BACKGROUND A rapidly ageing population with increasing prevalence of chronic disease presents policymakers the urgent task of tailoring healthcare services to optimally meet changing needs. While healthcare needs-based segmentation is a promising approach to efficiently assessing and responding to healthcare needs at the population level, it is not clear how available schemes perform in the context of community-based surveys administered by non-medically trained personnel. The aim of this prospective cohort, community setting study is to evaluate 4 segmentation schemes in terms of practicality and predictive validity for future health outcomes and service utilization. METHODS A cohort was identified from a cross-sectional health and social characteristics survey of Singapore public rental housing residents aged 60 years and above. Baseline survey data was used to assign individuals into segments as defined by 4 predefined population segmentation schemes developed in Singapore, Delaware, Lombardy and North-West London. From electronic data records, mortality, hospital admissions, emergency department visits, and specialist outpatient clinic visits were assessed for 180 days after baseline segment assignment and compared to segment membership for each segmentation scheme. RESULTS Of 1324 residents contacted, 928 agreed to participate in the survey (70% response). All subjects could be assigned an exclusive segment for each segmentation scheme. Individuals in more severe segments tended to have lower quality of life as assessed by the EQ-5D Index for health utility. All population segmentation schemes were observed to exhibit an ability to differentiate different levels of mortality and healthcare utilization. CONCLUSIONS It is practical to assign individuals to healthcare needs-based population segments through community surveys by non-medically trained personnel. The resulting segments for all 4 schemes evaluated in this way have an ability to predict health outcomes and utilization over the medium term (180 days), with significant overlap for some segments. Healthcare needs-based segmentation schemes which are designed to guide action hold particular promise for promoting efficient allocation of services to meet the needs of salient population groups. Further evaluation is needed to determine if these schemes also predict responsiveness to interventions to meet needs implied by segment membership.

中文翻译：

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基于医疗需求的人群细分是否可以预测老年人的结局？在城市化的低收入社区中进行的前瞻性队列研究结果。

背景技术随着人口的快速老龄化以及慢性病患病率的增加，决策者迫切需要调整医疗服务以最佳地满足不断变化的需求。尽管基于医疗保健需求的细分是一种有希望的方法，可以有效地评估人口层次上的医疗保健需求，但尚不清楚在非医学培训人员进行的基于社区的调查中，可用的方案如何执行。这项前瞻性队列社区设置研究的目的是针对未来健康结果和服务利用的实用性和预测有效性评估4种细分方案。方法通过对60岁及以上的新加坡公共租赁住房居民进行的横断面健康和社会特征调查，确定了一个队列。根据在新加坡，特拉华，伦巴第和西北伦敦开发的4种预定义的人口细分方案，使用基线调查数据将个人划分为细分。从电子数据记录中，评估基线段分配后180天内的死亡率，住院率，急诊科就诊和专科门诊就诊，并将其与每个细分方案的成员关系进行比较。结果在联系的1324位居民中，有928位同意参加该调查（回应率为70％）。可以为每个细分方案为所有主题分配一个专属细分。根据EQ-5D健康效用指数评估，处于较严重阶段的人的生活质量往往较低。观察到所有人口细分方案均具有区分不同死亡率和医疗保健利用水平的能力。结论通过由未经医学培训的人员进行的社区调查，将个人分配到基于医疗保健需求的人群中是可行的。以这种方式评估的所有4个方案的结果细分都具有预测中期（180天）的健康结果和利用率的能力，某些细分具有显着的重叠。旨在指导行动的基于医疗保健需求的细分计划在促进服务的有效分配以满足主要人群的需求方面具有特殊的希望。需要进一步评估以确定这些方案是否还预测了干预措施的响应能力，以满足部门成员所隐含的需求。