Simple Segmentation Tool to Understand Elderly Health Status and Needs

NCT02663037 | Completed

• 1 other identifier: HSRI 2016/0001
• Study Type: observational
• Target: 200
• Locations: 1 country
• Sites: 1

Brief Summary

Background: The delivery of targeted, patient-centered care for a population with heterogeneous healthcare needs while moderating costs is a key challenge in healthcare. Segmentation of patient populations based on clinically distinguishing features and social healthcare needs is currently a promising method for informing the organization of healthcare supply to these needs. Aims: In this prospective cohort study, the investigators aim to assess the Simple Segmenting Tool (SST) as a method of patient population segmentation in terms of its inter-rater reliability, as well as convergent and predictive validity. We will also revise the tool based on feedback from the validity studies should the need arises. Hypothesis: The investigators hypothesize that the SST is able to exhibit good inter-rater reliability, convergent validity and predictive validity for adverse events. Methodology: Non-critical patients aged 55 and above presenting to the Emergency Department will be screened with the SST. Raters will be paired in order to assess inter-rater reliability. To test convergent validity, the LACE, SF-12, and Clinical Frailty Scale (CFS) will also be used. Finally, predictive validity will be assessed by evaluating adverse event rates of patients in each SST category. Adverse events include all-cause mortality, length of hospital stay, emergency department visit and unplanned hospital readmission. Significance to Health Services Delivery: This study will provide evidence supporting the use of a standardized tool for evaluating the medical and social needs of patients at various sites of care. Following which, tailored packages of healthcare services can then be delivered in order to meet these needs.

Conditions

Health Status

Keywords

Segmentation; Health needs

Outcome Measures

Primary Outcomes (1)

• Number of identical ratings between physician-physician pairs (inter-rater reliability) as assessed using the SST Global Impression of Patient Category and SST Complicating Factors.

  The SST global impression of patient consists of seven categories (eg: healthy; acutely ill but curable; chronic condition(s), asymptomatic; chronic condition(s) stable but moderately/ seriously symptomatic; long course of decline; limited reserve and serious exacerbation; short period of decline before dying). Inter-rater reliability will be measured using the Intraclass correlation coefficient (ICC) through computation of number of identical and non-identical ratings. ICC will be calculated using a one-way random effects model. Raters will be nested in subjects. Inter-rater reliability reflects the probability of agreement between physician-physician pairs above the level of chance for the assignment of patient categories.

  Baseline

Secondary Outcomes (8)

• Number of identical ratings between physician-nurse pairs (inter-rater reliability) as assessed using the SST global impression of patient category

  Baseline

• Number of participants with adverse events (Predictive validity of patient SST global impression of patient category)

  3 months post discharge from baseline hospital admission

• 3 months post discharge from baseline hospital admission

  Baseline

• Number of identical ratings between nurse-nurse pairs (inter-rater reliability) as assessed using the SST Complicating Factors

  Baseline

• Rating of participants as assessed by the Rockwood Clinical Frailty Scale as compared with the rating of patients as assessed by the SST Global Impression of Patient Category

  Baseline

Study Arms (1)

1

Subjects will be recruited from a pool of elderly patients who present to the Emergency Department. To be eligible for participation in the study, patients must meet ALL of the following criteria: 1. Age ≥ 55 years old 2. Triaged as P2 or P3 in the Emergency Department 3. Singapore citizen or Permanent Resident 4. Provision of Informed consent 5. Not previously already enrolled in this study

Eligibility Criteria

• Age: 55 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Subjects will be recruited from a pool of elderly patients who present to the Emergency Department.

You may qualify if:

• Age ≥ 55 years old
• Triaged as P2 or P3 in the Emergency Department
• Singapore citizen or Permanent Resident
• Provision of Informed consent
• Not previously already enrolled in this study

You may not qualify if:

• Age \< 55 years old
• Triaged as P1
• Non Singapore citizen or Permanent Resident
• No Informed Consent
• Previously enrolled subject

Sponsors & Collaborators

• National University of Singapore: lead
• Singapore General Hospital: collaborator

Study Sites (1)

Singapore General Hospital

Singapore, 169608, Singapore

Location

Related Publications (1)

• Chong JL, Matchar DB, Tan Y, Sri Kumaran S, Gandhi M, Ong MEH, Wong KS. Population Segmentation Based on Healthcare Needs: Validation of a Brief Clinician-Administered Tool. J Gen Intern Med. 2021 Jan;36(1):9-16. doi: 10.1007/s11606-020-05962-4. Epub 2020 Jun 30.

  PMID: 32607929 DERIVED

Study Officials

• David B Matchar, MD

  Duke-NUS Graduate Medical School

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor and Director, Health Services & Systems Research, Duke-NUS Medical School

Study Record Dates

• First Submitted: January 18, 2016
• First Posted: January 26, 2016
• Study Start: May 1, 2016
• Primary Completion: January 1, 2017
• Study Completion: January 1, 2017
• Last Updated: May 24, 2017

Record last verified: 2016-05

Locations

SG (1)