When a patient enters a doctor’s office, clinic or hospital, there is an unspoken expectation that he or she will receive the best care possible and have it done in a timely manner. The healthcare professionals know this and work hard to make this happen. As such, they have a tool that helps them to understand the level of care that they are to be giving in the form of stratification of patients, or more simply stated: grouping of patients according to their level of risk and requirements.
Many of us have had the opportunity to sit in a hospital emergency department due to a severe health event or concern. Most of the time it feels like just about every patient before and after your arrival has been admitted, while you are stuck waiting for your name to be called. Obviously, there are some patients that need much more urgent attention, however, what is the way in which priority is determined as to who is seen above someone else who has been waiting a significant amount of time? In the past, this was somewhat of a guessing game that had to deal with the outward seriousness of the health condition or injury. Things have changed due to a number of factors, many of them technologically based, to help identity which patients are at a higher risk of having their health deteriorate. For example, someone suffering from possible effects of a stroke is at a much higher risk and need for immediate attention as compared to someone who might have gall stones. One bit of technology that has changed the face of healthcare is the move from handwritten and stored medical history to an all-digital format know as an EMR or electronic medical record. The reason that this is so significant is that digital files and records are able to be transmitted across the street and across the world to help enable healthcare professionals to know what is going on with the person in front of them. If the patient has a history of diabetic episodes, a doctor is then able to assess a situation much more acutely and provide the right treatment at the right moment.
Along with moving to a digital medical record comes the added benefit that millions of patients are contributing information about medical events into a medical database. Insights and patterns are then able to be formed and followed as a result. Thus, when a patient is admitted with certain characteristics, and his or her medical record is pulled up, healthcare software is able to piece apart what is going on, what has happened in the past and compare that to other patients that have had similar occurrences and be able to present information to the physician that will be essential to best treat the patient. Stratification of patients helps to identify the current and future needs of patients and places them into the following categories according to their risk levels:
- High risk category – usually includes elderly patients, patients with multiple chronic and severe ailments, may be in and out of healthcare facilities and taking several different medications
- Moderate risk category – usually includes patients with a number of chronic ailments, at risk for becoming high-risk, and may be on a number of medications
- Low risk category – usually include someone that only has minor or no health issues, may not be taking medications and may only need medical assistance on rare occasions
- Growing risk category – usually includes patients that have gradually increased in health risk due to ongoing issues, requires more prescriptions over time and has sought medical treatments more frequently
Though it seems like this categorization may seem quite easy and straightforward to figure out with each patient, the healthcare process is much more in-depth than putting a patient into a group. High-risk patients are not simply in need of physician’s care, medicine and checkups; these patients need a support system that can include family assistance, a care management program and a care manager, who would be able to answer questions, be an advocate between the patient and the doctor and also an advocate between the patient and insurance company. Unfortunately, many high-risk patients have worsened over time because they have fallen between the cracks of the healthcare system or they don’t understand all that they should be doing to sustain or better their health. This sort of cycle only leads to further complications and a deterioration of health, along with rising costs and more demands put upon the patient.
Each category helps the healthcare professionals to set into place a set of actions that will help to better the person’s health or their situation. This type of care management is needed to help guard the patient from becoming worse, being left without the assistance that he or she might need, and to provide insight for doctors to work with, which provides more accurate care for each patient on an individual basis. Stratification of patients is a way to more clearly define the needs of patients and help set into motion a plan to make sure that patient is able to recover, improve and live a better standard of life wherever possible.