193 General discussion about time to think on how the current CSPs can be optimized in such a way that both efficiency and effectiveness of programmes are increased, whereby individual harms ideally get further diminished. Introducing Population Health Management principles into cancer screening might help to achieve this goal. Defining Population Health Management Population Health Management (PHM) can be defined as a healthcare strategy that shifts its attention from individual patients to specific at-risk population groups in order to address the current challenges within the healthcare system.74, 75 Given the mounting difficulties in Western countries to deliver cost-effective, accessible, and high-quality healthcare, it appears that adopting this approach is becoming increasingly essential.76, 77 While current literature contains multiple definitions on PHM, we would like following the master programme in The Hague, by defining PHM as: “A proactive management of a population at risk for adverse health outcomes; through a variety of individual, organizational and cultural interventions to improve patient, clinical and financial outcomes, based on risk stratified needs assessment of the population; supported by a comprehensive governance infrastructure”.78 In order to pursuit PHM, the aims of the Quadruple Aim are often mentioned. These are: (I) to improve population health, (II) to provide better quality of care, (III) to ensure that healthcare provider experiences improve, and (IV) to reduce the (overall) healthcare costs.79 In order to understand the above-mentioned definition, the concept of ‘risk stratification’ might need some clarification. It refers to a methodical evaluation of a patients’ profile, in order to assign an individual risk score. This established risk profile can then serve as the basis for delivering tailored healthcare to both the individual and the larger population based on their respective risk levels. Population Health Management building blocks in this thesis Although individual studies have already been briefly summarized at the start of this chapter, it might help to now rethink about these findings within the definition of PHM in mind. It then becomes clear that the studies within the thesis can also be regarded as PHM building block for CSPs in the Netherlands. In Chapter 2, several characteristics are described that could be used for risk stratification. Chapter 3 highlights the importance of involving individuals residing in low socioeconomic status (SES) neighbourhoods in screening examinations. Here specific tailormade interventions are most likely needed in order to engage these people within the CSPs. In Chapter 4, we demonstrate the desire among potential participants to receive further support and guidance from primary healthcare providers. Subsequently, 7
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