The second aim was to elaborate on strategies toward enhanced health risk predictive modelling in the clinical scenario. First, to analyse population-based health risk assessment strategies, including assessment tools and health indicators, in the five ACT regions, in order to identify current barriers and to elaborate recommendations for large scale deployment of integrated care at the European level. The study, therefore, addresses two specific aims. However, it is acknowledged that modelling tools addressing specific clinical issues with a high predictive power may present limitations for their general application outside the source population. Moreover, clinical risk prediction may contribute to patient classification in the optimal healthcare tier, helping to define shared care arrangements between primary care and specialists. In the clinical management domain, risk prediction of well-defined medical problems (ie, prediction of survival in acute exacerbations of chronic obstructive pulmonary disease (COPD)) 12 can support health professionals in the decision-making process. 10, 11 Likewise, performing screening for discovery of cases with non-manifest illnesses may benefit from early diagnosis and cost-effective preventive interventions. The former, case finding, identifies highly vulnerable patients, allocated at the tip of the risk pyramid, who are prone to major deleterious health events such as unplanned hospital admissions/readmissions, fast functional decline and/or death. It allows identification of subsets of citizens with similar healthcare requirements facilitating both case finding and screening. In the healthcare services domain, population-based risk predictive modelling facilitates the elaboration of stratification maps characterising risk strata distribution of the entire population in a given geographic location. The four key drivers addressed in the ACT programme were: risk assessment and stratification, workflows and organisational structures, staff engagement and patient adherence. By specifically investigating four key drivers influencing the effective deployment of integrated care services and generating ‘best practice’ examples, ACT intended to provide the foundation to help overcome current barriers for extensive adoption of integrated care. The 2.5-year ACT programme, initiated in 2013, explored the organisational and structural processes needed to successfully implement integrated care services on a large scale. Integrated care was defined as the organisation of activities among participants involved in a patient's care to facilitate the appropriate delivery of healthcare services. The current study was carried out within the frame of the Advancing Care Coordination and Telehealth (ACT) programme ( ) 9 involving five leading European Union (EU) regions in terms of scaling up integrated care: Basque Country (ES), Scotland (UK), Lombardy (I), Groningen (NL) and Catalonia (ES). 1–4 It is well recognised that health risk assessment can be relevant for regional adoption of integrated care 5–7 because of its impact on the design of healthcare services, as well as for stratification and clinical management of chronic patients. Large scale deployment and adoption of integrated care services in Europe seek health efficiencies with simultaneous reduction of outcome variability within and among regions.
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