‘Population health’ holds that there are a wide range of determinants of health and wellbeing, many of which lie beyond the reach of health and care services, that determine the health of a population. An emphasis on reducing inequalities in health as well as improving health overall is core to population health approaches. There are several definitions of population health in use. The King’s Fund defines it as: Population health is sometimes confused with, or seen as synonymous with, public health. Public health bodies and local directors of public health do have a responsibility to understand the needs of their population and the organisation and delivery of some public health services, such as weight management, smoking cessation or sexual health services, as well as protecting people’s health from external threats, eg, disease outbreaks. While this is an invaluable skillset, there is often a mis-perception that health and wellbeing of a population is only the responsibility of public health professionals; those specialists who are explicitly trained to plan and deliver public health services. The reality is that population health requires input from numerous partner organisations, such as the NHS, community groups, local authorities and political leaders, as well as public health teams whose action and influence should be seen as key in a population health approach. Confusingly, the phrase ‘population health management’ is also widely used, with a specific meaning that is narrower in focus than population health. Population health management is a data-driven tool or methodology that refers to ways of bringing together health-related data to identify a specific population that health and care systems may then prioritise for particular services. For example, data may be used to identify groups of people who are frequent users of accident and emergency departments, to offer preventive interventions that improve health and reduce demand on acute services. One common approach to population health management is ‘population segmentation’. Our health is shaped by a range of factors, as set out in Figure 1. Figure 1 - What affects our health? Source: Dahlgren G, Whitehead M 1993 Recognising this, The King’s Fund vision for population health sets out a framework for population health, that focuses activity across four pillars. Improving population health requires action on all four of the pillars and, crucially, the interfaces and overlaps between them. For example, a population health approach to planning a new housing development would include building in active travel and green space, considering the size and design of individual homes, ensuring homes are affordable to all sections of the community, and action to allow people to stay independent as they age in their homes. The Healthy New Towns initiative was one example of how an emphasis on all these and more came together in sites around the country. The King’s Fund describes this way of applying a population health framework in a place, whether nationally, regionally or locally, as the way to develop an effective ‘population health system’. This is illustrated in Figure 2. Figure 2 - A population health system Source: Buck et al 2018 Given the breadth and complexity of things that affect our health, responsibility and accountability for driving population health improvement can be unclear as the levers for change sit across multiple organisations. Importantly, action to improve population health effectively needs to be taken at three levels:
In 2018, the NHS Long Term Plan set out the expectation that in time integrated care systems (ICSs) would bring together NHS, local authority, and voluntary sector and other community groups to help deliver population health approaches. Now, the Health and Care Act 2022 has established ICSs as statutory bodies with a responsibility to improve population health, and it also introduces new duties for the NHS to tackle health inequalities. At the same time, reforms to the national public health system led to the creation of the Office for Health Improvement and Disparities (OHID), which sits within the Department for Health and Social Care. OHID leads population health improvement policy development and advises the cross-government Health Promotion Taskforce, which is responsible for leading cross-government efforts to improve population health, including the wider determinants of health and community development.
Delivering an effective population health approach will take concerted, systemic and coherent efforts over the course of many years. New structures within the health and care system provide a strong foundation to deliver this, though change will be driven by local and regional teams.
Introduction A population health approach is a useful strategy to aid health organizations in improving patient outcomes for specific groups (e.g., those with chronic conditions such as chronic obstructive pulmonary disease and/or population sub-groups such as women of childbearing age). These kind of approaches also have the potential to save resources by reducing health care utlization (e.g., hospitalization and emergency department visits through prevention efforts). In particular, the strategies detailed in this article have demonstrated impact in a number of settings ranging from primary care to acute care hospitals, to public health clinics.
Segmenting Patient Populations Possible methods for grouping populations to improve care include age, gender, disease or condition, social and demographic factors, behaviour, and risk stratification on one or more of these variables. The most commonly used methods are by age and disease or condition; with risk stratification. Risk stratification can display a more precise view of the population under consideration. Segmenting patient populations using risk stratification is a critical first step in developing an appropriate population health strategy. Common risk groups include low-risk, rising-risk, and high-risk groups. The division of the population into groups of apparent risk is the first step to addressing the high cost of chronic diseases. This creates the possibility to decrease preventable readmissions, and connect sub-populations to community-based resources to enable individuals to live healthier lives. Though high-risk patients are also high-cost patients who have more than one chronic disease, the rising-risk population accounts for a higher amount of healthcare expenditures due to the high percentage of the population that they account for. The rising risk group is not ill enough for expensive clinical care, but they are also past the point where preventive solutions are effective. This gap is important to address in order to prevent the increasing multi-morbidity in the population. Identifying Risk Factors There is a small number of causes or risk factors, that contribute to most chronic disease. These include an unhealthy diet, physical inactivity, and tobacco use. These are the first-degree risk factors that are modifiable. These risk factors contribute to an intermediate set of risk factors such as hypertension, raised glucose levels, abnormal blood lipids, and obesity. These modifiable risk factors combine with non-modifable risk factors such as age and heredity; to establish most of the chronic diseases around the world. Therefore, the prevention and screening of risk factors enables a reduction in chronic disease.12
Utilizing Primary Medical Care Home Delivery Models Primary care medical homes are models of primary care that are patient-centered, comprehensive, team-based, coordinated, accessible, and are focused on both safety and quality.9 They are comprised of various providers in different disciplines to provide comprehensive and personalized care in an inter-professional team. The foundation of the medical home is the relationship between the patient and their primary physician. The medical home contributes to a population health approach that promotes wellness and helps patients prevent illness. Using Evidence-Based Screening and Prevention Focusing only on sick patients and patients with existing risk factors will be ineffective in controlling healthcare costs in the long run. As the largest driver of escalating healthcare costs is the expensive treatment of chronic disease, more preventive healthcare is necessary. The prevention of illness in the groups of patients who may become ill is important to reduce rising healthcare costs. There are sources for evidence-based preventive recommendations that can be accessed by healthcare providers around the world and applied to healthy and low-risk populations throughout the lifespan.
Focusing on Overall Health Evidence suggests that people living in disadvantaged circumstances tend to be less healthy than their more advantaged counterparts. Additionally, people who grow up in poverty and substandard housing have higher mortality and morbidity rates and increased healthcare costs. These determinants of health are also important drivers of health services utilization patterns over time. For the health system to improve the health of the population, while containing costs; more resources must be spent on health promotion and disease prevention. The increased emphasis on the population health approach, which decreased attention of purely the treatment of patient-centered illness is important. Better health outcomes can be achieved through the health system spending money on building healthier communities, with social supports and nourishing environments. Health policies need to expand to address factors outside the medical system that promote or compromise health. Moving from Volume-Based to Value-Based Care Current health systems in both Canada and the United States tend to emphasize volume (i.e., utilization) in healthcare over value. These funding systems historically have not provided incentives or encouraged providers to consider the cost of care and how it affects the overall health system. By moving the economic model from that of a "sick system" to one focused on prevention, encouraging patient engagement, and reducing expenditures will reduce costs and improve care. The shift to a system of value-based care are occurring but will take time, with some growing pains along the way. In the interim, there are various ways healthcare systems can implement some of the elements of value-based care. For example, by improving communication around hand-offs, calling patients after discharge to identify issues of concern and removing waste (non-value-added activities) within the system, patient care across the care continuum will be improved. Key Takeaways Population health management is an effective strategy to control increases in healthcare spending and the incidence of chronic disease, while improving outcomes for specific patient populations. Focusing on the prevention of illness before the clinical stage is key to this endeavour. The segmentation of populations and the identification of risk factors helps to address the underlying causes of chronic diseases, and the implementation of these approaches directs care and prevention to those most in need. Using new forms of more broadly linked treatment options such as value-based care and primary care medical homes allows patients to be treated seamlessly and with better integration between providers. Need more information? Have some resources to share? Please visit the Population & Public Health Community of Practice and ask a question in the discussion space and/or upload files to share with your colleagues. Related Articles
|
What are the advantages of using a public health approach to maximize individual and population health status?
zusammenhängende Posts
Urheberrechte © © 2024 frojeostern Inc.
