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Predicting high healthcare resource utilization in a single-payer public healthcare system: development and validation of the High Resource User Population Risk Tool (HRUPoRT)


Background — A large proportion of healthcare spending is incurred by a small proportion of the population. Population-based health planning tools that consider both the clinical and upstream determinants of high resource users (HRU) of the health system are lacking.

Objective — To develop and validate the High Resource User Population Risk Tool (HRUPoRT), a predictive model of adults that will become the top 5% of healthcare users over a 5-year period, based on self-reported clinical, sociodemographic, and health behavioral predictors in population survey data.

Research Design — The HRUPoRT model was developed in a prospective cohort design using the combined 2005 and 2007/2008 Canadian Community Health Surveys (CCHS) (N=58,617), and validated using the external 2009/2010 CCHS cohort (N=28,721). Healthcare utilization for each of the 5 years following CCHS interview date were determined by applying a person-centered costing algorithm to the linked health administrative databases. Discrimination and calibration of the model were assessed using c-statistic and Hosmer-Lemeshow (HL) χ statistic.

Results — The best prediction model for 5-year transition to HRU status included 12 predictors and had good discrimination (c-statistic=0.8213) and calibration (HL χ=18.71) in the development cohort. The model performed similarly in the validation cohort (c-statistic=0.8171; HL χ=19.95). The strongest predictors in the HRUPoRT model were age, perceived general health, and body mass index.

Conclusions — HRUPoRT can accurately project the proportion of individuals in the population that will become a HRU over 5 years. HRUPoRT can be applied to inform health resource planning and prevention strategies at the community level.



Rosella LC, Kornas K, Yao Z, Manuel DG, Bornbaum C, Fransoo R, Stukel T. Med Care.2018; 56(10):e61-9. Epub 2017 Nov 17.

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Dr. Laura Rosella discusses a population risk tool she developed as a model for predicting which adults in a health system are most at risk of becoming a heavy user of healthcare within five years.

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