Google Scholar. Prognostic ability of segments was used as a proxy indicator of clinically meaningful, needs-based segmentation. MFB K. Morbidity profiles at three primary care clinics in Perlis, Malaysia. Finally, development and evaluation of service packages tailored to specific healthcare need-based population segments’ need enables a virtuous cycle of continual refinement of service interventions designed in relation to need. Consumer segmentation is another aspect of using demographic data. Product differentiation and market segmentation as alternative marketing strategies. In this way, not only the company will benefit from the product but the purchasing power of customers will also not be affected. In. 1956;21(1):3–8. For example, any food that contains pork or any of its additives will not be consumed by Muslims and Jews, as it is forbidden in their religion. This is an area that deserves greater attention as by planning health services through focusing on healthcare needs based population segments, policymakers may become better able to match healthcare services to needs, thus improving whole population health outcomes. Getting it right: why bother with patient-centred care? J Am Geriatr Soc. [ 2] T The marketing segment for the purpose of this exercise is … Lafortune L, Beland F, Bergman H, Ankri J. Melis RJ, van Eijken MI, Teerenstra S, van Achterberg T, Parker SG, Borm GF, van de Lisdonk EH, Wensing M, Rikkert MG. A randomized study of a multidisciplinary program to intervene on geriatric syndromes in vulnerable older people who live at home (Dutch EASYcare Study). A work-sampling analysis of physicians’ activities. Fuller RL, Hughes JS, Goldfield NI. Thus, the generalizability of these tools merits further testing. Both segmentation systems have been validated through demonstration that patients categorized in different segments have differing expected healthcare utilization associated costs (see Additional file 1: Appendix D). Appendix E; adaptation of QUIPS tool for evaluation of segmentation tool validation studies. Am J Manag Care. Psychographic segmentation is “the next frontier” for health care, said David Homan, Director of Marketing and Innovation and a Shareholder at McGohan Brabender. 2). The proprietary group of tools include the Johns Hopkins Adjusted Clinical Groups (ACG) system [28,29,30,31,32,33,34,35,36,37,38,39], the 3M’s Clinical Risk Groups (CRG) [40,41,42,43,44] as well as Kaiser Permanente’s Senior Segmentation Algorithm (SSA) . However, given that no two patients are alike, the creation of models of care tailored for every individual in a population can become a prohibitively expensive and intractable endeavour . Therefore, we undertook a systematic review to identify all available tools which operationalize healthcare need-based population segmentation, to help inform policymakers developing population-level health service programmes. Haas LR, Takahashi PY, Shah ND, Stroebel RJ, Bernard ME, Finnie DM, Naessens JM, Takahashi PY, Shah ND, Stroebel RJ, et al. Validated, non-proprietary tools can in turn be divided into 2 groups based on whether these tools require a comprehensive electronic medical record. 2012;307(14):1513–6. QUIPS assesses the risk of bias in the following 6 domains: study participation, study attrition, prognostic factor measurement, outcome measurement and study confounding, as well as statistical analysis and reporting. Driven in part by demographic changes, a new paradigm of public and private sector collaboration is developing to transform healthcare financing and delivery. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. 2013;13(269). © 2020 BioMed Central Ltd unless otherwise stated. Michel Wedel, Wagner A. Kamakura: Market segmentation: conceptual and methodological foundations: Springer Science+Business Media, LLC; 2000. statement and Population segmentation based on healthcare needs: a systematic review. Designer products thus are priced high, rendering them purchasable only by the high income individuals, and placing them out of reach of other lower income market segments. process of dividing your market into segments based on things like ethnicity Background Healthcare needs-based population segmentation is a promising approach for enabling the development and evaluation of integrated healthcare service models that meet healthcare … 2). Med Care. The intention of this exercise was to assist policymakers in choosing the tool which is most suitable for their respective healthcare systems. Liu L-F, Tian W-H, Yao H-P. Using search terms reflecting concepts of population, healthcare need and segmentation, we systematically reviewed and included articles containing healthcare need-based adult population segmentation tools in PubMed, CINAHL and Web of Science databases. Appendix B; number of articles per tool. Cumulative Index to Nursing and Allied Health Literature, French acronym for System of Integrated Care for the frail elderly. A tool is said to be proprietary if it is used under exclusive legal right of the inventor or owner, while a comprehensive electronic medical record is defined as a record system which has sufficient scope (includes inpatient and outpatient records) as well as coverage (includes all individuals in a population of interest). A prospective comparison of standardized patients with the medical record. Examples include Calvin Klein and Christian Dior that offer different perfumes, cologne and other fragrance, watches ranges for men and women. Gray LC, Bernabei R, Berg K, Finne-Soveri H, Fries BE, Hirdes JP, Jonsson PV, Morris JN, Steel K, Arino-Blasco S. Standardizing assessment of elderly people in acute care: the interRAI Acute Care instrument. Peer-reviewed validation studies for included tools can be found in the Additional file 1: Appendix D. Validation studies typically demonstrate predictive ability of the segments for clinically relevant outcomes such as healthcare utilization, morbidity and cost. Bauman AE, Fardy HJ, Harris PG. This would likely involve the development of primary data collection-based tools as well if required segmentation base variables (e.g. In 1950, the population aged 65 and older represented 8.1 percent of the total U.S. population. In: Evidence Briefings. Yan S, Kwan YH, Tan CS, Thumboo J, Low LL. They include: healthy, acute illness, maternal and infant health, minor chronic disease, moderate chronic disease, frailty, major chronic illness, cancer, mental illness, end-of-life and excluded subjects. Tools that do not require a comprehensive electronic medical record typically involve prospective data gathering. Health Serv Res. Methods Inf Med. Suzman R, Beard J: Global health and aging. Nursing Economics. (Detailed search terms, databases utilized can be found in Additional file 1: Appendix A, while PRISMA adherence can be viewed on Additional file 2: PRISMA Checklist, and Fig 1: PRISMA Flow Diagram/ Systematic review workflow). Finally, Low et al.’s utilization-based segmentation scheme was able to segment patients into groups with different prospective healthcare utilization rates. Finally, due to insufficient data for a quantitative meta-analysis, the heterogeneity of segmentation tools’ healthcare need covariates, as well as the lack of consensus on a framework for assessing the quality of healthcare need-based population segmentation tools, the results of this review are presented as a narrative summary. Smith WR. Hayden JA, van der Windt DA, Cartwright JL, Cote P, Bombardier C. Assessing bias in studies of prognostic factors. 2010;48(5):402–8. lifestyle, loneliness, functional status, etc.). All other ‘low’ risk of bias validation studies evaluated the CRG (see Additional file 1: Appendix D). The goals of the guide are 1. explain the rationale for and importance of demographic data collection 2. highlight the impact of demographic data collection on improving health care … Next, while we attempted to evaluate the risk of bias of segmentation tool validation studies using an adapted QUIPS framework, we acknowledge that QUIPS was designed mainly for prognosis studies which tend to be longitudinal cohort studies utilizing continuous variable-type prognostic factors. http://www.healthknowledge.org.uk/public-health-textbook/medical-sociology-policy-economics/4c-equality-equity-policy/concepts-need-sjustice, https://nhsnwlondon.3.dev.fourplc.com/news-resources/information-sharing/what-population-grou/what-approach-should, https://www.birmingham.ac.uk/research/activity/mds/projects/HaPS/PHEB/HCNA/intro/index.aspx, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/, https://doi.org/10.1186/s13643-019-1105-6. Eliminating waste in US health care. PubMed Adjusting population risk for functional health status. While the potential value of population segmentation is appreciated, it is not self-evident how segmentation can be operationalized. Soc Sci Med. 6 However, the exponential growth in health care big data, 7, 8 together with the developments in data-mining tools, 9 provides new opportunities to use data for segmentation analysis. Companies consider this way to be the least costly way to segment their target market. In order to conduct a valid segmentation of this nature, it is vital to include a range of relevant insights including: 1. Paton F, Wilson P, Wright K. Predictive validity of tools used to assess the risk of unplanned admissions: A rapid review of the evidence. While QUIPS was originally designed for evaluation of prognostic studies rather than segmentation scheme validation studies, we have adopted it for our analysis given that in this study, prognostic ability of segments was used as a proxy indicator of clinically meaningful, needs-based segmentation (Additional file 1: Appendix E). BMC Health Serv Res. ; 2011. ; 2013. Health Policy. In this systematic review, we identified 16 unique adult population healthcare need-based segmentation tools and proposed a framework to assist policymakers in choosing the most optimal tool for use in their respective healthcare systems. This approach recognises that groups of people share characteristics that influence the way … Google Scholar, Concepts of need and social justice [http://www.healthknowledge.org.uk/public-health-textbook/medical-sociology-policy-economics/4c-equality-equity-policy/concepts-need-sjustice]. For example, in many countries, ICD diagnostic codes  may not be available in both inpatient and outpatient records, or patients may visit multiple healthcare institutions but policymakers have no access to the electronic medical records of all institutions. All authors read and approved the final manuscript. While these tools are useful for individual level (i.e. Medical Care. Carlsson L, Strender L, Fridh G, Nilsson G. Types of morbidity and categories of patients in a Swedish county. Currently, however, most population segmentation systems tend to be healthcare utilization risk-based  rather than healthcare needs-based. Population segments are mutually exclusive. Gender segmentation is another common market strategy, where customers are divided into categories of male and female. developed to help healthcare organizations overcome these challenges and embrace the opportunities in standardized demographic data collection. 2009;23(3). Healthcare needs-based segmentation thus has the distinct advantage of enabling development and evaluation of integrated services, in relation to the need for these services. Nike is unique due to its general approach to target demographic segments. A search was planned for the 5th of January 2016 for all literature to-date in PubMed, CINAHL and Web of Science databases. Med J Malaysia. As each calendar year ush… Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore, Jia Loon Chong, Ka Keat Lim & David Bruce Matchar, You can also search for this author in This enables formation of population segments based on common individual features which may have been assessed through different modalities at the individual level. As things currently stand, the typical clinician may already be spending a significant amount of time daily on electronic medical record data entry . Between tools that were expert driven and tools that were data driven, we note that data-driven tools utilized more segmentation bases that were non-medical, tended to be non-proprietary, as well as comprised typically of a smaller number of segments compared to expert-driven tools. 2) and underlying segment themes (see Additional file 1: Appendix C). Chong JL, Low LL, Chan DYL, Shen Y, Thin TN, Ong MEH, Matchar DB. Terms that were utilized revolved around the concepts of population, healthcare, segmentation and need. Partnerships with new market participants from industries such as retail, telecommunications, technology, wellness and fitness are expanding and reshaping the health … There are numerous people in the world and all have different ways of living. 2016;14:44. Explaining prescription drug use and expenditures using the Adjusted Clinical Groups case-mix system in the population of British Columbia, Canada. CAS The goal of demographic segmentation The goal of a good segmentation … For example, identifying patients as being in the healthcare need-based population category of ‘Limited reserve and serious exacerbations’  informs us that priority concerns for this type of patient include exacerbation avoidance, with major components of healthcare comprising self-care support and 24/7 on-call access to medical guidance . Van der Laan et al.’s study (demand-driven segmentation model) also examined social domain inputs . Int J Health Plan M. 2002;17(3):269–79. The global home healthcare market size was valued at USD 281.8 billion in 2019 and is expected to grow at a compound annual growth rate (CAGR) of 7.9% from 2020 to 2027. 2017;46(7):287–9. J Gerontol A Biol Sci Med Sci. The tools that require a comprehensive electronic medical record were Joynt et al.’s Medicare claims-based segmentation , Low et al.’s utilization-based segmentation , and the Singapore MOH (Ministry of Health) Segmentation framework . JAMA. Information types include demographic (e.g. 2006;76:38–48. Health Sector Planning and Innovation Division: Understanding the health care needs of the British Columbia population through population segmentation. Age is the most basic demographic segmentation variable. 1). Therefore, one way to reduce the number of data elements needed would be to determine patient population features at the ‘meso’-level. Marketing segmentation in healthcare is usually defined by demographic characteristics, disease categories and geographic location. Nike target consumer from 15 to 40 years of age. Data-driven tools are segmentation schemes that were typically generated ‘post-hoc’ using statistical clustering methods on a population dataset. USA, Canada), Europe (e.g. 2014;58(2). Demographic segmentation targets services for certain socioeconomic characteristics such as gen der, age, or cultural/ethnic background. 2013;10(2):1–11. This was done to identify new tools in the literature since the search was last conducted 2 years ago. When combined with other types of segmentation like behavioral, psychographic, geographic and demographic segmentation starts the procedure by dividing the overarching target customer groups into more manageable sections. Spain, Sweden, Netherlands) and Asia (e.g. 1978;32(1):10–5. Ideally, the electronic medical record should be a platform which enables triangulation of patient healthcare need variables from various sources (e.g. When marketers initiate a marketing campaign and devise a market strategy, besides considering other factors of their potential customers, they also segment their customers, based on their income level. By utilizing healthcare need-based tools such as the ones identified in this study, policymakers can tailor data entry fields on the electronic medical record based on variables required by the tool which has the dual benefit of enabling population healthcare need assessment while reducing clinician workload. If people can’t afford your product or service, there is no point in targeting … These brands follow a market segmentation strategy where different fashi… These themes represent population segments with diverse and distinctive healthcare needs that exist at a population level. J Epidemiol Community Health. Med J Aust. That said, both ACG and CRG create a large number of segments which may in turn make it difficult for policymakers to develop programmes to cater to every unique segment. Ann Intern Med. Every product that contains some kind of differentiation which caters to the different needs of the two genders is divided based on this type of market segmentation. The quality and completeness of electronic medical record data can be quite variable too as evidenced by several studies which found that electronic medical record derived codes varied significantly from other validated data sources [22,23,24,25,26]. David Bruce Matchar. Stevens A, Gillam S. Needs assessment: from theory to practice. These tools sourced for medical, demographic and frailty indicator variables from administrative records to describe and classify their respective patient populations. In a healthcare context, the benefits of population segmentation analysis for the provision of patient-centred care include the facilitation of healthcare needs evaluation, outcome tracking and care integration . In. This can be done ‘a priori’ through expert inputs or ‘post-hoc’ using statistical methods in a data-driven manner (often followed by an interpretive step). Famous fashion designers such as Chanel, Gucci and Burberry all formulate their fashion collections targeting demographic market based on age, gender and income. Products that practice income based demographic segmentation include all designer labels. Risk-stratification methods for identifying patients for care coordination. 2012;67(4). 2019. Four phenomena underlie the presence of need, namely risk of morbidity, pain/discomfort, dysfunction and risk of mortality . Popul Health Metr. A psychographic segmentation that showed differences in health or outcomes is a perfect case for population health. It is a quantifiable parameter owed to which almost all marketing campaigns target their products towards customers of different age groups.Famous fashion designers such as Chanel, Gucci and Burberry all formulate their fashion collections targeting demographic market based on age, gender and income. Epidemiol Biostat Public Health. Table 1 illustrates the differences between all identified tools in terms of several selected variables which may impact the operationalization of a tool in different health systems and populations. : World Health Organization; 2011. All disagreements between reviewers were resolved through discussion. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Thereafter, using an algorithm, patients are classified into mutually exclusive Adjusted Clinical Groups . Given the worldwide trend of ageing populations and increasing prevalence of chronic disease , healthcare policymakers increasingly recognize the need to improve the management of patients with chronic diseases through patient-centred care [2, 3]. However, healthcare policymakers interested in understanding adult population healthcare needs may not be aware of suitable population segmentation tools available for use in the literature and barring better-known alternatives, may reinvent the wheel by creating and validating their own tools rather than adapting available tools in the literature. : World Health Organization; 2002. Thereafter, hand searching was conducted independently on all 11 included articles by the same 2 reviewers (JLC and KKL). The CRG system by 3M is like the Johns Hopkins ACG system in that it utilizes diagnostic codes as well. Halling A. Validating the Johns Hopkins ACG case-mix system of the elderly in Swedish primary health care. Therefore, schemes that include a larger number of these segment themes are potentially more actionable and responsive to tailored interventions. Millennials in their 20s … Madotto F, Riva MA, Fornari C, Scalone L, Ciampichini R, Bonazzi C, Mantovani LG, Cesana G. Administrative databases as a tool for identifying healthcare demand and costs in an over-one million poulation. effectiveness) for specific population segments by quantifying effectiveness as a reduction in the probability of progression to higher morbidity population segments because of specific healthcare interventions delivered. Tool proprietary status is important to consider as such tools can be potentially expensive to licence, and users are not able to freely modify the tool’s internal logic to adapt for use in local contexts. New York: McGraw-Hill; 1979. ACG, Adjusted Clinical Groups; CRG, Clinical Risk Groups; SSA, Senior Segmentation Algorithm; SG-MOH, Singapore Ministry of Health Segmentation Framework. Therefore, to bridge this gap in the literature and provide an overview of available population segmentation instruments for policymakers, we conducted a systematic review of all adult population healthcare need-based segmentation tools. That said, because the quality of an electronic medical record system depends on inputs primarily from clinicians, there is a concomitant need to minimize the need to gather patient information which are not actionable to avoid unduly burdening clinicians. Nike and Adidas are good examples of footwear brands that offer different sports footwear, apparels and related accessories for men and women and youth. Vuik SI, Mayer E, Darzi A. Demographic segmentation is predominantly used in marketing, but can also be helpful for things like brand positioning, UX design and CX too. Patient segmentation is usually based on the following elements: the assessment, definition, and operationalisation of population or patient characteristics that are related to healthcare needs, … Demographic segmentation divides the market into segments based on variables like age, gender and family and offers the product and services that satisfy their mutual needs. The total number of articles screened, including hand and Google search from both primary and secondary searches, was 9970 (Fig. Tools that utilize a comprehensive electronic medical record include Vuik et al.’s utilization based segmentation scheme  and the segmentation schemes developed in Lombardy , North West London , British Columbia  and Delaware , as well as Complexedex [7, 17]. Van der Laan et al.’s study on the other hand demonstrated descriptively that the segmentation results can be replicated in different populations within the Netherlands. When a population is segmented into groups with similar patterns of healthcare need, policymakers may better understand a heterogenous population thus facilitating the planning of healthcare resources and interventions [5, 6]. If required healthcare need variables are not found in the electronic medical record, an alternative is to conduct primary data collection using healthcare need assessment tools such as Easycare  and Interrai . The Permanente journal. Currently, the outcomes of healthcare interventions are commonly evaluated through objective variables such as incidence of hospital admission and disease biomarkers . 2003;179(5):253–6. Correspondence to JL was involved in methodology design, screening/extracting articles, creating figures and tables, writing the original draft and reviewing/editing the draft. Population segmentation tools play an integral role in enabling the creation and refinement of integrated care systems . The judgement of multiple professionals (i.e. The health care market segmentation has also become very important because of many reasons which cannot be shunned. Companies also design their market strategies towards potential customers based on their marital status, education level and other demographic segmentation such as occupation, etc. For example, baby products from Mothercare a British retailer for mother and babies, are directed towards married couples who have or expectedly will be having a family and will require purchasing baby products. This search involved a review of the PubMed database using identical search terms as the primary search, as well as hand searching of previously included articles using Google scholar by the first author (JLC). Following a review of segmentation and risk stratification models used in healthcare, we have developed our own dynamic data-driven application of the internationally-recognised Bridges to Health … A segmentation analysis of this data, focusing on health care attitudinal and behavior questions rather than demographics, offered us a far richer understanding of consumers than analysis focused solely on demographics. BMC Health Serv Res. In this study, we define a healthcare need as a capacity to benefit from healthcare, where benefit can be quantified in various ways, depending on the outcomes of primary relevance to healthcare policymakers (e.g. ), medical (e.g. Applying the Johns Hopkins ACG case-mix system in a retrospective study of electronic patient records. 2015. Singapore National Medical Research Council (NMRC)—Health Services Research Grant (HSRG), NMRC/HSRG/0086/2018. ‘micro’ level) care planning (which may take too much time to collect in the routine outpatient clinical setting), the patient variables required for population-level healthcare need assessment through segmentation typically does not require as many data elements. Delaware Health Care Commission: Delaware state innovation models (SIM) initiative. Hewner S. A population based care transition model for chronically ill elders. Orueta JF, Nuño-Solinis R, Mateos M, Vergara I, Grandes G, Esnaola S. Predictive risk modelling in the Spanish population: a cross-sectional study. Therefore, patient stratification based on morbidity risk, while useful as a proxy for intensity of need, is insufficient for informing the development of healthcare services in order to reduce this risk . Starbucks is an American coffeehouse chain operating in 6 continents and 75 countries and territories. Carreras M, Ibern P, Coderch J, Sanchez I, Inoriza JM. Chong JL, Matchar D. Benefits of population segmentation analysis for developing health policy to promote patient-centred care. Chong, J.L., Lim, K.K. Privacy age, gender, etc. Products offered by a company, sets its product price based not only on the cost of production but also on the income level of its target market segment. Am J Med. As demonstrated in this study, most population segmentation base variables exist on the meso-level. Meanwhile as can be seen in Additional file 1: Appendix D, segmentation tool validation studies were found to be conducted in North America (e.g. Strategies that target women, in particular, arc becoming increasingly prevalent for several tea ... improved health care … The top reasons for exclusion of articles after full-text review were the absence of an operationalized segmentation scheme and schemes that did not categorize patient populations. Archives of Gerontology and Geriatrics. volume 8, Article number: 202 (2019) The strengths of this study include its novelty as the first systematic review for adult population healthcare need-based segmentation tools to our knowledge where both peer-reviewed and grey literature was reviewed. However, when assessing a population, one may opt for meso-level assessment instead such as whether individuals have any impairment in their ability to conduct activities of daily living (i.e. Tailoring services to needs is important as inadequate services lead to worse outcomes while excessive services lead to higher healthcare costs with little or no benefit to patients . Terms and Conditions, DB was involved in the conceptualization of the study, methodology design and reviewing/editing the draft. In addition, studies that compare interchangeability of segments between hypothetically mappable tools may aid inter-population healthcare need profile comparisons. 1998;316(7140):1310–3. Type #1: Demographic Segmentation Marketers believe that the segmentation of the audience is highly beneficial in delivering a high degree of customer service .
2020 multi layer perceptron classifier