Validation and application of a needs-based segmentation tool for cross-country comparisons.
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 articleSubject
HumansRisk Factors
Cross-Cultural Comparison
Health Services Needs and Demand
Patient Acceptance of Health Care
Israel
Europe
Female
Male
Surveys and Questionnaires
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https://hdl.handle.net/10161/24180Published Version (Please cite this version)
10.1111/1475-6773.13873Publication 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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Show full item recordScholars@Duke
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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