Please use this identifier to cite or link to this item: https://doi.org/10.1186/s12913-017-2736-8
Title: Evaluation of a practical expert defined approach to patient population segmentation: A case study in Singapore
Authors: Low, L.L 
Kwan, Y.H
Liu, N 
Jing, X
Low, E.C.T 
Thumboo, J 
Keywords: adult
aged
chronic disease
classification
cross-sectional study
electronic health record
feasibility study
female
health care planning
health service
health services research
health status
hospitalization
human
International Classification of Diseases
male
middle aged
patient
retrospective study
Singapore
statistics and numerical data
utilization
very elderly
Adult
Aged
Aged, 80 and over
Chronic Disease
Cross-Sectional Studies
Electronic Health Records
Feasibility Studies
Female
Health Resources
Health Services
Health Status
Hospitalization
Humans
International Classification of Diseases
Male
Middle Aged
Organizational Case Studies
Patients
Retrospective Studies
Singapore
Issue Date: 2017
Citation: Low, L.L, Kwan, Y.H, Liu, N, Jing, X, Low, E.C.T, Thumboo, J (2017). Evaluation of a practical expert defined approach to patient population segmentation: A case study in Singapore. BMC Health Services Research 17 (1) : 771. ScholarBank@NUS Repository. https://doi.org/10.1186/s12913-017-2736-8
Abstract: Background: Segmenting the population into groups that are relatively homogeneous in healthcare characteristics or needs is crucial to facilitate integrated care and resource planning. We aimed to evaluate the feasibility of segmenting the population into discrete, non-overlapping groups using a practical expert and literature driven approach. We hypothesized that this approach is feasible utilizing the electronic health record (EHR) in SingHealth. Methods: In addition to well-defined segments of "Mostly healthy", "Serious acute illness but curable" and "End of life" segments that are also present in the Ministry of Health Singapore framework, patients with chronic diseases were segmented into "Stable chronic disease", "Complex chronic diseases without frequent hospital admissions", and "Complex chronic diseases with frequent hospital admissions". Using the electronic health record (EHR), we applied this framework to all adult patients who had a healthcare encounter in the Singapore Health Services Regional Health System in 2012. ICD-9, 10 and polyclinic codes were used to define chronic diseases with a comprehensive look-back period of 5 years. Outcomes (hospital admissions, emergency attendances, specialist outpatient clinic attendances and mortality) were analyzed for years 2012 to 2015. Results: Eight hundred twenty five thousand eight hundred seventy four patients were included in this study with the majority being healthy without chronic diseases. The most common chronic disease was hypertension. Patients with "complex chronic disease" with frequent hospital admissions segment represented 0.6% of the eligible population, but accounted for the highest hospital admissions (4.33 ± 2.12 admissions; p < 0.001) and emergency attendances (ED) (3.21 ± 3.16 ED visits; p < 0.001) per patient, and a high mortality rate (16%). Patients with metastatic disease accounted for the highest specialist outpatient clinic attendances (27.48 ± 23.68 visits; p < 0.001) per patient despite their relatively shorter course of illness and high one-year mortality rate (33%). Conclusion: This practical segmentation framework can potentially distinguish among groups of patients, and highlighted the high disease burden of patients with chronic diseases. Further research to validate this approach of population segmentation is needed. © 2017 The Author(s).
Source Title: BMC Health Services Research
URI: https://scholarbank.nus.edu.sg/handle/10635/175415
ISSN: 1472-6963
DOI: 10.1186/s12913-017-2736-8
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