ASSEHS aims at activating real life stratification strategies on the ground and evaluating the results of their deployment in different European Health Services, by focusing on their utilization and added value to the delivery of care to complex frail elderly patients. In order to create valid, replicable and transferable stratification strategies, we will define deployment methodologies, analyse structural and organizational changes induced by the implementation and also their cost-effectiveness. In parallel, we will deepen in the utilities of the stratification tools in health management, policy making and clinical practice.
Additionally, we will address the issues identified during the stratification process, specifically related to tool availability and usability, data requirements and accessibility, adaptation to real life services and clinical practice circumstances, as well as clinical acceptance.
ASSEHS deals with one of the three overarching objectives of the Second Programme of Community Action in the Field of Health 2008-2013; improve citizens` health security. It includes promoting actions related to high quality and safe healthcare, using amongst other, risk assessment.
ASSEHS is fully aligned with the priorities of the EIP on AHA and will support the implementation of its Action Plans, especially the B3 Group Action Plan “Integrated care”. ASSEHS can give a great support to the Action Area 4 thanks to the alignment of the project with this Action Area and the contribution to achieve the deliverables planned in Action Area 4. Moreover, the experiences assessed will be in an integrated care context, which will enrich other action areas of Action Plan B3. ASSEHS will as well contribute to the Action Plan A3 by contributing to the identification of people in risk of frailty and implementation of coordinated interventions to improve the quality of life of complex frail patients. ASSEHS’s outputs will pave the way for the development of personalized integrated care.
ASSEHS will map existing tools for population risk stratification. Tools will be analysed and best-in-class determined. We will address the feasibility of including stratification tools in Health Systems, analyse real life implementation experiences and report challenges and barriers based on the regions’ experience in introducing risk stratification tools. We will study the impact of implementing stratification tools in Health Systems, focusing on integrated care, changes in services organizations, professionals’ roles and funding and reimbursement models. We will determine the effect of deploying stratification tools on structure, processes and outcomes of healthcare organizations. Different integrated interventions targeted to complex frail chronic patients will be implemented. Interventions will incorporate innovative aspects resulting from previous activities and will be integrated in ongoing programmes and initiatives in the participating regions. Sustainability is ensured by seeking the right balance between innovation and integration into existing actions.
ASSEHS will generate knowledge on the use of stratification tools at policy making, healthcare management and clinical practice levels. ASSEHS will generate knowledge on how to widen the use of stratification tools (methodologies and solutions to barriers) coming as a result of the implementation of the stratification). This knowledge will help policy makers and stakeholders to decide and advocate the implementation of stratification methods.
The best practices on stratification methods validated in ASSEHS regions can serve as examples for the development of programs for managing multimorbidity among complex frail older European citizens. This will help policy makers and stakeholders plan customized interventions for frail older citizens.
ASSEHS´s deliverables, including the White Paper on stratification methods, will be very valuable for transferring results to other regions and health care systems; supporting them in the transformation towards a new model of providing health to the citizens.