Population Health Management Flashcards
Define population health
the health outcomes of a group of individuals, including the distribution of such outcomes within the group - look at patterns of determinants and outcomes and qaulity; direct policy and research agendas
no one in the public or private sector currently has responsibility for overall health improvement
Population health is NOT just the overall health of a population, but also includes
the distribution of health
overall health could be quite high if the majority of the population is relatively healthy, even though a minority of the population is much less healthy
Health is defined not simply as a state free from disease but as,
the capacity of people to adapt to, respond to, or control life’s challenges and changes
greater focus on SDOH
Goals of population health
set targets for overall population; maintain and improve health of entire population; eliminate or significantly reduce deficiencies and disparitites between subgroups
Access to health services by family income
poor or near poor had no target met/exceeded for health outcomes
higher the outcome –> more likely the targets are met
Healthy people 2030
sets data driven national objectives (355) to improve the health and well-being over the next decade
Healthy people 2030 objectives grouped by
health conditions
health behaviors
populations
settings + systems
SDOH: economics stability, education access and quality, health care access and quality, neighborhood and built envrionment, social and community context
COVID19 revealed
inadequecies in our public health system
Differentiate population health from public health
traditionally, public health has been understood by many to be the critical functions of state and local public health departments such as preventing epidemics, containing environmental hazards, and encouraging healthy behaviors
much of the US public health activity does not have such a broad mandate even in its assurance functions, since major population health determinants like health care, education, and income remain outside public health authority and responsibility
current resources provide inadequate support for traditional, let alone emerging, public health functions
Describe how population health differs from healthcare for individual patients
source of potential conflict: self interest of the individual vs the common good
List examples of different patient populations
Types of groups in healthy people 2030: adolescents/children/infants/older adults; LGBTQ; parents/care givers; men/women; people with disabilities; workforce
health outcomes of such groups are of relevance to policy makers and payers in both the public and private sectors: $$$ and productivity (healthier a pop is, more productive they’ll be)
List potential outcomes associated with population health initiatives
life expectancy; mortality - infant, maternal; premature death
cost burden, access to care, quality of life/care indicators, unhealthy days, percentage reporting fair or poor health, percentage reporting mentally unhealthy
USA ranking for life expectancy
45th
life expectancy is 77 yo
infant mortality: 5.8
maternal mortality: 10
even though we spend the most on HC compared to anyone else
Females vs males life expectancy
females have a greater life expectancy than males
Life expectancy at birth, by hispanic origin and race
greatest life expectancy: non-hispanic asian –> hispanic –> non-hispanic white –> non-hispanic black –> non-hispanic american indian/alaska native
Leading cause of death in US
heart disease
Leading cause of child death in US
firearms
Describe the basic foundations of population health and discuss the possible role of pharmacists in each
- descriptive epidemiology: the health of populations
- etiology, benefits, and harms - health research evaluation
- evidence based practice
- implementation of health promotion and disease prevention interventions
- determinants of health
- population health informatics
- evaluation
Descriptive epidemiology: the health of populations
burden, course, and distribution of disease/injury
Etiology, benefits, and harms - health research evaluation
comparative effectiveness research: aims to produce the type of evidence that will assist all partied to make informed decisions to improve health care at both the individual and population levels
Evidence based practice
assessing the evidence using nationally recognized guidelines
Implementation of health promotion and disease prevention interventions
target audience for direct interventions
Determinants of health
impact of social factors on individual behaviors - income, education, employment
Population health informatics
collection of population health data to assess population health, guide the provision of healthcare services and analyze health outcomes
Evaluation
process, quality, and outcome assessments; decision analysis; quality improvement processes
What makes examining population health possible
data
Types of healthcare data important for population health data
claims data, electronic health record data, socioeconomic data, patient-generated health data, prescription and medication adherence data
Claims data
easy to obtain; standardized; diagnosis codes
Electronic health record data
provides clinical clues; ease of grouping patients
Socioeconomic data
not frequently linked with EHR data
Patient-generated health data
satisfaction surveys; patient reported outcomes
Prescription and medicaiton adherence data
EHR and claims data
What is population health management
optimizes health outcomes for a specific segment of a population; segment can be any group sharing a characteristic: location, income, age, illness
population health management goals/benefits: preventive health, manage chronic disease, recude HC costs
Population health conceptual framework
population health management program strives to address health needs at all points along the continuum of health and well-being through participation of, engagement with, and targeted interventions for the population
Goal of population health conceptual framework
maintain or improve the physical and psychosocial well-being of individuals through cost-effective tailored health solutions
