Improving Implementation of Risk Prediction in Primary Care

Risk stratification, or the categorization of patients according to the level of care they require, is a crucial step in tailoring interventions to the needs of high-need, high-cost patients. Most primary care practitioners, however, currently do not use available risk scores generated by software programs or other current technologies, often finding them lacking in clinical meaningfulness or intuitiveness. In this project, researchers will identify promising approaches to risk stratification that are accurate in identifying high-need, high-cost patients and responsive to physicians’ concerns. The findings will be incorporated into a practical framework, or tool, to guide primary care providers in the implementation of risk stratification. This framework will then be reviewed and revised in collaboration with 10 primary care sites and an expert panel.