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Table 5 Purposes for population segmentation – themes and illustrative quotes

From: Identifying optimal indicators and purposes of population segmentation through engagement of key stakeholders: a qualitative study

DomainThemeQuotations
MicroMesoMacro
Improving health outcomes- Delay progression of chronic conditionsBasically, we want to promote and advocate for positive ageing experience at the end of the day.”
#2 Social Service Provider
So, for residents who have three or more chronic diseases, who require assistance to manage the chronic diseases, and if they are able to walk, they will come down to the nursing post to seek consultation from my nurses and for those who can’t walk, then my nurses will go up to their house.”
#6 Healthcare Professional
Helps us to focus on a few key things on how the health system is able support the person in doing some of these things well so that they don’t transit into a worse state.”
#13 Government Official
- Care of patients with multi-morbidityOne of the outcomes will be: Did they get their service can improve their health? You know, for example, if someone needs dialysis and needs to be referred to the NKF [National Kidney Foundation], we make sure that it is done.”
#14 Healthcare Professional
We look at the usual length of stay, number of discharges, [the] number of dead. Not everybody dies here you know? Some people do go home.”
#23 Healthcare Professional
Because if someone is in the, let’s say, a pre-frail stage, can we do something to delay their movement into their worse stage.”
#25 Government Official
- Healthy aging through self-care
Planning for resource allocation- Identify high resource consumption groupsSo, they try to think about [how] to reduce wastage in terms of resource allocation.”
#12 Researcher
It tells us that [with] whatever limited resources and time you have, you are addressing patient’s needs. Patient’s needs are prioritised so at least you know you are helping that patient.”
#11 Healthcare Professional
So, the question is where should we direct the resources to get the most return for the money we put in? Basically, having all these indicators right from the start and seeing which are performing well, which are not performing well, [it] could help us to know exactly where to target.”
#20 Government Official
- Reduce inappropriate medical treatmentsFor the patients, they don’t get unnecessary treatment and for the institution, you don’t actually waste money and resources. Then, for countrywide right, you actually saved on financial expenditure and healthcare planning.
#22 Healthcare Professional
Ideally, you have identified a population segment that is fairly substantial like a big chunk of your interest population and they have interventions available for them that is fairly effective. Then wouldn’t this be a place that you want to put money in and give them the improvements in health outcome that is possible through the service you have?
#3 Researcher
So [for] resources allocation, the whole notion about population segmentation is actually to be able to use of our resources wisely.”
#17 Government Official
Optimising healthcare utilisation- Assess impact of healthcare interventions on hospital readmissionOf course, for the vulnerable elderly, we will be looking at the hospital admissions.”
#5 Social Service Provider
I mean the hospital admission rates is important for prognosis. [If] somebody keeps being admitted regularly in the hospital, it tells you something. Either they’re not coping at home so it’s a huge social problem, or the disease is getting worse. So, it does tell you a lot about the patient.”
#23 Healthcare Professional
Because the purpose of segmentation is the risk of readmission and then you intervene and monitor the rate of readmission. Has the rate of readmission gone up? Gone down? Or never change at all? So, if you have the model, you have the intervention and the readmission drops, I won’t say it is a true cause and effect yet there’s a correlation.”
#24 Government Official
- Identify and manage high utilisation groupThese are indicators that they can be easily measured. Like the rate of readmission and the length of stay. How often do people come back to emergency department? How often do they default treatment?
#15 Healthcare Professional
We look at utilisation status after segmenting, to see which group consumed the most healthcare resources.”
#23 Healthcare Professional
It allows us to identify segments of needs so existing programmes like H to H [Hospital to Home] has very high resource utilisation as a segment.
#16 Government Official
Enhancing psychosocial and behavioural outcomes- Improve patient’s quality of lifeOf course, there is [the] emotional wellbeing. We track their attendances [to our activities] so that we know [how] connected they are to [the] community. This is the outcome that we look for under the well elderly.”
#5 Social Service Provider
For example, in end of life group, the focus is to make sure that we optimise their quality of life at this point in time, rather than to focus on treating or prolonging their life.”
#7 Researcher
So, we will be looking at outcomes such as reduced disability and increased quality of life till the end of life.”
#13 Government Official
- Promote psychosocial wellbeing
Strengthening preventive effort- Reduce fall risk to improve health outcomesWe look at their frailty score because our wellness programme targets on reversing or preventing frailty. As you know a fall is a major risk factor for death, especially for elderly living alone.”
#5 Social Service Provider
The second group is people that have different types of chronic diseases. Then the goal is actually to optimise their chronic disease management so that we are able to delay or prevent complications.”
#7 Researcher
We are only delaying the frailty because we want him to stay on in his home rather than readmitted to the hospital, when most of the time it will take a very long time for him to recover.”
#13 Government Official
- Prevent disease complications
Driving policy changes- Facilitate government funding on specific key areasWell, for example, the senior mobility fund. Because senior mobility fund is for 65 and above and they [must be] means tested in order to qualify for subsidies for care aid and mobility aid. If this patient exceeds the means testing by $1, technically this means that he is not qualified for the subsidy. But do you think that the $1 is really that significant? So, we hope that whatever we are doing now could influence policy changes.
#9 Healthcare Professional
You can actually have the data and if the evidence supports it, it can facilitate policy planning in healthcare financing. For example, patients with high BPS [biopsychosocial] score will have better capitated funding or better funding for their GP visit.”
#23 Healthcare Professional
We probably would have to identify key areas to work on, focus area. Again, how this is done then leads into a larger policy framework.”
#16 Government Official
- Target previously neglected healthcare needsIf you can get all these [healthcare utilisation data] and then study the data, this could be a way to inform the ministry [on] how to finance primary care properly.”
#21 Healthcare Professional
If we found [out] that lower income families are having poorer outcomes because of affordability, then we need to craft out more policies to help in terms of affordability.”
#20 Government Official