A methodology for identifying high‐need, high‐cost patient personas for international comparisons

Figueroa, Jose F.; Horneffer, Kathryn E.; Riley, Kristen; Abiona, Olukorede; Arvin, Mina; Atsma, Femke; Bernal‐Delgado, Enrique; Blankart, Carl Rudolf; Bowden, Nicholas; Deeny, Sarah; Estupiñán‐Romero, Francisco; Gauld, Robin; Hansen, Tonya Moen; Haywood, Philip; Janlov, Nils; Knight, Hannah; Lorenzoni, Luca; Marino, Alberto; Or, Zeynep; Pellet, Leila; ... (2021). A methodology for identifying high‐need, high‐cost patient personas for international comparisons. Health Services Research, 56(S3), pp. 1302-1316. Wiley 10.1111/1475-6773.13890

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To establish a methodological approach to compare two high-need, high-cost (HNHC) patient personas internationally.

Data sources
Linked individual-level administrative data from the inpatient and outpatient sectors compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC) across 11 countries: Australia, Canada, England, France, Germany, the Netherlands, New Zealand, Spain, Sweden, Switzerland, and the United States.

Study design
We outline a methodological approach to identify HNHC patient types for international comparisons that reflect complex, priority populations defined by the National Academy of Medicine. We define two patient profiles using accessible patient-level datasets linked across different domains of care—hospital care, primary care, outpatient specialty care, post-acute rehabilitative care, long-term care, home-health care, and outpatient drugs. The personas include a frail older adult with a hip fracture with subsequent hip replacement and an older person with complex multimorbidity, including heart failure and diabetes. We demonstrate their comparability by examining the characteristics and clinical diagnoses captured across countries.

Data collection/extraction methods
Data collected by ICCONIC partners.

Principal findings
Across 11 countries, the identification of HNHC patient personas was feasible to examine variations in healthcare utilization, spending, and patient outcomes. The ability of countries to examine linked, individual-level data varied, with the Netherlands, Canada, and Germany able to comprehensively examine care across all seven domains, whereas other countries such as England, Switzerland, and New Zealand were more limited. All countries were able to identify a hip fracture persona and a heart failure persona. Patient characteristics were reassuringly similar across countries.

Although there are cross-country differences in the availability and structure of data sources, countries had the ability to effectively identify comparable HNHC personas for international study. This work serves as the methodological paper for six accompanying papers examining differences in spending, utilization, and outcomes for these personas across countries.

Item Type:

Journal Article (Original Article)


11 Centers of Competence > KPM Center for Public Management

UniBE Contributor:

Blankart, Rudolf, Shatrov, Kosta Donislavov


300 Social sciences, sociology & anthropology > 350 Public administration & military science






[UNSPECIFIED] The Commonwealth Fund (US) ; [UNSPECIFIED] The Health Foundation (UK) ; [UNSPECIFIED] European Regional Development Fund ; [UNSPECIFIED] Institute for Clinical Evaluative Sciences ; [UNSPECIFIED] Ontario Ministry of Health and Long-Term Care


[UNSPECIFIED] International Collaborative on Costs, Outcomes and Needs in Care (ICCONIC)




Carl Rudolf Berchtold Blankart

Date Deposited:

06 Dec 2021 10:06

Last Modified:

02 Mar 2023 23:35

Publisher DOI:


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