Community for an age-friendly society

Activation of Risk Stratification Strategies - ASSEHS Project

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Objectives of ASSEHS

The Basque Country leads at European level the project ASSEHS on risk stratification for frail patients. The project aims to improve the implementation of risk stratification strategies, identifying success factors that translate into a better population health planning. In ASSEHS, 9 European partners with expertise in risk stratification will work alongside. The project has a duration of 3 years and in its final stage it will implement best practices in risk stratification in 4 regions; Basque Country, Catalonia, Lombardy and Puglia.

What is risk stratification?

Risk stratification allows predicting the health needs of each patient through the use of mathematical tools. By anticipating to the needs of the patient, health resources are maximized and the emergence of health complications can be prevented. As a consequence, risk stratification enables the design and implementation of tailored interventions and helps to achieve better health outcomes of the population. Risk stratification has been proven useful in different kinds of health systems and organizations within and outside the European Union.

Importance of risk stratification in the Basque Country

Since 2009 the Basque Country is working in the transformation of the health care model to provide better care for chronic patients, improving their quality of life and health outcomes and contributing to the sustainability of the health system. As part of this transformation process, in 2010, the Health Department of the Basque Government and Osakidetza developed a statistical tool adapted to the characteristics of the population served by Osakidetza.

The result was a tool based on data of drug consumption, hospitalization, medical diagnoses of primary and specialized care and socio-demographic data of each patient. The tool produces a predictive index (PI) that locates each patient on a scale of risk of need of assistance. The Department of Health and Osakidetza have used this information to design a set of Population Intervention Plans, with the aim of providing a proactive and preventive care appropriate for patients who can benefit from it. Therefore, the Basque Country accumulates valuable experience in risk stratification.

Basque leadership

As a result, the Basque Country leads ASSEHS European project, which began in January this year. It is funded by the European Commission as part of the strategy to increase healthy life years and promote healthy and active aging. The main objective is to activate and drive ASSEHS based risk stratification strategies and evaluate its effectiveness for treating frail patients. A European consortium of 9 partners with expertise in risk stratification for patients will participate in ASSEHS: Catalonian Government-Ticsalut, Ares-Puglia, Mario Negri, Kronikgune, Osakidetza, Philips, CHRU-Montpellier, University of Valencia-Polibienestar Institute and Telbios. Additionally, this project will have external expert advice accredited internationally for its expertise in implementing stratification strategies.

Future Plans

The outcomes of this project are expected to contribute to strengthen and extend the use of risk stratification in daily practice, planning and management of health systems, and to generate knowledge about which risk stratification strategies are best suited for each situation, taking into account variables such as the target health system model, the health care setting where the organization wants to implement the tool or the pathology. Finally, ASSEHS aims further than analyzing only tools themselves but also the stratification process of implementing these tools in health systems.