Abstract
BackgroundThe literature suggests that although adult hospitals are establishing population health programs around the country, there is considerable definitional ambiguity regarding whether interventions are aimed at the social determinants of health or the management of existing patient populations. U.S. children’s hospitals also undertake population health programs, but less is known about how they define population health. The purpose of this study is to understand how U.S. children’s hospitals define population health, and how institutions are adjusting to new preventive health care models.MethodsWe conducted semi-structured interviews with key stakeholders at ten hospitals with the highest amount of staff time dedicated to population health activities as reported in the 2016 Children’s Hospital Association’s population health survey. Using a semi-structured interview guide, we interviewed representatives from each hospital. Verbatim interview notes were coded and analyzed using the data analysis software Dedoose. Data analysis followed a modified constructivist grounded theory approach.ResultsOur results suggest that even population health innovators employ a variety of approaches that span both population health management and public health. We present further evidence that U.S. children’s hospitals are actively debating the definition and focus of population health.ConclusionsDefinitional debates are ongoing even within children’s hospitals that are dedicating significant resources to population health. Increased clarity on the conceptual boundaries between population health and population health management could help preserve the theoretical differences between the two concepts, especially insofar as they mark two quite different long-term visions for health care. Without agreement about the meaning of population health within and among institutions, hospitals will not be able to know whether projects aimed at addressing the social determinants of health are likely to improve the health of populations.
Highlights
The literature suggests that adult hospitals are establishing population health programs around the country, there is considerable definitional ambiguity regarding whether interventions are aimed at the social determinants of health or the management of existing patient populations
Based on self-reported full time equivalent (FTE), we assumed that the hospitals had dedicated significant resources to population health initiatives
Despite sharing a large number of FTEs devoted to population health, hospitals described disparate frameworks for understanding the role of population health in children’s hospitals
Summary
The literature suggests that adult hospitals are establishing population health programs around the country, there is considerable definitional ambiguity regarding whether interventions are aimed at the social determinants of health or the management of existing patient populations. A widely-referenced definition of population health comes from Kindig and colleagues, who describe this concept as “the health outcomes of a group of individuals, including the distribution of such outcomes within the group” [2] In their understanding, population health emphasizes well being and quality of life and includes activities beyond those traditionally associated with hospitals, addressing the needs of populations beyond those of a hospital’s patient population. Skinner et al BMC Health Services Research (2018) 18:494 view population health improvement as a shared responsibility of health-care, public health, and community-based organizations This perspective has been shared more recently by Pennel and colleagues [3]. Examples of social determinants that may be targeted by hospitals in population health approaches include housing, education, employment, and food access [5]
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