Risk Stratification: A Two-Step Process for Identifying Your Sickest Patients
Assessing the health risk of your patients can yield improvements in efficiency and use of resources.
Fam Pract Manag. 2019 May-June;26(3):21-26.
Author disclosure: no relevant financial affiliations disclosed.
When my office received our initial shipment of influenza vaccine in 2018, we wanted to provide immunizations to our most vulnerable patients quickly. But how could we find them out of the thousands who regularly look to us for care? Earlier in the year, through a process known as risk stratification, we had evaluated our entire patient panel and assigned a risk level to each one. We immediately assigned staff to reach out to our highest risk patients to ensure that they received the vaccine.
In family medicine, we manage patients with conditions that vary widely in their medical complexity. Each requires a different amount of resources, depending on that complexity. An otherwise healthy patient with a viral upper respiratory tract infection needs a short office visit and no referrals, while a patient receiving end-of-life care requires extra previsit planning, additional in-office time, referrals to specialists or home care providers, and an extended follow-up plan.
Risk stratification is a technique for systematically categorizing patients based on their health status and other factors. It allows for risk-stratified care management, in which practices manage patients based on their assigned risk level to make better use of limited resources, anticipate needs, and more proactively manage their patient population. (See “From risk stratification to risk-stratified care management.”)
This article will explain how our practice uses a structured, algorithmic approach to determine our patients' risk levels and drive better care team support for our patients.
Risk stratification uses a mix of objective and subjective data to assign risk levels to patients.
Practices can systematically use patient risk levels to make care management decisions, such as providing greater access and resources to patients in higher risk levels.
Risk stratification helps practices to better focus on their sickest patients, reduce costs, and improve care.
FROM RISK STRATIFICATION TO RISK-STRATIFIED CARE MANAGEMENT
Risk stratification has enabled our practice to provide risk-stratified care management. Here are some examples.
We are better able to select patients who will benefit most from working with our integrated behaviorist, who is on-site only one day a week.
We use risk to identify patients for longitudinal care management.
We schedule higher-risk patients for longer visits.
We consider patients' risk levels when prioritizing resources, such as flu shots or education classes.
A TWO-STEP APPROACH
For the purpose described in this article, “risk” refers to clinical risk, or the likelihood of an adverse clinical outcome. Sometimes clinical risk is obvious; for example, you would expect a patient with rheumatoid arthritis to have more complications in the future than
1. American Academy of Family Physicians. The EveryONE Project: Advancing Health Equity in Every Community.” https://www.aafp.org/patient-care/social-determinants-of-health/everyone-project.html. Accessed March 27, 2019.
2. Haas LR, Takahashi PY, Shah ND, et al. Risk-stratification methods for identifying patients for care coordination. Am J Manag Care. 2013;19(9):725–732.
3. Reddy A, Sessums L, Gupta R, et al. Risk stratification methods and provision of care management services in comprehensive primary care initiative practices. Ann Fam Med. 2017;15(5):451–454.
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