title: Estimating community health needs against a Triple Aim background: What can we learn from current predictive risk models?
abstract: BACKGROUND
  To support providers and commissioners in accurately assessing their local populations' health needs, this study produces an overview of Dutch predictive risk models for health care, focusing specifically on the type, combination and relevance of included determinants for achieving the Triple Aim (improved health, better care experience, and lower costs).
  
  
  METHODS
  We conducted a mixed-methods study combining document analyses, interviews and a Delphi study. Predictive risk models were identified based on a web search and expert input. Participating in the study were Dutch experts in predictive risk modelling (interviews; n=11) and experts in healthcare delivery, insurance and/or funding methodology (Delphi panel; n=15).
  
  
  RESULTS
  Ten predictive risk models were analysed, comprising 17 unique determinants. Twelve were considered relevant by experts for estimating community health needs. Although some compositional similarities were identified between models, the combination and operationalisation of determinants varied considerably.
  
  
  CONCLUSIONS
  Existing predictive risk models provide a good starting point, but optimally balancing resources and targeting interventions on the community level will likely require a more holistic approach to health needs assessment. Development of additional determinants, such as measures of people's lifestyle and social network, may require policies pushing the integration of routine data from different (healthcare) sources.
authors.affiliation: Maastricht University, Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Duboisdomein 30, 6229GT Maastricht, The Netherlands. Electronic address: a.elissen@maastrichtuniversity.nl.
authors.forename: Arianne M J
authors.initials: AM
authors.lastname: Elissen
authors.affiliation: Harvard School of Public Health, Department of Health Policy and Management, 677 Huntington Avenue, Boston, MA 02115, United States; National Institute for Public Health and the Environment, Centre of Nutrition, Prevention and Health Services, Antonie van Leeuwenhoeklaan 9, 3721MA Bilthoven, The Netherlands. Electronic address: jeroen.struijs@rivm.nl.
authors.forename: Jeroen N
authors.initials: JN
authors.lastname: Struijs
authors.affiliation: National Institute for Public Health and the Environment, Centre of Nutrition, Prevention and Health Services, Antonie van Leeuwenhoeklaan 9, 3721MA Bilthoven, The Netherlands. Electronic address: caroline.baan@rivm.nl.
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Baan
authors.affiliation: Maastricht University, Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Duboisdomein 30, 6229GT Maastricht, The Netherlands. Electronic address: d.ruwaard@maastrichtuniversity.nl.
authors.forename: Dirk
authors.initials: D
authors.lastname: Ruwaard
mesh_terms: D003697:Delphi Technique; D006801:Humans; D007407:Interviews as Topic; D015233:Models, Statistical; D020380:Needs Assessment / Q000706:statistics & numerical data*; D009426:Netherlands; D011634:Public Health; D018570:Risk Assessment / Q000379:methods*
keywords: Community-based care; Health needs assessment; Integrated care; Predictive risk models; Triple Aim