Abstract
Improving population health requires a focus on neighborhoods with high rates of illness. We aimed to reduce hospital days for children from two high-morbidity, high-poverty neighborhoods in Cincinnati, Ohio, to narrow the gap between their neighborhoods and healthier ones. We also sought to use this population health improvement initiative to develop and refine a theory for how to narrow equity gaps across broader geographic areas. We relied upon quality improvement methods and a learning health system approach. Interventions included the optimization of chronic disease management; transitions in care; mitigation of social risk; and use of actionable, real-time data. The inpatient bed-day rate for the two target neighborhoods decreased by 18percent from baseline (July 2012-June 2015) to the improvement phase (July 2015-June 2018). Hospitalizations decreased by 20percent. There was no similar decrease in demographically comparable neighborhoods. We see the neighborhood as a relevant frame for achieving equity and building a multisector culture of health.
Highlights
Improving population health requires a focus on neighborhoods with high rates of illness
I nequities “entail a failure to avoid or overcome inequalities that infringe on fairness and human rights norms.”[1]. Equity gaps are ever present in pediatrics, with neighborhood-to-neighborhood variation in child morbidity paralleling differences in underlying rates of poverty.[2,3,4,5,6]
We have pushed our health care system and community to be accountable to populations and neighborhoods that are disproportionately affected by medical and social challenges
Summary
Improving population health requires a focus on neighborhoods with high rates of illness. I nequities “entail a failure to avoid or overcome inequalities that infringe on fairness and human rights norms.”[1] Equity gaps are ever present in pediatrics, with neighborhood-to-neighborhood variation in child morbidity paralleling differences in underlying rates of poverty.[2,3,4,5,6] Such gaps have persisted for generations, driven at least in part by upstream social, environmental, and economic challenges (for example, racial discrimination, substandard housing, limited access to health-promoting resources, and socioeconomic deprivation).[7,8,9,10] These challenges affect one’s ability to access preventive services, adhere to care recommendations, and trust that the health care system has one’s interests at heart.[11,12,13] They trigger morbidity directly via adverse exposures (such as in-home cockroaches and asthma exacerbations) or indirectly via “toxic” stress responses (for example, repetitive stress that alters immunologic functioning).[14,15] With an evolution toward value-based payments, health care systems are focusing more attention on population health outcomes for lower-income patients. Whether driven by mission or margin, health care systems increasingly see themselves as accountable to more than just the people who walk through their doors.[16,17,18,19,20] They recognize that achieving equitable outcomes requires different—often multilevel— approaches, but little has been published about how to do this for, and with, populations
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