Risk stratification is a technique to systematically categorize patients according to their health status and other factors. It enables management of care stratified by risk, in which practices manage patients based on their assigned risk level to make better use of limited resources, anticipate needs, and more proactively manage patients.
FROM RISK STRATIFICATION TO RISK-STRATIFIED CARE MANAGEMENT
The risk stratification It has enabled medical practice to provide risk-stratified care management.
Here are some examples.
The use of risk to identify patients for longitudinal care management.
Scheduling higher risk patients for longer visits.
Consider patient risk levels when prioritizing resources, such as flu shots or education classes.
A TWO-STEP APPROACH
“Risk” refers to the clinical risk or probability of an adverse clinical outcome. Sometimes the clinical risk is obvious; for example, a patient with rheumatoid arthritis would be expected to have more complications in the future than a patient with osteoarthritis. Other times, risk assessment comes down to your “intuition” about what is happening with the patient.
FIRST STEP
The first step is to classify patients into one of three risk groups (high, medium and low) based on objective data, which we take from claims or electronic health records (EHR).
Determinations should be made based on the presence or absence of factors such as chronic conditions, advanced age, multiple comorbidities. As well as physical limitations, substance abuse, lack of health insurance, low health literacy, frequent hospitalizations or visits to the emergency department (ED), major surgery or brain trauma, polypharmacy or difficulty in following a treatment plan.
Some will calculate a risk score automatically based on this data. In either case, it is important to adjust the score based on additional subjective considerations, which are the focus of step two.
SECOND STEP
In step two, we assign each patient to one of six risk levels based on how doctors and staff answer the following questions:
Is the patient healthy and without medical problems? If so, is your biometrics in or out of range?
Does the patient have chronic diseases but is he well?
Does the patient have chronic diseases out of control but without complications?
Is the patient potentially in danger of dying or being institutionalized in the next year?
SCALE / DISQUALIFICATION CRITERIA
These intangible factors can lead staff to increase or decrease a patient’s level of second-step risk:
Assessment of whether the patient is “living on the edge.”
Ease or difficulties with activities of daily living and instrumental activities of daily living.
INCORPORATION OF RISK STRATIFICATION INTO YOUR PRACTICE WORKFLOW
There are several ways to implement risk stratification in your practice workflow, depending on your staff, patient population, and goals. A smaller practice with fewer resources may want to focus on only a subset of patients, while a larger practice may want to stratify risk across the entire patient population.
Here are some ways to get started:
- Use a daily team group to discuss and assign risk levels to patients who are scheduled to be seen that day or the next.
- Use designated weekly or monthly team meetings to discuss and assign risk levels to all patients. Starting with those whose objective data suggests they are potentially most at risk.
REMEMBER:
Whichever method you use, risk stratification should be viewed as a dynamic process. You should reassess risk scores regularly and also as you become aware of changes in the patient’s condition.
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