A person-centred segmentation study in elderly care: towards efficient demand-driven care.

Providing patients with more person-centred care without increasing costs is a key challenge in healthcare. A relevant but often ignored hindrance to delivering person-centred care is that the current segmentation of the population and the associated organization of healthcare supply are based on diseases. A person-centred segmentation, i.e., based on persons' own experienced difficulties in fulfilling needs, is an elementary but often overlooked first step in developing efficient demand-driven care. This paper describes a person-centred segmentation study of elderly, a large and increasing target group confronted with heterogeneous and often interrelated difficulties in their functioning. In twenty-five diverse healthcare and welfare organizations as well as elderly associations in the Netherlands, data were collected on the difficulties in biopsychosocial functioning experienced by 2019 older adults. Data were collected between March 2010 and January 2011 and sampling took place based on their (temporarily) living conditions. Factor Mixture Model was conducted to categorize the respondents into segments with relatively similar experienced difficulties concerning their functioning. First, the analyses show that older adults can be empirically categorized into five meaningful segments: feeling vital; difficulties with psychosocial coping; physical and mobility complaints; difficulties experienced in multiple domains; and feeling extremely frail. The categorization seems robust as it was replicated in two population-based samples in the Netherlands. The segmentation's usefulness is discussed and illustrated through an evaluation of the alignment between a segment's unfulfilled biopsychosocial needs and current healthcare utilization. The set of person-centred segmentation variables provides healthcare providers the option to perform a more comprehensive first triage step than only a disease-based one. The outcomes of this first step could guide a focused and, therefore, more efficient second triage step. On a local or regional level, this person-centred segmentation provides input information to policymakers and care providers for the demand-driven allocation of resources.

Tailor-made quality systems in healthcare.

At present many healthcare organizations are being pressed by national governments or client groups to develop and implement quality systems. Unfortunately, not much is known about the development and implementation of these systems in healthcare organizations. There still are definition questions to be answered and it is not clear in which way a quality system can be outlined and which outline is most effective in a particular situation. In practice, many healthcare organizations adopt ideas from industrial quality management and develop ISO 9000 based quality systems, which are only useful in relatively stable situations. In this paper a typology of healthcare processes is developed on the basis of input and throughput characteristics, following the literature on professional quality systems and service systems. The typology is tested and illustrated by a few case studies. From this typology, on the basis of logic, suggestions have been deduced for tailor-made quality systems in a general hospital setting. The main point of these systems is an examination, treatment and nursing plan with a timescale. Control is executed on the basis of performance indicators for groups of patients.