Population segments as a tool for health care performance reporting: an exploratory study in the Canadian province of British Columbia

Abstract

Background: Primary care serves all age groups and individuals with health states ranging from those with no chronic conditions to those who are medically complex, or frail and approaching the end of life. For information to be actionable and guide planning, there must be some population disaggregation based on differences in expected needs for care. Promising approaches to segmentation in primary care reflect both the breadth and severity of health states, the types and amounts of health care utilization that are expected, and the roles of the primary care provider. The purpose of this study was to assess population segmentation as a tool to create distinct patient groups for use in primary care performance reporting. Methods: This cross-sectional study used administrative data (patient characteristics, physician and hospital billings, prescription medicines data, emergency department visits) to classify the population of British Columbia (BC), Canada into one of four population segments: low need, multiple morbidities, medically complex, and frail. Each segment was further classified using socioeconomic status (SES) as a proxy for patient vulnerability. Regression analyses were used to examine predictors of health care use, costs and selected measures of primary care attributes (access, continuity, coordination) by segment. Results: Average annual health care costs increased from the low need ($ 1460) to frail segment ($10,798). Differences in primary care cost by segment only emerged when attributes of primary care were included in regression models: accessing primary care outside business hours and discontinuous primary care (≥5 different GP's in a given year) were associated with higher health care costs across all segments and higher continuity of care was associated with lower costs in the frail segment (cost ratio = 0.61). Additionally, low SES was associated with higher costs across all segments, but the difference was largest in the medically complex group (cost ratio = 1.11).

Differences in tobacco smoking status in segments of the Australian population

“…In the words of Andreasen and most other health educators, it is necessary to segment the market. This approach can be seen in Barnet et al (2011) and Langdon et al (2020) for example.…”

Strategies for primary care providers in British Columbia's community primary care practice settings to prevent burnout

“…Primary care providers play an important role in delivering accessible, quality health care that empowers people and their communities (WHO, 2018). Primary care providers provide primary health care to people of all ages and backgrounds, from individuals with no medical problems to those with multiple chronic medical conditions (Gov of BC, n.d.;Langton et al, 2020). All PCPs can autonomously assess, diagnose, and treat illnesses; order and interpret tests; prescribe medications; perform medical procedures; and refer or consult with other practitioners (CNA, 2020;Statistics Canada, 2018).…”

“…According to Langton et al (2020), there are four distinct patient population groups in BC: low need (82%), multiple morbidities (13%), medically complex (3%), and frail (2%). A patient with low needs has one or fewer chronic conditions and no event indicating medical complexity.…”

“…A patient with low needs has one or fewer chronic conditions and no event indicating medical complexity. A patient with multiple morbidities is an individual with two or more chronic conditions, which may or may not interact with each other, and no event indicating medical complexity (Langton et al, 2020;Whitson et al, 2020). On the other hand, comorbidities refer to conditions that coexist in the environment of a primary disease (Whitson et al, 2020).…”

“…Medically complex patients are those with one or more chronic conditions who have had an event, as defined in the glossary, associated with the chronic condition. Lastly, frail patients are those who are 65 or older, have been deemed palliative, are receiving frailty-based care, and/or have met at least two criteria of the Edmonton Frailty Scale (Langton et al, 2020). While many PCPs in BC have patient distributions that mirror the above patient population groups, others do not (Delvin et al, 2018).…”