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The use of a population stratification tool has helped Spain develop health services that respond more accurately and comprehensively to the actual health needs of both groups and individuals.
As part of a broader shift towards more patient-centred care, the Spanish Ministry of Health, Social Services and Equality has promoted the scaling up of a population grouper named Adjusted Morbidity Groups (AMG). The tool was initially developed in Catalonia and is now used in most Spanish regions. This population stratification tool groups patients according to their health status, giving the health authorities valuable information about how to plan services and the use of resources. Sound and reliable information is the foundation of decision-making in building efficient, patient-centred health systems.
A tool with many uses for better population health management
The AMG tool provides a helpful entry point to better understand the distribution of health risk across the population, and different Spanish regions have used the tool for different analytical purposes. Based on morbidity data, the AMG grouper allowed the identification of the number of people with chronic diseases and different complexity levels, which provided a picture of the risk of occurrence of some health outcomes, such as mortality, needing emergency assistance, and greater pharmaceutical expenditure. As expected, such risks were particularly high among those aged 65 and older. This information is crucial in designing the right interventions for both disease prevention and management of different chronic conditions.
“The most widespread use of the AMG tool is in case finding,” says Paloma Casado Durández, Deputy Director of Quality and Cohesion at the Ministry of Health, Social Services and Equality. The different regions utilize the health data to identify and refer high-risk patients to regional programmes for chronic patients. The tool can also be used in primary care for proactive management of patients within different risk levels. “In some regions, the AMG risk score is listed in the patient’s electronic health records. With this information, health professionals can forecast the patient´s prognosis and tailor clinical interventions to specific health needs,” says Ms Casado Durández.
Further uses of the tool include resource and health workforce planning, among others. The AMG tool also helps analyse population morbidity and identify vulnerable groups. One region used the AMG data to identify the people who were eligible for influenza vaccination and was then able to encourage the populations most at risk to get vaccinated through an SMS campaign.
No single tool is enough – action on all fronts is needed
With the data provided by the AMG tool, regions are now able to better estimate current and future risks of mortality and morbidity, as well as a set of health service utilization variables. As a result, it is possible to improve overall health-care management through the introduction of transparent and evidence-based criteria in decision-making about health programmes, policies and resource allocation. AMG is, however, only one tool among many others that has supported the overall reshaping of the health system in the different Spanish regions.
“At the end of the day, it’s not about which software or tool you choose – the tool is just a means,” says Ms Casado Durández. “All reforms have to be guided by a strategy, which places the patient at the heart of actions. You need multiple approaches to achieve your vision. One tool can provide one part of the solution, but not all of it,” she emphasizes.
The population health management approach to health services delivery is increasingly recognized as the future of primary health care. Population risk stratification will play an important role in creating better health services.
“Rooting services delivery transformations in the population’s health needs and risk factors is one of the key priorities identified in the European Framework for Action on Integrated Health Services Delivery,” says Juan Tello, Head of Office, WHO European Centre for Primary Health Care in Almaty, Kazakhstan. “The experience from Spain shows us how countries are already making progress towards our common goal of people-centred, integrated health care.”
The population stratification tool is one of many examples of good practice which will be shared to inspire policy-makers attending the high-level regional meeting Health Systems Respond to Noncommunicable Diseases (NCDs), on 16–18 April 2018, in Sitges, Spain.