed and supported," the "experts" and the "advanced" patients. Their policies and managerial implications are outlined. CONCLUSIONS: With this research, we provide the following: - a method for profiling patients based on common patient satisfaction surveys that is easily replicable in all health systems and contexts;- a proposal for segments based on the results of a broad-based analysis conducted in the Italian National Health System (INHS).Segments represent profiles of patients requiring different strategies for delivering health services. Their knowledge and analysis might support an effort to build an effective population-based medicine approach.

SUBMITTER: Lega F

PROVIDER: S-EPMC3573906 | biostudies-other | 2012

REPOSITORIES: biostudies-other

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Profiling the different needs and expectations of patients for population-based medicine: a case study using segmentation analysis.

Lega Federico F Mengoni Alessandro A

BMC health services research 20121221

<h4>Background</h4>This study illustrates an evidence-based method for the segmentation analysis of patients that could greatly improve the approach to population-based medicine, by filling a gap in the empirical analysis of this topic. Segmentation facilitates individual patient care in the context of the culture, health status, and the health needs of the entire population to which that patient belongs. Because many health systems are engaged in developing better chronic care management initia ...[more]

PMID: 23256543

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Project description:BackgroundHealthcare needs-based population segmentation is a promising approach for enabling the development and evaluation of integrated healthcare service models that meet healthcare needs. However, healthcare policymakers interested in understanding adult population healthcare needs may not be aware of suitable population segmentation tools available for use in the literature and barring better-known alternatives, may reinvent the wheel by creating and validating their own tools rather than adapting available tools in the literature. Therefore, we undertook a systematic review to identify all available tools which operationalize healthcare need-based population segmentation, to help inform policymakers developing population-level health service programmes.MethodsUsing search terms reflecting concepts of population, healthcare need and segmentation, we systematically reviewed and included articles containing healthcare need-based adult population segmentation tools in PubMed, CINAHL and Web of Science databases. We included tools comprising mutually exclusive segments with prognostic value for clinically relevant outcomes. An updated secondary search on the PubMed database was also conducted as the last search was conducted 2?years ago. All identified tools were characterized in terms of segment formulation, segmentation base, whether they received peer-reviewed validation, requirement for comprehensive electronic medical records, proprietary status and number of segments.ResultsA total of 16 unique tools were identified from systematically reviewing 9970 articles. Peer-reviewed validation studies were found for 9 of these tools.Discussion and conclusionsThe underlying segmentation basis of most identified tools was found to be conceptually comparable to each other which suggests a broad recognition of archetypical patient overall healthcare need profiles. While many tools operate based on administrative record data, it is noted that healthcare systems without comprehensive electronic medical records would benefit from tools which segment populations through primary data collection. Future work could therefore include development and validation of such primary data collection-based tools. While this study is limited by exclusion of non-English literature, the identified and characterized tools will nonetheless facilitate efforts by policymakers to improve patient-centred care through development and evaluation of services tailored for specific populations segmented by these tools.

Project description:BackgroundAs populations age with increasingly complex chronic conditions, segmenting populations into clinically meaningful categories of healthcare and related service needs can provide healthcare planners with crucial information to optimally meet needs. However, while conventional approaches typically involve electronic medical records (EMRs), such records do not always capture information reliably or accurately.ObjectiveWe describe the inter-rater reliability and predictive validity of a clinician-administered tool, the Simple Segmentation Tool (SST) for categorizing older individuals into one of six Global Impression (GI) segments and eight complicating factors (CFs) indicative of healthcare and related social needs.DesignObservational study ( ClinicalTrials.gov , number NCT02663037).ParticipantsPatients aged 55 years and above.Main measuresEmergency department (ED) subjects (between May and June 2016) had baseline SST assessment by two physicians and a nurse concurrently seeing the same individual. General medical (GM) ward subjects (February 2017) had a SST assessment by their principal physician. Adverse events (ED visits, hospitalizations, and mortality over 90 days from baseline) were determined by a blinded reviewer. Inter-rater reliability was measured using Cohen's kappa. Predictive validity was evaluated using Cox hazard ratios based on time to first adverse event.Key resultsCohen's kappa between physician-physician, service physician-nurse, and physician-nurse pairs for GI were 0.60, 0.71, and 0.68, respectively. Cox analyses demonstrated significant predictive validity of GI and CFs for adverse outcomes.ConclusionsWith modest training, clinicians can complete a brief instrument to segment their patient into clinically meaningful categories of healthcare and related service needs. This approach can complement and overcome current limitations of EMR-based instruments, particularly with respect to whole-patient care.Trial registrationClinicalTrials.gov Identifier: NCT02663037.

Project description:ObjectiveTo compare countries' health care needs by segmenting populations into a set of needs-based health states.Data sourcesWe used seven waves of the Survey of Health, Aging and Retirement in Europe (SHARE) panel survey data.Study designWe developed the Cross-Country Simple Segmentation Tool (CCSST), a validated clinician-administered instrument for categorizing older individuals by distinct, homogeneous health and related social service needs. Using clinical indicators, self-reported physician diagnosis of chronic disease, and performance-based tests conducted during the survey interview, individuals were assigned to 1-5 global impressions (GI) segments and assessed for having any of the four identifiable complicating factors (CFs). We used Cox proportional hazard models to estimate the risk of mortality by segment. First, we show the segmentation cross-sectionally to assess cross-country differences in the fraction of individuals with different levels of medical needs. Second, we compare the differences in the rate at which individuals transition between those levels and death.Data collection/extraction methodsWe segmented 270,208 observations (from Austria, Belgium, Czech Republic, Denmark, France, Germany, Greece, Israel, Italy, the Netherlands, Poland, Spain, Sweden, and Switzerland) from 96,396 individuals into GI and CF categories.Principal findingsThe CCSST is a valid tool for segmenting populations into needs-based states, showing Switzerland with the lowest fraction of individuals in high medical needs segments, followed by Denmark and Sweden, and Poland with the highest fraction, followed by Italy and Israel. Comparing hazard ratios of transitioning between health states may help identify country-specific areas for analysis of ecological and cultural risk factors.ConclusionsThe CCSST is an innovative tool for aggregate cross-country comparisons of both health needs and transitions between them. A cross-country comparison gives policy makers an effective means of comparing national health system performance and provides targeted guidance on how to identify strategies for curbing the rise of high-need, high-cost patients.

Project description:Data on the prevalence of chronic hepatitis B (HBV) and hepatitis C (HCV) virus infections, including the proportion of individuals aware of infection, are scarce among migrants living in Europe. We estimated the prevalence of past and present HBV and HCV infection, along with their determinants and peoples' awareness of infection status, among different groups of first-generation migrants and Dutch-origin residents of Amsterdam. Methods:Cross-sectional data of 998 Surinamese (mostly South-Asian and African-Surinamese), 500 Ghanaian, 497 Turkish, 498 Moroccan and 500 Dutch-origin participants from the observational population-based HELIUS study were used. Blood samples of participants were tested for HBV and HCV infection. Infection awareness was determined using records from participants' general practitioners. Results:Age- and gender-adjusted chronic HBV prevalence was highest among Ghanaian participants (5.4%), followed by Turkish (4.1%), African-Surinamese (1.9%), Moroccan (1.2%), South-Asian Surinamese (0.9%) and Dutch (0.4%) participants. A total of 58.1% of the cases were aware of their infection. In multinomial logistic regression analyses, Ghanaian (adjusted odds ratio [aOR] 42.23; 95% confidence interval [CI] 9.29-192.01), African-Surinamese (aOR 6.16; 95% CI 1.27-29.79), and Turkish (aOR 13.44; 95% CI 2.94-61.39) participants were at increased risk of chronic HBV infection compared with those of Dutch origin. Older participants were also at increased risk (aOR 1.02 per year; 95% CI 1.00-1.05), whereas women were at lower risk (aOR 0.49; 95% CI 0.29-0.83). HCV prevalence was 0.4% (95% CI 0.1-1.3%) among Dutch and African-Surinamese and 0% (95% CI 0.0-0.5%) for each of the other groups; all cases with follow-up data were aware of their infection. Conclusions:Ghanaian, Turkish and African-Surinamese first-generation migrants are at increased risk of chronic HBV infection and many are unaware of their infection, whereas HCV prevalence was low among all ethnic groups. Screening campaigns are urgently warranted and need to consider specific ethnic groups. Lay summary:First-generation migrants of Ghanaian, Turkish and African-Surinamese origin were at increased risk of chronic hepatitis B infection, with most infections occurring in older individuals and males. Since over 40% of people were unaware of their chronic hepatitis B infection, screening of these migrant groups is urgently needed. The proportion of first-generation migrants chronically infected with hepatitis C virus was very low among all groups studied.

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Profiling the different needs and expectations of patients for population-based medicine: a case study using segmentation analysis.

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Profiling the different needs and expectations of patients for population-based medicine: a case study using segmentation analysis.

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