Recommendations for good practice population-based health risk assessment
| Domain | Recommendations | Level of evidence |
|---|---|---|
| Type of risk stratification tool | Predictive model using a population health approach | High15–21 |
| Validation of the model | Longitudinal follow-up | High41 |
| Predicted/explained outcomes | Unplanned hospital-related events; risk of institutionalisation; death; case prognosis | High15–21 |
| Source sample | Whole regional population | High15 16 |
| Statistical model | Predictive modelling | High15–21 |
| Statistical indices | Standardisation on reporting performance (positive predictive value, PPV)41 and sensitivity across risk bands | Moderate41* |
| Population usefulness | Risk adjustment; planning and commissioning health services Support to novel reimbursement models | High22–24 |
| Clinical and social usefulness | Identification of patients at high risk and cost-effective preventive clinical and social interventions | High15–22 |
| Periodicity of updates | Semester | Low† |
| Clinical accessibility | Available in the professional workstation through clinical decision support systems | High‡ |
| Flexibility and transferability | Open algorithms, open source, reduced or no licence binding. Morbidity grouper based on statistical criteria adjusted to the target population | High |
*To report metrics indicating sensitivity/specificity of predictions is recommended for good practice. However, some regions adopt a pragmatic approach classifying individuals into specific of the risk-strata pyramid without informing on sensitivity/specificity because of rather poor robustness of predictions provided by most of the models.
†Periodicity of updates depends on the logistics available in each site. A yearly or 6-monthly basis seem reasonable.
‡Development of adequate clinical decision support systems (CDSS) depends on three main factors: (1) robustness of computational modelling feeding the CDSS; (2) refinement of the CDSS generated by the clinical feedback and (3) appropriate dashboard providing a user-friendly interface.