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Validation and application of a needs-based segmentation tool for cross-country comparisons.

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Date
2021-12
Authors
Duminy, Lize
Sivapragasam, Nirmali Ruth
Matchar, David Bruce
Visaria, Abhijit
Ansah, John Pastor
Blankart, Carl Rudolf
Schoenenberger, Lukas
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Abstract
<h4>Objective</h4>To compare countries' health care needs by segmenting populations into a set of needs-based health states.<h4>Data sources</h4>We used seven waves of the Survey of Health, Aging and Retirement in Europe (SHARE) panel survey data.<h4>Study design</h4>We developed the Cross-Country Simple Segmentation Tool (CCSST), a validated clinician-administered instrument for categorizing older individuals by distinct, homogeneous health and related social service needs. Using clinical indicators, self-reported physician diagnosis of chronic disease, and performance-based tests conducted during the survey interview, individuals were assigned to 1-5 global impressions (GI) segments and assessed for having any of the four identifiable complicating factors (CFs). We used Cox proportional hazard models to estimate the risk of mortality by segment. First, we show the segmentation cross-sectionally to assess cross-country differences in the fraction of individuals with different levels of medical needs. Second, we compare the differences in the rate at which individuals transition between those levels and death.<h4>Data collection/extraction methods</h4>We segmented 270,208 observations (from Austria, Belgium, Czech Republic, Denmark, France, Germany, Greece, Israel, Italy, the Netherlands, Poland, Spain, Sweden, and Switzerland) from 96,396 individuals into GI and CF categories.<h4>Principal findings</h4>The CCSST is a valid tool for segmenting populations into needs-based states, showing Switzerland with the lowest fraction of individuals in high medical needs segments, followed by Denmark and Sweden, and Poland with the highest fraction, followed by Italy and Israel. Comparing hazard ratios of transitioning between health states may help identify country-specific areas for analysis of ecological and cultural risk factors.<h4>Conclusions</h4>The CCSST is an innovative tool for aggregate cross-country comparisons of both health needs and transitions between them. A cross-country comparison gives policy makers an effective means of comparing national health system performance and provides targeted guidance on how to identify strategies for curbing the rise of high-need, high-cost patients.
Type
Journal article
Subject
Humans
Risk Factors
Cross-Cultural Comparison
Health Services Needs and Demand
Patient Acceptance of Health Care
Israel
Europe
Female
Male
Surveys and Questionnaires
Permalink
https://hdl.handle.net/10161/24180
Published Version (Please cite this version)
10.1111/1475-6773.13873
Publication Info
Duminy, Lize; Sivapragasam, Nirmali Ruth; Matchar, David Bruce; Visaria, Abhijit; Ansah, John Pastor; Blankart, Carl Rudolf; & Schoenenberger, Lukas (2021). Validation and application of a needs-based segmentation tool for cross-country comparisons. Health services research, 56 Suppl 3(S3). pp. 1394-1404. 10.1111/1475-6773.13873. Retrieved from https://hdl.handle.net/10161/24180.
This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.
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Scholars@Duke

Matchar

David Bruce Matchar

Professor of Medicine
My research relates to clinical practice improvement - from the development of clinical policies to their implementation in real world clinical settings. Most recently my major content focus has been cerebrovascular disease. Other major clinical areas in which I work include the range of disabling neurological conditions, cardiovascular disease, and cancer prevention. Notable features of my work are: (1) reliance on analytic strategies such as meta-analysis, simulation, decision analy
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