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Selection of the method to appraise and compare health systems using risk stratification: the ASSEHS approach


To face the challenge of active and healthy ageing, European Health Systems and services should move towards proactive, anticipatory and integrated care. The comparison of methods to combine results across studies and to determine an overall effect was undertaken by the EU project ASSEHS (Activation of Stratification Strategies and Results of the interventions on frail patients of Healthcare Services, EU project (No. 2013 12 04). The questions raised in ASSEHS are broad and involve a complex body of literature. Thus, systematic reviews are not appropriate. The most appropriate method appears to be scoping studies. In this paper, an updated method of scoping studies has been used to determine the questions needed to appraise the health systems and services for frailty in the ageing population. Three objectives were set (i) to detect a relevant number of risk stratification tools for frailty and identify the best-in-class, (ii) to understand the feasibility of introducing stratification tools and identify the difficulties of the process and (iii) to find evidence on the impact of risk stratification in Health Services. This novel approach may provide greater clarity about scoping study methodology and help enhance the methodological rigor with which authors undertake and report scoping studies.

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Activation of Stratification Strategies and Results of the interventions on frail patients of Healthcare Services


European innovation Partnership on Active and Healthy Ageing


European union


Patient, problem or population, intervention, comparison, control or comparator, outcome


Preferred reporting items for systematic reviews and meta-analyses


Randomised controlled trial


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Correspondence to J. Mora.

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The authors declare that they have no conflict of interest.

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This article does not contains any studies with human and participants or animals performed by any of the authors.

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For this type of study informed consent is not required.

Additional information

The members of the ASSEHS Study Group are listed in Appendix.



The members of the ASSEHS study group are given below:

E de Manuel, M David, J Mora, L Prieto; Kronikgune, International Center for Research in Chronicity, Spain

C Domingo, J Orueta; Osakidetza, Basque Public Health Provider, Spain

E Valía, F Ródenas; Polibienestar Institute-University of Valencia, Spain

S Pauws, J op den Buijs, D De Massari, M Asim; Philips Electronics Nederland B.V. acting through Philips Research

J Contel; Generalitat de Catalunya, Spain

T Martí; Fundació Ticsalut, Spain

I Baroni, M Nalin; Telbios S.p.a, Italy

F Robusto, V Lepore; Fondazione Mario Negri Sud, Italy Centre Hospitalier Régional Universitaire Montpellier, France

F Avolio; Regional Healthcare Agency of Puglia, Italy

A Bedbrook, R Bourret, J Bousquet; Centre hospitalier régional universitaire de Montpellier, Montpellier, France

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Mora, J., De Massari, D., Pauws, S. et al. Selection of the method to appraise and compare health systems using risk stratification: the ASSEHS approach. Aging Clin Exp Res 27, 767–774 (2015).

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  • Scoping studies
  • EIPonAHA
  • Health system
  • Frailty