Table 1

Risk predictive modelling tools in the ACT regions*

	Basque	Catalonia	Lombardy	Scotland
Model	Predictive (based in Adjusted Clinical Groups-Predictive Model ACG-PM)	Predictive (based in the self-developed model GMA) (until 2014, use of the 3M Clinical Risk Groups, 3M-CRG)	Classificatory (based in the Diagnosis-Related Group, DRG, and a self-developed scheme CReG)	Predictive (Scottish Patients at Risk of Readmission and Admission, SPARRA-3)
Source population	Entire population of the Basque Country (2 100 000 citizens)	Entire population of Catalonia (7 500 000 citizens)	Patient group attended by one Primary Care provider (GReG cohort) (100 000 patients)	Data base of patients attended by NHS24 (3 400 000 patients)†
Updates	Annual	Semester	Once	Monthly
Scope of the use	Population-based risk assessment and stratification for health policy and service design, as well as use as case finding tool	Population-based risk assessment and stratification for health policy and service design, as well as use as case finding tool	Case finding tool and reimbursement model	Case finding tool
Clinical application	All levels of care can see the same information. Practising physicians receive a risk score for each patient	All levels of care can see the same information. Practising physicians and nurses receive a risk score for each patient	All levels of care can see the same information. Practising physicians receive a risk score for each patient	All levels of care can see the same information. Practising Physicians receive a risk score for each patient
Outcomes (dependent variables)	Mainly: health costs	Mainly: unscheduled hospital admissions at 1 year, readmission at 180 days and risk of death at 12 months	Costs of pharmacy, outpatient and inpatient costs	Individual's risk of emergency hospital inpatient admission over the next 12 months Risk of Institutionalisation
Covariates (independent variables)	Demographic information Diagnosis Comorbidity using a grouper Past healthcare consumption Aggregated socioeconomic status	Demographic information Diagnosis Comorbidity using a grouper Aggregated socioeconomic status	The classification system uses diagnosis for grouping	Demographic information Diagnosis Comorbidity using a grouper Past healthcare consumption

*Groningen was not included in the table because the integrated care programmes do not use population-based health risk predictive modelling tools.
†The total population of Scotland is 5 295 000 inhabitants.
ACT, Advancing Care Coordination and Telehealth Deployment.