The project work plan is structured in 7 work packages (WPs). 3 Horizontal WPs, Coordination, Dissemination and Evaluation, led by Kronikgune, CHRU Montpellier and Polibienestar Institute, respectively, and 4 Core WPs, lead by Philips, Kronikgune, Ticsalut and Telbios (WP4, 5, 6 and 7 respectively).
Analysis and implementation work plans
ASSEHS is comprised by 3 analysis WPs and one implementation WP (please find WP names in Figure). WP4 will map and analyse existing risk prediction, adjustment and stratification tools. WP5 will address the feasibility of including stratification tools in Health Systems by analysing real life implementation experiences and focusing on challenges and barriers of their introduction. WP6 will study the impact of implementing stratification tools in Health Systems, focusing on structure, processes and outcomes of healthcare organizations. WP7 will activate stratification models incorporating key findings of previous WPs and will analyse cost effectiveness of implementing integrated interventions targeted to frail complex chronic patients.
Work plan 4, 5, 6 and 7
WPs 4, 5 and 6 will build on a scoping review of the literature that aims at collecting documents on risk stratification, detecting interventions where risk stratification has been used and identifying names and contact details of Key Informants.WP4 will develop an Appraisal Standard to determine the best-in-class risk stratification tools. WPs 5 and 6 will perform structured interviews in intervention sites with previous experience on risk stratification and surveys and focus groups on ASSEHS implementation sites, ending up in Feasibility and Performance Management Frameworks. Downstream, shaped by the contributions of the previous WPs, interventions in WP7 will focus on frail complex chronic patients and will result in a White Paper.
White Paper on stratification methods
An independent evaluation has been considered in the composition of the consortium (WP3). We will monitor project progress and impact according to a set of defined indicators which will include also community participation and social indicators. To facilitate the uptake of the project results and knowledge transfer to other health systems and regions, a White Paper on stratification methods will be developed summarizing ASSEHS’ findings, lessons learnt, best practices and recommendations.
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