Final Exam

Population Health

The health outcomes of a group of individuals, including the distribution of those outcomes within the group

Socioecological Model of Health (SEM)

Conceptualizes health by focusing on factors affecting human health and the interplay between individuals, groups/communities, and broader physical, social, and political environments

Center for Urban Population Health (CUPH)

Policies, programs, and practice form the base, fundamentally shaping the environment, which influences health factors, ultimately leading to health outcomes

Health Impact Pyramid

As individual effort increases, the impact on population health decreases (Socioeconomic factors at base )

US Health Outcomes

- high infant mortality rate

- low life expectancy

- high spending on healthcare

Social Determinants of Health (SDOH)

economic stability, healthcare access/quality, neighborhood/built environment, social/community context

economic stability

Employment status, income level, housing stability, food security

education access and quality

High school graduation rates, health literacy, language and literacy skills

health literacy

Ability to understand medical information and make informed health decisions

healthcare access and quality

Insurance coverage, provider availability, transportation to care

neighborhood and built environments

Housing quality, transportation options, safety, access to healthy foods

social and community context

family support, community cohesion, cultural beliefs, social networks

SDOH Barriers in Getting Prescription

no insurance, no transportation, no time off work

SDOH Barriers in Picking Up Medication

pharmacy too far away, cannot afford copay, pharmacy hours don’t match work schedule, no ID/insurance card

SDOH Barriers in Taking Medication Directly

cannot read instructions, complex work schedules affecting timing, cultural beliefs about medications, no safe storage space

SDOH Barriers to Following Up on Medication

cannot afford follow-up appointments, lack of transportation to labs, work schedule

SDOH Barriers

create “cascading effects” that undermine entire treatment plan

Federally Qualified Health Centers (FQHCs)

innovative community health pharmacy models that serve underserved populations and address social determinants of health barriers by using income-based sliding fee scales and integrating pharmacists into their healthcare teams

Health Disparities

Preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially-disadvantaged populations

Health Equity

When every person has the opportunity to attain his or her full health potential" regardless of social position or other socially determined circumstances

Healthy People 2030 Initiative

US federal government's 10-year plan, led by DHHS, to improve the health and wellbeing of all Americans by setting data-driven national objectives and promoting health equity

Health People 2030 Goals

▪ Attain healthy, thriving lives free of preventable disease, disability, injury, and premature death.

▪ Eliminate health disparities, achieve health equity, and attain health literacy to improve the health and wellbeing of all.

▪ Create social, physical, and economic environments that promote full health potential for all.

▪ Promote healthy development, healthy behaviors, and wellbeing across all life stages.

▪ Engage leadership and the public across multiple sectors to design policies that improve health

Populations at Risk for Pop. Disparities

Racial or ethnic minority groups, Sexual or gender minority groups, Socioeconomically disadvantaged populations, Individuals in rural environments with underserved healthcare, Elderly people, Persons with disabilities.

Causes of Health Disparities

often multifaceted or multifactorial, requiring multifaceted interventions to fully address them

Primary Drivers of Health Disparites

health behaviors, social/economic factors, structural racism/discrimination, historical/systemic, biological/physiological

health behaviors

choices we make are directly related to choices we have

Structural Racism and Discrimination

macro-level conditions that limit opportunities, resources, and wellbeing for individuals based on race or ethnicity

Allostatic Load

cumulative burden of chronic stress from both daily life and major life events

Native Americans Disparities

- higher mortality rate from diabetes

- alcohol induce diseases

- lower life expectancy (5.5 yrs lower)

Black/African American Disparities

- higher prevalence of HBP, diabetes, and stroke

- higher mortality for CVD and cancers

- infants w/ low birth weight

- pregnancy related-mortalities

Historical Redlining

ID areas based on population risk; led to neighborhood disinvestment

Pharmacisi’s Role in Population Health

serves as a bridge between individual patient needs and boarder community/systemic factors; most accessible healthcare provider; “on the front lines”

equity focused MTM Approach

Recognizes medication-related problems often have social and cultural roots requiring different solutions

Cultural Humility

lifelong practice of self-reflection to learn about biases; Recognizing you cannot be an expert in every culture, but approaching each patient with genuine curiosity, respect, and a willingness to learn from their experiences

Cultural Competence

ability to provide care to patients with diverse values, beliefs, and behaviors

LEARN model

Listen to patient perceptions

Explain your perceptions

Acknowledge differences

Recommend treatment

Negotiate agreement

explicit bias

conscious, openly expressed attitudes or beliefs that affect how individuals are treated

implicit bias

unconscious attitudes or stereotypes that healthcare professionals hold about certain groups of people; potentially leading to disparities in care

common types of bias

- racial and ethnic bias in pain management

- socioeconomic bias

- age and gender bias

systemic approaches for bias reduction

Standardized protocols, clinical decision support tools, regular training and self-reflection, diverse healthcare teams

clinical documentation as advocacy tool

Captures medical information, social determinants, and systemic barriers; creates an evidence base to influence policy and resource allocation

Population-level advocacy

Engaging with policymakers (legislative days), participating in professional organizations, working with community coalitions to address systemic issues

physical healthcare access

Geographic location, transportation infrastructure, parking, hours of operation

financial healthcare access

Insurance coverage, co-payments, deductibles, prescription costs, and hidden expenses

cultural healthcare access

Culturally appropriate services, language interpretation, culturally competent providers/staff

administrative healthcare access

Appointment scheduling systems, documentation requirements, bureaucratic processes overwhelming for those with limited health literacy

community level cultural factors

influence, collective health beliefs, social networks, traditional healing practices, community norms around help-seeking

Native Americans Cultural Considerations

traditional healing systems, intergeneration trauma, medical mistrust, tribal sovereignty, diversity

Community Health Workers (CHW)

trusted members of the community they serve who leverage their lived experience and specialized training to bridge the gap between healthcare systems and underserved populations by providing culturally appropriate health education, navigation, and advocacy

policy

law, regulation, procedure, administrative action, incentive or voluntary practice of governments or other institutions

law/statue

- from elected body (federal/state)

- acts on everyone

- enforceable by government (criminal or civil)

ordinance

- from elected legislature or council (local)

- acts on everyone in local jurisdiction

- enforceable by local government (civil penalty = fine)

regulation

- from non-elected bureaucratic organization

- acts on those specified

- enforceable by government (civil penalty = fine)

rule

- from public or private organization (health system)

- acts on those operating within organization

- enforceable by organization (may be consequences if violated)

guidance document (clinical guidlines)

- from any organization with vested interest

- acts on those specified in document

- voluntary, not enforceable by government

Policy Process

1. Problem Identification

2. Policy Analysis

3. Strategy and Policy Development

4. Policy Enactment

5. Policy Implementation

6. Evaluation

infrastructural policy

Creates or strengthens fundamental public health structures; enabling public health statues

interventional policy

modifies health risk factors

intersectoral policy

implemented by a NON-health agency for non-health purposes, but can affect health outcomes

de-regulation

Providing access, distributing equipment, making resources available, or removing previous regulations

direct regulation

forces a behavior

indirect regulation

often related to liability

money tool for pop health

taxes, incentives, and spending

rescue imperative (rule of rescue)

preference for emergency fixes rather than prevention

technological imperative

Cutting-edge biomedical technology has greater appeal than population-based interventions

visibility imperative

Public/population health practices are often INVISBLE until a crisis occurs.

partisanship

New federal legislation can be hampered by disagreements

health care systems

Organizations of people, institutions, and resources that deliver healthcare services to meet the health needs of a target population-

National Quality Strategy (NQS)

- developed by AHRQ due to lack of a national plan for quality

- order as a part of ACA

- includes 3-6-9 framework

3-6-9 Framework for NQS

All health systems must adopt three aims focusing on six priorities, using nine levers (tools) to improve healthcare quality

3 Aims of NQS

better care, healthy people/communities, and affordable care

6 Priorities of NQS

Health and wellbeing; prevention and treatment of leading causes of mortality; person and family-centered care; patient safety; effective communication and care coordination; affordability

9 Levers (tools) of NQS

Measurement and feedback (publicly available data); learning and technical assistance; certification, accreditation, and regulation; consumer incentives and benefit designs; payment models (influencing clinician reimbursement); health information technology and innovation/diffusion (interoperability); workforce development

Accountable Care Organizations

A group of providers that collectively accepts responsibility for improving the overall health status, care efficiency, and healthcare experience for some defined population

ACO vs HMO

no restriction of provider for ACOs; ACOs focus on outcomes

Patient-Centered Medical Homes (PCMHs)

A care delivery model, typically operating within an ACO. The patient is at the center of all shared decision-making with a primary care provider (PCP), and all other clinicians report back to the PCP

Medicare Part A

hospitalizations, funded by federal payroll tax

Medicare Part B

regular coverage (Outpatient care, checkups, ambulatory services); Requires monthly premium

Medicare Part C

Private health plan alternative to traditional Medicare. Requires opting in and often higher monthly premiums

Medicare Part D

Prescription medications. Requires monthly premium

Children’s Health Insurance Program (CHIP)

insurance program for low-middle income children; funded by state taxes and federal allotment

Social Security Disability Insurance (SSDI)

insurance programs for those with approved disability funded by payroll tax; administered by federal government

Medicaid

public health insurance program for those with low-income (state-run, federally supported)

Affordable Care Act (ACA)

most comprehensive piece of US healthcare designed to improve population health by expanding insurance coverage, regulating insurers, protecting consumers, and reforming care delivery systems

Economic Theory of Disparities in Quality of Care

spending primarily via a third party (insurance) rather than the consumer creates misaligned incentives for care quality and consumption

ACA provisions

insurance regulations, consumer protections, mandates, public coverage expansion

upstream determinant

include broad social and structural influences on the health of a population

downstream determinants

factors that are closer to the individual (i.e., risk behavior, disease/injury, and mortality)