risk stratification approach using cluster analysis H e a l t h M e d i c a l

risk stratification approach using cluster analysis H e a l t h M e d i c a l


PEER #1 Alex

Case management protocols are essential to build in healthcare settings to systematically identify patient risk while developing effective treatment goals and an intervention plan. Appendix 1A-1G in our textbook is a clear example of how protocols can be administered for high-risk clients. The first step in the case management protocol identifies high-risk patients who are in the top 5% of severity (Kathol et. al, 2010) through the initial and iterative intervention phase. It is important to note that high-risk typically is identified among a spectrum of issues including acute psychiatric symptoms, substance abuse, domestic violence, etc. There are many life situations that lead a person into crisis which will produce clients with a wide range of issues. Once patients are classified as high-risk, they are triaged to be in a safe place and patient consent is obtained to include all patient healthcare providers in the treatment programming. The most important voice is the client voice which is why the next step includes the patient setting personal goals from the IM-CAG/PIM-CAG (Kathol et. al, 2010). This step includes documenting the patient’s goals and identifying strategies to achieve those goals while including all patient stakeholders in the process. A care plan will then be developed with the integrated healthcare team to accomplish the treatment goals.

The next phase of intervention is the progression review in which the case manager determines follow-up dates to assess progress on patient goals and the status of the treatment plan. This process will include working with the patient to evaluate progress in the treatment goals set, how the intervention is progressing, continued goal setting and care plan adjustments as needed. It is also important in this step to determine if there are any barriers to care that need to be addressed. The case manager then updates the integrated healthcare team on the review of patient progress and what steps will follow. This is also a productive time for consultation amongst team members.

The final step in case management protocols is determining when discharge is necessary. Discharge occurs when the patient is assessed to have met their goals and have demonstrated improvement and clear stability. With high-risk cases, the main goal is to empower the client in getting into a safe place where they can return to daily living with continued care from outside providers. In order for discharge to be successful, the case manager must work with the client and their support system to ensure a clear plan of care with a plethora of resources prepared to aid the client in their transition. The team will be consulted in the process to help ensure a smooth discharge of care into the hands of the client and their family/care providers. Having a very clear case management protocol is essential to develop proactively and to have all case managers trained in so all professionals are prepared to assess and treat patients in a systematic way. The appendix of our textbook is a great example of how this process can be developed to help patients who are at immediate high-risk.


Kathol, R. G., Perez, R., & Cohen, J. S. (2010). The integrated case management manual: Assisting complex patients regain physical and mental health. New York, NY: Springer. ISBN-13: 9780826106339


Hello Class,

After looking over the Appendix 1A-!G It seems as though the case management protocols for high risk clients are based on the assessments made by the first mental care specialist they come across. They have protocols set in motion where they look for certain criteria that would redly flag the patients as a high-risk client. It also seems as though they triage high risk patients before they speak to the case manager in order to spend less time trying to get information once they are being seen. This in turn may help both the client and the facility obtain the safest and best possible help while being pro active and consistent throughout their recovery.

They have a triage system that is available for case management, disease management, disability management, and health coaching.

Kathol, R. G., Perez, R., & Cohen, J. S. (2010). The integrated case management manual: Assisting complex patients regain physical and mental health. New York, NY: Springer. ISBN-13: 9780826106339


Individuals who are candidates for case management are in the top 5% of the risk stratum. These individuals are identified using a variety of tools including the IM-CAG assessment. If risk stratification is used and patient needs are appropriately addressed, case management will be a cost-effective way to avoid wasteful and unnecessary care (Pablo et al., 2020).

After doing some digging into what the IM-CAG is, I was able to wrap my head around the graphs in appendix 1A-1G (Latour et al., 2010) slightly better.

Health complexity can be measured efficiently with INTERMED methodology using the IMTERMED-Complexity Assessment Grid (IM-CAG). The IM-CAG puts the patients health risks and needs into a scored grid (highest priority to least). This allows the case manager, the patient, and care team to address the most serious issues first by creating a care plan and tracking patient outcomes (Becker, n.d.). Then the same process is used to address the second most pressing concerns etc (Latour et al., 2010).


Becker, M. (n.d.) https://doi-org.lopes.idm.oclc.org/10.1186/s12913-020-05668-7