Risk stratification is the process of using tools to identify and predict which patients are at high risk or likely to be at high risk and prioritizing the management and care of these patients in order to prevent deadly outcomes such as amputation, blindness or death. Risk stratification is an intentionally planned and proactive process carried out to effectively target clinic services to patients. Put simply, to risk-stratify patients is to
sort them into high, moderate and low health risk tiers. Risk stratification aligns a practice’s very limited time and resources to prioritize the needs of its patient population. It can and should involve sophisticated algorithms and robust registries, but it relies just as much on patient experience and the physician’s judgment.When it comes to risk management it almost always begins with risk stratification. The foundational step of targeting these high-risk patients is, of course, to identify them. For example, accountable care organizations have to be able to pinpoint which heart failure patients are at high risk for readmission. Armed with this knowledge, clinicians can schedule follow-up appointments and ensure those patients understand their medications and other aspects of the care plan. Likewise, ACOs must be able to identify patients with a rising risk index that could be triggered by sudden weight gains or hemoglobin A1c values that are trending upward.
The process of separating patient populations into high-risk, low-risk, and the ever-important rising-risk groups is called risk stratification. Having a platform to stratify patients according to risk is key to the success of any population health management initiative.
There are some things that guide physicians in Understanding Risk Stratifications
Better data means a better process: The ability to get a useful stratification depends on integrating multiple sources of data. The more data an organization has, the better able they are to predict outcomes. Access to more actionable data within a process driven by clinical judgment and shared patient decision-making improves the ability of a practice team to proactively align resources with patient needs.
The patient’s voice and the clinician’s judgment are both essential: Perhaps the most important source of data, is the patient. Do not ignore the patient. Patient Activation Measures, screening and health risk assessments all have predictive value. But so does asking “Do you think your health is ‘good,’ ‘fair’ or ‘poor’?”
Start where you are: There’s no one perfect way to stratify risk. The “how” of getting that list varies depending on the practice, its patients and the reasons for making a list in the first place. Healthcare organizations and health practitioners should not become bogged down in the “how”. And should not let the fear of the process overwhelm or prevent achievement of the goal. There’s no one right way: Start somewhere— don’t be paralyzed by the multitude of choices at the outset. Think of it as a classic process improvement challenge. Start with something, measure how it works, learn from it, and keep refining it as you go through iterative cycles.”
Multiple studies have found that people overestimate their ability to influence events that, in fact, are heavily determined by chance. We tend to be overconfident about the accuracy of our forecasts and risk assessments and far too narrow in our assessment of the range of outcomes that may occur. We also anchor our estimates to readily available evidence despite the known danger of making linear extrapolations from recent history to a highly uncertain and variable future. We often compound this problem with a confirmation bias, which drives us to favor information that supports our positions (typically successes) and suppress information that contradicts them (typically failures). When events depart from our expectations, we tend to escalate commitment, irrationally directing, even more, resources to our failed course of action.
Organizational biases also inhibit our ability to discuss risk and failure. In particular, teams facing uncertain conditions often engage in groupthink: Once a course of action has gathered support within a group, those not yet on board tend to suppress their objections—however valid—and fall in line.