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Risk Stratification Definition, and How It Affects Patients’ Care

nurse administering medications to elderly woman patient for risk stratification definition

You’re probably familiar with the lab tests and in-office screening procedures clinicians use to assess your current clinical conditions or your risk of developing certain diseases. But that’s just a starting point for the next steps in your care.

Risk stratification definition

Through a process called risk stratification, clinicians can systematically categorize patients’ health risk levels based on their health status and other objective and subjective factors. Risk stratification is an approach clinicians use to make sure their patients get what they need in terms of care and to allocate limited resources to the patients who need them most.1

Below we, along with an expert perspective, answered frequently asked questions about how clinicians assign risk levels to their patients, as well as how it informs the care they provide.

Can people be at risk of having a medical issue and not even know it?

“When we risk-stratify patients, we try to put them into high-, medium-, or low-risk categories. To do that, we use objective data (things we can measure, like blood pressure and blood sugar) and subjective data (things we notice about a patient),” explains Dr. James Dom Dera, M.D., a family physician at Ohio Family Practice Centers in Fairlawn, Ohio. He’s also the population health medical director at the NewHealth Collaborative in Akron, Ohio.

In risk stratification, healthcare systems may also take into account:

  • advanced age
  • physical limitations
  • comorbid conditions, including substance abuse
  • polypharmacy
  • difficulty with adherence
  • a lack of health insurance
  • frequent hospitalizations
  • a recent major surgery
  • genetics

Because of the assessment of multiple factors, Dr. Dom Dera states ““Yes. You can feel fine and think you have no medical issues whatsoever, but you can have a higher risk score.”

Is it important for people to know their risks?

Yes. Since most management of chronic conditions occurs outside of a healthcare facility, educating patients encourages them to take appropriate steps on their own.2

As Dr. Dom Dera points out, “It’s part of their health care literacy to understand what’s going on and whether they’re at high risk for the future. If they don’t know, they can’t be sure that they’re getting or demanding the care they need.”

For example, by helping a patient understand that they are at risk of cancer or heart disease, the patient knows they should schedule regular screenings and tests.3 Or in the case of a patient being at risk of diabetes, they understand the importance of maintaining a healthy diet in their daily life.4

How can medications relate to risk stratification?

Within the course of risk stratification, several specific medication-related factors, such as the use of polypharmacy or a lack of adherence to treatment, may be assessed. Patients with these identified risk factors, or with higher risk scores in general, may require additional engagement and communication to ensure that care is optimized.1

“There are a couple of factors, such as how a medication might work differently in a high-risk person than it would for someone at low risk. In the elderly, for example, kidney function decreases over time, so the dose of certain medications needs to be lower at age 85 because of who they are” according to Dr. Dom Dera.

Why is risk stratification important?

Risk-stratification allocates (what can be limited) healthcare provider time and resources to those that would benefit the most, first. This strategically directs care efforts through different sub-populations, or groups of patients, organized by risk score.5

In the case of Dr. Dom Dera’s practice, “It changes how we deliver the appropriate care to the appropriate patients. It also changes how we triage patients if they have the same symptoms. If someone has a cough and they’re at high risk, they need attention right away, but if they’re low risk, we could probably do symptomatic therapy for that person.”

While other healthcare systems may employ risk stratification techniques differently, Dr. Dom Dera’s explanation of his practice’s approach provides a great example of risk stratification and its importance in clinical care. “The concept of risk stratification is very common. We’ve been doing this for a long time, but we’ve been doing it subjectively and by the seat of our pants. Now we’re putting some structure behind it, so we can do it reliably over and over again” he says.

Overall, risk stratification can help clinicians provide their patients with necessary care.

What is population health, and how does it relate to risk stratification?

Population health involves defining a population and assessing the health risks and outcomes of the population, in comparison to assessing individual patients one at a time.6

As Dr. Dom Dera describes, “It’s about managing patients who aren’t in front of you. We go after those patients and proactively manage them; we don’t wait for them to become ill. Once I’ve identified that population, I want to identify the people who really need my attention — that’s where risk stratification comes in.”

“As a primary care physician, I see everything. When I go from room to room, I’m putting out fires all day, which isn’t very satisfying. But preventing that fire from happening, preventing that illness or bad outcome from happening, is satisfying. The health care system has never been designed for that — it’s designed for acute care. This proactive approach is more modern, and it has downstream benefits for improving outcomes and saving health care dollars. We’re at an exciting crossroads for [patient] care, and risk stratification is one piece of the puzzle.”

Genomind has found a way to utilize this type of approach in the context of pharmacogenomics: stratifying large patient populations by their medication and genetic interaction risk. This way, prescribers could start utilizing pharmacogenetic testing for those identified as ideal candidates. Then, prescribers can proactively manage medications to potentially optimize treatment response and safety.

Bottom line

Now that you know the risk stratification definition, you can better understand how clinicians use risk stratification to categorize your health risk and provide you with more precise care.

Sources

  1. Background information on risk stratification: Risk Stratification: A Two-Step Process for Identifying Your Sickest Patients (2019)
  2. Importance of health literacy: Why Patient Education Is Vital for Engagement, Better Outcomes (2022)
  3. Screenings encourage early detection of cancer: American Cancer Society Guidelines for the Early Detection of Cancer (2022)
  4. How diet can help prevent diabetes: Simple Steps to Preventing Diabetes (2022)
  5. How risk stratification works: A systematic review of risk stratification tools internationally used in primary care settings (2021)
  6. Definition of population health: Making New York the Healthiest State: Achieving the Triple Aim Population Health Summit (2013)

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