JMIR Publications

ABSTRACT

Background:

Ageing population and increasing multimorbidity challenges the health care systems worldwide. Patient segmentation aims to recognize groups of patients with similar needs, and offer targeted services to these groups, and thus reduce the burden of health care. In this study, the unique Finnish innovation Navigator, a web-based service for patient segmentation, is presented. Both patients and health-care professionals complete the electronic questionnaire concerning patients’ coping in everyday life and health state. Thus, it considers the patient perspective on self-care. One of four customership-strategy groups (self-acting, community, cooperating and network) is then proposed in response to the answers given. This resulting strategy helps both professionals to coordinate patient health care and patients to utilize appropriate health services.

Objective:

The feasibility, validity, and reliability of the Navigator service in the segmentation of diabetic patients into four CS groups are studied in a primary care setting. Patients’ characteristics concerning demographic status, chronic condition, disability, health-related quality of life and well-being in different CS groups are described. Our hypothesis is that patients in the network group are older, have more illnesses, chronic conditions or disabilities, and require more healthcare services, than do patients in the self-acting group.

Methods:

In this mixed-method study, data collection is based on questionnaires (user experience of Navigator, demographic and health status, WHO DAS 2.0, EQ-5D, W-BQ12, and DTSQ) issued to 300 diabetic patients and on user-experience questionnaires for and semi-structured focus-group interviews with 12 nurses. Navigator-database reports and diabetes-care values (RR, BMI, HbA1c, LDL, cU-AlbKre, smoking status) are collected. Qualitative and descriptive analyses are used to study Navigator’s feasibility, content, concurrent, and face validity. While criterion and concurrent validity are examined with correlations, reliability is examined by calculating Cohen’s kappa and Cronbach’s alfa. Exploratory-factor analysis performed on Navigator data reports and hypothesis-testing study construct validity. The values, demographics, and health status of patients in different groups are described, and differences between groups are studied by comparison of means. Linear regression analysis is performed to assess which variables affect CS group variation.

Results:

While data collection was completed in September 2019, the first results of Navigator’s feasibility are expected in 2020. Further results and publications are expected in 2021 and 2022.

Conclusions:

This is the first scientific study concerning the psychometric properties of Navigator. In addition, the segregation of diabetic patients into four CS groups in primary care setting, and the differences between patients in groups are examined. Results of this study will assist in Navigator’s further development as a patient segmentation method considering patients individual perspective on self-care. This study does not prove the effectiveness or efficacy of Navigator, therefore, it is essential to study these outcomes of separate care pathways in the future.