Table 3.

Variation Among Risk Stratification Approaches

Automated (N = 5)Manual (N = 5)Hybrid (N = 5)
DescriptionProgramming in the EHR or other database uses pre-selected criteria to assign patients a risk score.Practice staff or clinicians review patients to generate a risk score, often based on pre-selected criteria.Any mixture of clinical intuition, automated algorithm, and manual algorithm.
Practice CharacteristicsSize: 2 Medium, 3 LargeSize: 3 Medium, 2 LargeSize: 2 Medium, 3 Large
Location: 2 Rural, 2 Urban, 1 SuburbanLocation: 5 UrbanLocation: 2 Rural, 3 Urban
Ownership: 2 Independent, 3 SystemOwnership: 2 Independent, 3 SystemOwnership: 1 Independent, 4 System
WorkflowAlgorithm is programed into EHR or other database, and mapped to data sourcesCriteria are developed to systematically assess riskCriteria are developed to systematically assess risk, and data sources are identified
Risk scores are generatedEmpaneled patient lists are generated for each clinicianAlgorithm is programed into EHR* or other database to generate risk scores
Care team members review each patientCare team members review each patient
BenefitsEfficient for large populationsCare team member(s) generates risk scoreCare team member(s) generates risk score
Automatically generates and updates scoresCan include information not reportable from EHRCan include information not reportable from EHR
Pre-packaged algorithms availableTechnical expertise not requiredValidated algorithm criteria available
Risk scores generated within EHR or database
Validated criteria
ChallengesTechnical skills requiredTime-intensiveTime-intensive
Dependent upon consistent EHR documentationRisk score manually entered into EHR or databaseTechnical skills required
Difficulty including psychosocial criteriaDeveloping new criteriaDependent upon consistent EHR documentation
  • EHR, electronic health record.