Risk stratification in Dutch primary care: a promising approach to manage population health

Abstract

Risk stratification, the systematic assessment of patients’ profiles in order to assign individual risk scores, can be used to provide personalized and population care according to that risk. In different countries, risk stratification is used to identify the right subpopulations for specific care interventions and lower expensive care utilization such as emergency care and hospitalization.

In the Netherlands, risk stratification is not yet notably used in primary care. Despite the great possibilities due to the widespread catchment area of primary care in the Netherlands and the gatekeepers function of general practitioners, systematic risk stratification approaches in Dutch primary care are minimal. The aim of this dissertation was therefor to identify and asses a suitable risk stratification tool to be used in Dutch primary care.

The main question was answered by describing a study assessing the model performance of US-based hospitalization and high costs models applied in the Dutch primary care setting. Both models showed good performance regarding discrimination and calibration properties. In addition, the models were adjusted to best fit the Dutch primary care situation. Coefficients of the underlying predictors of the models were adjusted, improving the good model performances for both the hospitalization and the high costs model.