The United States has no healthcare resources to waste. Everybody has been stretched lately, encouraging more programs to proactively use community paramedicine risk stratification to manage illness.
Risk stratification is about categorizing patients to ensure optimal deployment of resources. In a way, think about risk stratification, such as maintenance for a vehicle, where the goal is to expend the least resources to achieve a maximum lifespan. With risk stratification, the vehicle is public health, and the goal is to allocate resources to maximize the wellness of the entire community.
Let’s look at risk stratification in more detail, discuss how community paramedicine leverages risk-related data, and discuss the nuances of prioritizing patients.
Why is Community Paramedicine Risk Stratification Important?
Community paramedicine is a growing force within healthcare, particularly in underserved and rural areas. While mobile integrated healthcare-community paramedicine (MIH-CP) is gaining momentum, there is no room for waste or error. MIH-CP programs must ensure they use their resources to make the most significant impact.
With risk stratification, community health programs can break patients into groups, ensuring that the neediest patients get the most help. Again, we can go back to vehicle maintenance as an analogy. If your car’s transmission is about to give out, then it wouldn’t make much sense to worry about the tires, would it?
Risk stratification falls under the umbrella of patient triage, but not in an acute sense. Risk stratification is about looking at an individual patient and making judgments about their “risks,” including the severity of their illness, their history of hospitalization, the number of medications they take, and the number of co-morbidities.
When community paramedicine programs practice good risk stratification, they set themselves up to see positive results in the community and ensure that the proper care reaches the right patients. Let’s discuss how risk stratification works and some nuances and challenges it may present.
How Risk Stratification Works for Community Paramedicine
Risk stratification can take several forms, but each type tries to accomplish the same goal. Community paramedics have unique problems to consider, unlike regular health clinics, including drive time and vehicle upkeep. Even though there are differences between mobile healthcare and traditional clinics, principles of risk stratification apply to both.
Here are several methods of risk stratification:
- Objective and subjective data
- The various levels of risk
- Recording dynamic changes
The goal of these various risk stratification methods is simple: determine which patients most need the available resources and adjust as patient conditions change. Let’s look at some of the details of how risk stratification works.
Risk Stratification and Mobile Integrated Healthcare: Objective and Subjective Assessment
Risk stratification usually envelopes a two-step process: observable and measurable data and the provider’s opinion. How does this work?
First, a patient’s risk is measured by the objective data about their health. Patients with poor blood pressure, chronic diseases, or a history of many visits to the ER will be ranked higher on the risk level (we’ll talk about the specific risk levels for patients in the next section).
Second, the provider offers professional judgment and answers patient health questions. Does the person have their condition under control? Are the numbers poor but better than they were before? Are there compounding psychological or social factors that come into play?
Many organizations will then take this information and assign the patient a level of risk. Some places will develop their criteria, which is often necessary as different areas face different problems. With that said, assigning a risk level should be set up in an algorithmic, systematic way, thus ensuring that each person is judged with the same criteria.
Let’s chat about the specific risk levels.
Various Risk Levels for Patients
Risk stratification is based on the idea that some patients are much more likely to need intensive medical attention than others. The goal is to protect patients who are at high risk of suffering catastrophic health failure while ensuring that those who are at a lower risk don’t get worse.
Here are the main risk stratification management categories:
- Low risk: A low-risk patient has their health under control and is not anticipated to have significant health problems anytime soon. These patients may have minor health issues, but they are well-managed and don’t require exhaustive attention from health professionals.
- Rising risk: These are those patients who have chronic health problems and walk the line between having their health “under control” and spiraling to high risk. Those in a rising risk category may be managing a chronic condition but have a compounding factor (such as smoking) that makes them unstable. Generally, this group receives a lot of attention, as preventing them from slipping into high risk can reduce expenses and positively impact the patient’s life.
- High risk: These patients have chronic conditions that require focused support. High-risk patients generally make up about 20 percent of the patient population. Without help, these patients will likely become highly complex, leading to more significant resources.
- Highly complex: This is the most dangerous category for patients. A highly complex patient has many uncontrolled chronic diseases that are compounded by a lack of compliance, mental health issues, and other social factors. Highly complex patients represent a relatively small percentage of the patient pool but take up most of the resources.
After a community paramedicine program has determined a patient’s risk status, they will treat them accordingly. Low-risk patients may require fewer resources than those who are high-risk.
Note: Risk stratification can help improve a stagnant community paramedic program by optimizing resources and improving patient outcomes.
Changing a Patient’s Risk Category Based on Observed Changes
Another critical component of risk stratification is ensuring that a patient’s risk status is constantly evaluated and that resources are changed as needed.
For example, a high-risk patient who begins complying with medications and eating healthy might be moved to a less severe category. The same is true of a low-risk patient who starts to avoid treatment or begins smoking. They are then moved up on the risk level. Both patients are then treated according to their new risk levels.
When needed, it’s crucial to make dynamic changes in a patient’s risk level. If a patient doesn’t need as many health resources, focusing on other areas is wise. Likewise, if a patient presents a significant risk but no change in treatment, there could be a more significant strain on their health in the future.
The Relationship Between Risk Stratification and “Impactability”
Some patients might be at high risk but may not respond to treatments well. This is known as impactability. The idea is that some patients will be more impacted by care than others. Certain patients are unlikely to alter their habits or health behaviors, no matter how many resources are expended.
This is not a settled idea, nor is it easy to determine whether a patient will or will not be impacted by a treatment. However, there needs to be some critical thinking regarding input and output. Community paramedicine programs trying to help someone at high risk might consider changing methods if they don’t see results.
Ultimately, the impact on an individual patient is an aspect of risk stratification that each organization should discuss.
Now, let’s talk about another aspect of risk stratification: triage.
Tough Decisions: Who Gets Treatment?
As we mentioned earlier, community paramedicine risk stratification is like complex primary care triage. Those in EMS will be familiar with triage during a mass casualty incident where there are multiple patients (such as a bad car accident).
Those who know these triage algorithms understand that, sometimes, it is not the “sickest” victims who get help first. It is those people who are most likely to benefit from the care.
This article does not judge how risk stratification should operate. Still, it highlights that departments must ask themselves: does it make more sense to place extra resources on highly complex, high-risk, or rising-risk patients? What’s the balance? This is a topic each MIH-CP department must manage for themselves.
Conclusion: Improving Risk Stratification with Objective Data
Risk stratification helps community paramedicine programs determine a patient’s health risk and allocate resources accordingly. Those with low risk may not need as many resources as those patients who are high risk.
One way MIH-CP programs determine risk stratification is with good data management software. Platforms like Julota help you record patient information and dynamically record risk levels. Contact Julota for a simple demonstration of how their secure cloud-based software can help you perform good risk stratification.