NURS 8310 – Epidemiology and Population Health Case Study Paper

NURS 8310 – Epidemiology and Population Health Case Study Paper

Epidemiology is the study of how often diseases occur in different groups of people and why. Epidemiological information is used to plan and evaluate strategies to prevent illness and as a guide to the management of patients in whom disease has already developed.

Like the clinical findings and pathology the epidemiology of a disease is an integral part of its basic description. The subject has its special techniques of data collection and interpretation, and its necessary jargon for technical terms. This short book aims to provide an ABC of the epidemiological approach, its terminology, and its methods. Our only assumption will be that readers already believe that epidemiological questions are worth answering. This introduction will indicate some of the distinctive characteristics of the epidemiological approach. NURS 8310 – Epidemiology and Population Health Case Study Paper

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Epidemiology is the study of disease in populations. Veterinarians and others involved in the preventive medicine and public health professions use epidemiological methods for disease surveillance, outbreak investigation, and observational studies to identify risk factors of zoophytic disease in both human and animal populations. Knowledge of these risk factors is used to direct further research investigation and to implement disease control measures The use of hazard analysis critical control point (HACCP) systems depends greatly on information produced by epidemiological studies. Epidemiological methods are used for disease surveillance to identify which hazards are the most important. Epidemiological studies are also used to identify risk factors which may represent critical control points in the food production system.

Although the role for epidemiology is widely accepted in public health programs in general, its role in chronic disease programs is not as widely recognized. One possible barrier to improving epidemiological capacity in chronic disease prevention and health promotion programs is that chronic disease program managers and public health decision makers may have a limited understanding of basic chronic disease epidemiology functions. We describe the assessment process of data collection, analysis, interpretation, and dissemination, and, using examples from two states, illustrate how this approach can be used to support program and policy development in three areas: by defining the problem, finding programs that work, and evaluating the effects of the program over time. Given the significant burden of chronic diseases in the United States, the scientific guidance provided by epidemiology is essential to help public health leaders identify priorities and intervene with evidence-based and effective prevention and control programs.

By the end of the 20th century, chronic diseases and their risk factors had became the leading causes of preventable deaths in the United States.1 In response, public health programs at the national, state, and community level established a variety of chronic disease prevention and health promotions programs.2-4 As these programs have evolved, the Centers for Disease Control and Prevention (CDC) and others have encouraged states and communities to dedicate resources to support epidemiological activities in chronic disease programs.5-7 NURS 8310 – Epidemiology and Population Health Case Study Paper

Although the role for epidemiology is widely accepted in public health programs in general, its role in chronic disease programs is not as obvious. In public health departments, epidemiology is used to uncover the causes of disease, as in a communicable disease outbreak investigation. However, because many of the causes of chronic disease are well known (e.g., poor diet, physical inactivity, smoking), program directors may prefer to spend limited resources on intervention programs rather than supporting further “research.”

According to recent study (see Frey et al. in this issue of JPHMP 9:4), one important barrier to improving epidemiological capacity in state health department chronic disease programs was a limited understanding of basic chronic disease epidemiology functions among program directors.5 This study suggested that commitment may be tenuous from senior health officials and administrators, who often have the least understanding and appreciation for epidemiology and who were subject to frequent organizational and political changes

To address these findings, we consider the role of epidemiology in chronic disease prevention and health promotion programs. We describe the assessment process of data collection, analysis, interpretation, and dissemination, and, using examples from two states, illustrate how this approach can be used to support program and policy development in three areas: (1) by defining the problem; (2) by finding programs that work; and (3) by evaluating the effects of the program over time. NURS 8310 – Epidemiology and Population Health Case Study Paper

Epidemiology is the study of the human health in community, It is the scientific method of investigation problem-solving to get to the root of health problems and outbreaks in a community.

The functions of the epidemiology include:

a) discovering the agent, host and environmental factor that affect community health to provide scientific basis for prevention of disease and injury including health promotion.

b) to determine relative importance of causes of diseases, disability and death to establish priorities for public health intervention

c) Identifying at risk population at greater risk of specific diseases

d) to evaluate effectiveness of health program mes and services

Population health has been defined as “the health outcomes of a group of individuals, including the distribution of such outcomes within the group”.^[1] It is an approach to health that aims to improve the health of an entire human population. This concept does not refer to animal or plant populations. It has been described as consisting of three components. These are “health outcomes, patterns of health determinants, and policies and interventions”.^[] A priority considered important in achieving the aim of Population Health is to reduce health inequities or disparities among different population groups due to, among other factors, the social determinants of health, SDOH. The SDOH include all the factors (social, environmental, cultural and physical) that the different populations are born into, grow up and function with throughout their lifetimes which potentially have a measurable impact on the health of human populations.^[2] The Population Health concept represents a change in the focus from the individual-level, characteristic of most mainstream medicine. It also seeks to complement the classic efforts of public health agencies by addressing a broader range of factors shown to impact the health of different populations. The World Health Organization’s Commission on Social Determinants of Health, reported in 2008, that the SDOH factors were responsible for the bulk of diseases and injuries and these were the major causes of health inequities in all countries.^[3] In the US, SDOH were estimated to account for 70% of avoidable mortality.^{[4] NURS 8310 – Epidemiology and Population Health Case Study Paper}

From a population health perspective, health has been 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”.^[5] The World Health Organization (WHO) defined health in its broader sense in 1946 as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”^[6][7]

The CDC’s National Center for Injury Prevention and Control updated its Prevention Status Reports Monday, which ranks the biggest public health issues in all 50 states and the District of Columbia.

The Prevention Status Reports organize information on state public health policies and practices in a format that is easy to use for public health professionals, community leaders and policy makers. The reports allow these individuals to understand their state’s status and identify improvement areas.

According to the reports, the 10 most important public health problems and concerns are (listed alphabetically):

• Alcohol-related harms
• Food safety
• Healthcare-associated infections
• Heart disease and stroke
• HIV
• Motor vehicle injury
• Nutrition, physical activity and obesity
• Prescription drug overdose
• Teen pregnancy
• Tobacco use

While the vast majority of diseases certainly do have genetic or biological underpinnings, environment also plays a critical role in determining who is most likely to fall sick—as well as who is most likely to get well once afflicted Public health research addresses the many issues that can influence the overall health and well-being of individuals and the greater community at large.  NURS 8310 – Epidemiology and Population Health Case Study Paper

“Understanding these issues and how they affect patient populations is key to providing more efficient and effective healthcare,” says Joshua Gordon, MD, PhD, director of the National Institute of Mental Health. “Not only will it help improve the health of patients but it will also reduce healthcare costs and increase healthcare organizations’ ability to negotiate with private insurance sectors.”

Here are the top five public health issues currently impacting healthcare organizations.

1. Behavioral health integration. Julia Andrieni, MD, vice president of Population Health and Primary Care at Houston Methodist Hospital in Houston, says that, too often, proper assessments of mental health conditions aren’t done. As these conditions can significantly impact a patient’s physical health status, she believes more healthcare organizations need to integrate behavioral health assessments into primary care. NURS 8310 – Epidemiology and Population Health Case Study Paper

“Assessments of a population for anxiety, depression, addiction, and with our aging population, cognitive ability, is really important,” she explains. “It’s very difficult to be effective in treating chronic conditions if you have an unaddressed behavioral health issue. For example, a diabetic with unaddressed anxiety or depression likely won’t be motivated to go to appointments, check blood glucose levels, or change their diet or exercise plan to stay healthier. Behavioral health is a vital part of a person’s whole health status.”

2. The suicide epidemic. Gordon says that the suicide in the United States is currently a national public health emergency.

“Suicide rates continue to go up—and we know there are things we can do to reduce suicide risk,” he explains. “Healthcare organizations have a large role to play in rolling out the kind of risk identification and intervention measures that can be effective to address this issue.” NURS 8310 – Epidemiology and Population Health Case Study Paper

3. The opioid crisis. According to the CDC, approximately 115 Americans are dying each day from opioid-related overdoses. Through integrated models of care, Andrieni argues, healthcare organizations are in a unique position to identify and treat individuals who may be suffering from a substance misuse disorder.

“So often, with opioids, alcohol, and tobacco misuse, we see that people are self-medicating and that’s what leads to addiction” she says. “We need to be addressing the other issues that commonly appear with substance abuse, those potential dual diagnoses, or diagnoses of physical or behavioral health conditions with substance misuse disorders, to better get a handle on this growing issue.”

4. Social determinants of health. Andrieni says that two patients may present with the same physical symptoms of a disease—but if they differ in socioeconomic status, education level, healthcare accessibility, family support, or other non-clinical factors, their diseases are likely to progress in very different ways.

“Healthcare providers need to address the non-clinical as well as the clinical factors when we treat a patient. Because they do impact health,” she says. “Think of a diabetic patient again.  If that patient has no transportation, food insecurity, an inability to pay for medicine, and a low literacy level, it will be a challenge to be effective in treatment. We have to address the disparities in social determinants of health so we can help our patients get healthier.” NURS 8310 – Epidemiology and Population Health Case Study Paper

5. The obesity epidemic. Research study after research study has shown the relationship between obesity and conditions like cardiovascular disease, diabetes, sleep apnea, and osteoarthritis.

“This is a public health issue that not only impacts adults but also is important to childhood health,” Andrieni says. “Understanding how a healthy weight can help set people toward a path of good health is critically important.”

There are, of course, many more public health issues that influence population health in the United States—and some have more impact in certain communities over others. But Gordon says that, especially regarding behavioral health issues, collaborative care models can help healthcare organizations develop the right strategies to keep their patient communities healthy and whole.

“When primary care doctors work with mental healthcare professionals of all different persuasions, we see a big difference. I would encourage hospital executives to think about integrating care across departments,” he says. “If we saw more of that in the private healthcare industry, we could see more cost-efficient and higher quality patient care.” NURS 8310 – Epidemiology and Population Health Case Study Paper

For those interested in a career path as a Healthcare Professional, something to consider when determining a career path is the differences between population health and public health. Both of these titles work to improve the health of the public itself and fall under the umbrella of the field of Health Sciences. There are many similarities and differences between the two. To understand the distinction, one must first correctly define them.

NURS 8310 – Epidemiology and Population Health Case Study Paper

What is Population Health?

Population health is a relatively new term professionals are using in the healthcare industry. It is a broad strokes approach that can be defined as a focus on understanding the conditions and factors that influence the health of populations over lifetimes. Population health also measures the patterns of occurrences of certain problems and implements policies for the overall health and well being of society as a whole entity. Healthcare professionals work to improve the health of populations by preventing disease, promote healthy lifestyles, and addressing health inequities. Some outcomes that population health responds to are improving the health of the people with limited resources, implementing cost-effective strategies to address health disparities, and developing practice guidelines for practitioners. Providers use population health solutions to identify any risk factors, coordinate care needed, and find specific information related to the patient to assist them accurately. NURS 8310 – Epidemiology and Population Health Case Study Paper

What is Public Health?

According to the American Public Health Association (APHA), Public Health promotes and protects the health of people and the communities where they live, learn, work and play. Public Health works on a more personal level than population health. It promotes wellness to the public by encouraging patients to live healthier lives. Public Health workers also educate people to help prevent bad habits, like smoking and drug use from getting out of control. These might include alcohol, tobacco and other substance abuse. Social workers and caseworkers who work with the healthcare industry in providing government assistance and counseling to the public fall under the umbrella of Public Health workers.

Public Health workers tasks can vary greatly depending on the practitioner’s interests and education. One might be the healthcare provider of a sick child, while another may be the scientist working to find a vaccine for a growing epidemic or the first res ponder to a horrific accident. Public Health workers can be policymakers as well They may set standards for safety rules to protect construction workers while on the job, or promote a new facility that provides an after-school program for underprivileged children to attend. Wherever the calling may take them, Public Health workers interact with society on some level of their work. Their job primarily is to change the quality of life for all people. NURS 8310 – Epidemiology and Population Health Case Study Paper

Why are Population Health and Public Health so important?

As each new advancement in technology takes off, the healthcare industry also often benefits. People in the healthcare field have access to data, resources, and innovations more now than ever before. Technology has allowed healthcare workers to monitor patients more closely and allowed for more determined outcomes for each patient, regardless of their condition. According to the National Center for Biotechnology Information, both Population Health and Public Health have been fields affected by the increase in new technology. They work together to prevent diseases and keep people safe and healthy. With new technology comes better, more efficient and advanced procedures, as well as innovations for existing methods. That is why Population Health and Public Health are so important to society as a whole.

Difference between Population Health and Public Health?

Population health and public health are among st the most popular buzzwords in the healthcare delivery sector today.  Although both the terms appear to sound and mean the same, they are definitely two different concepts in both their meaning and application.

Population health and public health equally value the community’s well being.  The primary task for both is examining health trends and evaluating causes of health conditions in the community.  The objective of these two concepts is to suggest ways of promoting health and delivering quality healthcare.  The key difference between population health and public health is in the demographic grouping through which the health of a community is addressed and studied. NURS 8310 – Epidemiology and Population Health Case Study Paper

Population Health

The prime focus of population health is on the health outcomes of a particular community or sub population.  Various societal issues, attitudes, values, beliefs and behaviors are taken into consideration in measuring and determining the outcomes as these are the prime factors that influence the health of a population.  The outcome seeks out effective ways to improve the health of the community or population or sub-population along with reducing the health inequities among different population groups.

The approach of population health represents a broad range of health determinants within the society.  As per several population health thought leaders, in a society, the factors that play the most important role in influencing health patterns of individuals are economic, social and physical environment, personal health tradition, individual abilities and managing skills, biological factors, development in the early childhood, gender, culture and the available health facilities.  Hence, the main approach of population health involves addressing these determinants. NURS 8310 – Epidemiology and Population Health Case Study Paper

Considering all the above factors, the term can be largely defined as the ability of people to address life’s changes and challenges and derive modes of staying healthy.

Public Health

Instead of concentrating on a selected community of individuals, public health puts its prime focus upon the population’s health as a whole.  Practitioners in this arena are primarily concerned about preventing injuries and diseases to the overall population of the country and work towards identifying causes of health related problems that can affect the larger population.  Their efforts result in benefits for all the individuals in the country NURS 8310 – Epidemiology and Population Health Case Study Paper

Considering the past achievements of public health, there is no doubt that these efforts do generate positive results.  The immunization programs that have resulted in almost complete eradication of diseases like smallpox, polio and diphtheria are a part of public health programs.  The exclusion of asbestos from workplaces and home is also an achievement.  Since ages, practitioners in public health have constantly focused on enhancing people’s quality of life both locally and globally, thus ensuring better health for all.

Population health management (PHM) refers to a concentrated holistic approach to improving the patient health outcomes of a group of individuals. These individuals are part of a larger group that could consist of people within a predetermined health system, a geographic area, those with a specific disease or ones sharing another defined characteristic. The move away from patient fee-for-service to a value-based model has made managing population health the focus for most  Accountable Care Organizations (ACO), insurance providers, quality improvement agencies, health care systems and health care providers as they strive for the provision of quality care at less cost. NURS 8310 – Epidemiology and Population Health Case Study Paper

PHM involves applying public health concepts to chronic disease management with a comprehensive data analyzation. The goal includes seeking methods to improve patient outcomes and control overall costs. The information gathered can assist in finding and filling patient care gaps and developing actionable treatment steps to care for individual patients, or specific groups. A provider may benefit from implementing PHM strategies as it can aide in the transition to value-based care and reimbursement.

NURS 8310 – Epidemiology and Population Health Case Study Paper

Elements for Population Health Management (PHM)

PHM requires a combination of clinical, financial and operational data that can provide actionable steps and predictable analytics. This information is gathered through the utilization of health IT. The health IT is most beneficial when it can monitor and analyze data about a patient population, provide the ability to draw conclusions from the data, and then develop a clinical picture of a population to help manage the specific diseases within it. NURS 8310 – Epidemiology and Population Health Case Study Paper

Although data collection and technology are essential for PHM, a few other elements are beneficial in improving the health outcomes of a specific patient population. Those include:

• Robust care management that is cohesive and features well-managed objectives supported by the provider and the patient. These objectives can vary based upon organizational goals, but most focus on improving the patient’s ability to self-manage their care and medication. Patient compliance and self-motivation can contribute to the reduction of the cost of care and readmission.
• Data collection that can provide real-time insights and information regarding social determinants and claims data. This should include tools to track, analyze and submit data that is required to report for financial incentives and in meeting compliance regulations.
• Utilizing patient risk scores regarding health, lifestyle and medical history to create sub populations through the division of a patient population. This method of risk stratification can help the provider understand their health care needs and trends.
• The creation of a complete, comprehensive patient population profile can assist with identifying patients at risk for readmission and create patient-specific care plans.
• The motivation to act with information gathered using of efficient EHR technology that could assist with notifying patients, making appointments, referring, and securely share data within the network. NURS 8310 – Epidemiology and Population Health Case Study Paper
• Striving to empower patients to have a higher level of engagement, education and participation in their care. The provision of tools, resources, clinical support and methods of prevention and care self-management can assist in keeping the patient motivated to make and maintain changes outside of the care setting.

Benefits of Population Health Management

PHM can help in determining how to make evidenced-based decisions from data analysis. This can assist in choosing how to best allocate resources across health care settings to improve organized efforts to coordinate clinical care at lower costs. The information gathered from comprehensive PHM data collection can provide an overall picture of the risk, incidence, prevalence and trends of chronic diseases to compare and benchmark across providers.

With a growing aging population and chronic disease burden, PHM can provide the ability to be proactive with health care treatment and prevention. This may aide in empowering patients to play a bigger role in managing their health. Other potential benefits of PHM include:

• Financial improvement for the organization may occur by determining the utilization of necessary services to assist in the mitigation of costs.
• Better health outcomes with a focus on the prevention and management of chronic diseases and the identification of care gaps by assessing the health of the patient population. This can enable the provider to identify the greatest health care needs of the patient population for improved disease management and the appropriate allocation of health care resources.
• Increased patient engagement and the motivation to maintain wellness through preventative care may assist patients with improvement before moving into high-risk groups.