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ASSEHS paper published in European Geriatric Medicine

January 26, 2015

To face the challenge of active and healthy ageing ( AHA), European Health Systems and services should move towards proactive, anticipatory and integrated care. Health care systems thus need to personalize services, put patients in the centre of care and provide services using the adequate resources. Population health risk management is emphasized through the use of tools to stratify people with chronic diseases according to their risk and offering support commensurate with this risk. Effective screening of frailty is key in optimizing care for frail population at risk. The analysis of risk stratification in different Health Systems generates solutions transferable to many regions. 


Risk Stratification tools can (i) help to identify complex frail and high-risk patients and maintain these patients on the radar of the Health Services (ii) to ensure appropriate coverage of health risk prevention interventions. Systematic screening of groups of people in risk of suffering a disease constitutes a part of a broader area-level strategy on public health.


Activation of Stratification Strategies and Results of the interventions on frail patients of Healthcare Services (ASSEHS) EU project (N° 2013 12 04) is an international effort to bring together stratification related professionals from Health Services, Academia and Research in the EU to study current existing health risk stratification strategies and tools spread their use and the application on frail elderly patients, minimize deterioration of conditions and/or prevent emergency or hospital admissions.


The ASSEHS consortium lead by KRONIKGUNE is enriched by the presence of stakeholders and regions in which the health system is organized in different ways, i.e. general practitioners as public salaried employees, general practitioners cooperatives or health care models based on private care suppliers and with public and private hospitals providing secondary care. This gives to the project a strong focus on the European reality and with heterogeneity of input, which we believe is beneficial for the design of patient stratification tools that ought to be exportable to different regions and diverse health care models. The structure of ASSEHS makes it possible to achieve the goals.

The analysis of Risk Stratification in different Health Systems will generate conclusions and risk stratification solutions, which will be transferable to a variety of regions in the future. ASSEHS is in line with Area 4 of the B3 Action Plan of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA).

KRONIKGUNE is the research center created by the Department of Health of the Basque Country as part of the regional Strategy to Tackle the Challenge of Chronicity. The aim of this research center is to enable innovative practices and the structured generation of scientific evidence regarding chronicity and health services sustainability, evaluating innovative pilot activities in order to assess their efficiency and their capacity to be scaled up throughout the regional Health System.

Link here to read the paper in European Geriatric Medicine magazine. 

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