Risk Stratification Model for Healthcare

by Risk Stratification
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As a means of improving the quality of care that healthcare organizations provide, many have adopted a systematic approach to classifying or grouping patients according to the needs of that patient at the time of service.  This allows the healthcare professional working with the patient to understand if that individual may require more attention, stand to have more information provided for them or need personalized one-on-one care during or after a significant event.  This categorization is known in the medical community as a risk stratification model.

Like many things within businesses and organizations, there isn’t just one model out there, or a standardized format that everyone follows.  Some healthcare organizations use a three-tier system with:

  • High Risk
  • Moderate Risk
  • Low Risk

Other organizations feel that this sort of grading system isn’t specific enough, and doesn’t provide enough information for the healthcare providers, so they utilize a more extensive five-tier system that is set up with:

  • Tier 0 – Patient has no underlying conditions
  • Tier 1 – Patient has 1 to 3 different conditions
  • Tier 2 – Patient has 4 to 6 different conditions
  • Tier 3 – Patient has 7 to 9 different conditions
  • Tier 4 – Patient has 10 or more different conditions

No matter what risk category or tier level a patient is designated to be in, there are different measures that are taken to ensure the best care is given to each patient.  And, those patients that have more pressing issues, or are in need of much more attention should have that consideration given to them.  Part of the reason that high risk patients or tier 3-4 patients should receive more responsiveness in their care is because short-term help can translate into less long-term care needed.  The right care (or the right amount of care) is given at the right time to the right person. 

What many organizations have noticed, some of which is self-explanatory, is that patients that have more health problems are also those that need more attention both within and without the wall of a hospital or doctor’s office.  Some of this is due to the complexity with health conditions, physical therapy, medications, appointment with specialists, routines that are not normal or many other extenuating circumstances.  Unfortunately, particular patients have a tendency to revert back to old habits, whether it be a specific schedule or not remembering to take prescriptions, or they out right refuse to change their lifestyle to fit the new demands placed in their life.  Either way, having an advocate or an outside person that checks up on them, helps to answer questions, encourages changes to behavior or whatever the case may be, can help that individual improve the health outcome.

This same dedication and personalized care is not necessary with a person who is mostly healthy, only needs to come in for a yearly physical, and doesn’t have their daily habits interrupted by a health concern.  So, by dedicating resources to where they are needed, everyone can benefit, and the cost of healthcare can be controlled a little better.

The risk stratification models in healthcare are not and should not be seen as a way to discriminate or to offer special care to only certain individuals, but is a way to not only improve the care that each patient receives, but to control the costs for care and to make sure that each patient has the best possible outcome, even if it is a long-term outlook.  No matter which model a healthcare organization utilizes, everyone, from patients to professionals, can work in the most efficient and effective atmosphere possible.

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