Risk Stratification

Our Risk Stratification & Case Finding tool will help you deliver a cost-effective service by identifying your high risk patients who will benefit the most from an immediate and early intervention. These high risk patients are people who are likely to be high service users in the future and therefore will benefit from pro-active disease management and preventative services straight away.

The Risk Stratification & Case Finding module offers an end-to-end solution that will support Commissioners and General Practice in:

• Risk Stratification
• Case Finding for Integrated Care Teams
• Systematising Self Care (Care Planning)

Key Features & Benefits

• Highly flexible as it supports multiple risk algorithms including the Kings Fund Combined Predicative Model and the Nuffield Trust recalibrated Combined Predicative Model
• Supports all the different Primary Care clinical systems
• Complies with all the latest Governance guidance
• Supports the Integrated Care agenda
• Integrates with Community and Social Care data
• Supports Multidisciplinary Teams (MDT)
• Risk profiling in support of the “frail elderly”
• Seamless process of case-finding and referring patients to appropriate early interventions
• Re-admission reporting to identify ‘revolving door’ patients
• ‘High Climbers’ report to identify those patients whose risk is increasing
• Predictive data/scenario modelling available to support the planning of services
• Economic evaluation to measure cost-effectiveness of interventions

Our Risk Stratification tool now supports the Unplanned Admissions Direct Enhanced Service 2014/15, where the “very high risk” patients include the top 2% of adult patients (aged 18 and over) of the practice’s registered list. For further information please contact us.

This service is available on G-Cloud (SaaS or SCS) and GP Systems of Choice (GPSoC) Lot 2 frameworks to help make buying from us quicker and easier.