Population Health Model Research Articles

The Synergistic Health Threats of State Laws Targeting Marginalized Groups in the United States.

Discriminatory state laws have deleterious effects on the health of socially marginalized groups. Health care clinicians, institutions, researchers, and research funders have tended to view different discriminatory laws in isolation, focusing on particular issues or groups. In contrast, intersectionality calls attention to the overlapping and synergistic systems of oppression that discriminatory legislation promotes or upholds, warranting an integrated analysis of these laws. In this analytic essay, we assess discriminatory state laws simultaneously and discuss their implications for health care clinicians, institutions, and researchers. We present a multifunctional model of law and population health that describes how discriminatory law affects health outcomes among marginalized groups. We then draw on publicly available legislation trackers to identify 30 states that have enacted legislation since 2020 that targets Black people and other people of color; lesbian, gay, bisexual, and queer people; transgender and nonbinary people; and women and other birthing people. Finally, we call for a coordinated, multilateral, and forceful effort by health care professionals, institutions, researchers, and research funders to counter these laws and address their predictable health consequences. (Am J Public Health. 2024;114(12):1335-1343. https://doi.org/10.2105/AJPH.2024.307830).

Health and economic burden of insufficient physical activity in Saudi Arabia.

Insufficient physical activity (PA) was estimated to cause 4.8% of deaths and 2.6% of disability-adjusted life-years (DALYs) due to noncommunicable diseases in Saudi Arabia in 2019. While Saudi Arabia is already achieving great improvements, we predict the health and economic burden of insufficient PA up to 2040 to present a case for policy makers to invest more in the uptake of PA. Using a population health model to estimate avoidable health loss, we identified four causes of health loss related to low PA (cardiovascular diseases, diabetes, breast cancer, and colorectal cancer) and estimated the deaths and DALYs from these causes. We projected the expected disease burden until 2040 under alternative assumptions about future PA levels and trends by using three health scenarios: baseline (no change in 2019 PA levels), intervention (81% of the population achieving sufficient PA levels), and ideal (65% of population: moderate PA, 30%: high PA, and 5%: inactive). We applied an "intrinsic value" approach to estimate the economic impact of each scenario. Overall, we estimate that between 2023 and 2040, about 80,000 to 110,000 deaths from all causes and 2.0 million to 2.9 million DALYs could be avoided by increasing PA levels in Saudi Arabia. The average annual economic loss from insufficient PA is valued at 0.49% to 0.68% of the current gross domestic product, with an average of US$5.4 billion to US$7.6 billion annually till 2040. The most avoidable disease burden and economic losses are expected among males and because of ischemic heart disease. This study highlights that low PA levels will have considerable health and economic impacts in Saudi Arabia if people remain inactive and do not start following interventions. There is an urgent need to develop innovative programs and policies to encourage PA among all age and sex groups.

A closer look at Cuba’s public health model that prioritizes population health

As the largest Caribbean island, Cuba is known for its picturesque Havana boardwalk, musical rhythms, and tropical climate. A closer look at the national public health model that integrates care for Cuban citizens, however, is fundamental to learn and adapt lessons learned and best practices to bridge knowledge-practice gaps within global health systems. In this visual essay, the author explores connections between photography and community health, illustrating an invaluable story about a primary care workforce, supported by the health system infrastructure, dedicated to achieve high-quality community health for citizens. She shares photographs coupled with narrative elements to showcase the population health model of Cuba, one Latin America and Caribbean country that has received international recognition for achieving universal health care to residents. She weaves words and images to portray her experiences of completing clinical rotations in tuberculosis prevention and control at the ‘Pedro Kourí’ Tropical Medicine Institute and surrounding public health institutions in the capital city of Havana.

Population Health Model Predicting the Long-Term Impact of Sotatercept on Morbidity and Mortality in Patients with Pulmonary Arterial Hypertension (PAH).

Pulmonary arterial hypertension (PAH) is a rare, progressive disease associated with significant morbidity and mortality. The phase 3 STELLAR trial tested sotatercept plus background therapy (BGT) versus placebo plus BGT. BGT was comprised of mono-, double-, or triple-PAH targeted therapy. Building on STELLAR findings, we employed a population health model to assess the potential long-term clinical impact of sotatercept. Based on the well-established ESC/ERS 4-strata risk assessment approach, we developed a six-state Markov-type model (low risk, intermediate-low risk, intermediate-high risk, high risk, lung/heart-lung transplant, and death) to compare the clinical outcomes of sotatercept plus BGT versus BGT alone over a lifetime horizon. State-transition probabilities were obtained from STELLAR. Risk stratum-adjusted mortality and lung/heart-lung transplant probabilities were based on COMPERA PAH registry data, and the post-transplant mortality probability was obtained from existing literature. Model outcomes were discounted at 3% annually. Sensitivity analyses were conducted to examine model robustness. In the base case, sotatercept plus BGT was associated with longer life expectancy from model baseline (16.5 vs 5.1years) versus BGT alone, leading to 11.5years gained per patient. Compared with BGT alone, sotatercept plus BGT was further associated with a gain in infused prostacyclin-free life years per patient, along with 683 PAH hospitalizations and 4 lung/heart-lung transplant avoided per 1000 patients. According to this model, adding sotatercept to BGT increased life expectancy by roughly threefold among patients with PAH while reducing utilization of infused prostacyclin, PAH hospitalizations, and lung/heart-lung transplants. Real-world data are needed to confirm these findings. ClinicalTrials.gov identifier, NCT04576988 (STELLAR).

Beyond the biomedical, towards the agentic: A paradigm shift for population health science

Life expectancy in the United States is decreasing. Health disparities are widening. Growing evidence for and integration of social and structural determinants into theory and practice has not yet improved outcomes. The COVID-19 pandemic reinforced the fact.In this paper, we argue that the biomedical model and its underlying scientific paradigm of causal determinism, which currently dominate population health, cannot meet population health needs.While criticism of the biomedical model is not new, this paper advances the field by going beyond criticism to recognize the need for a paradigm shift. In the first half of the paper, we present a critical analysis of the biomedical model and the paradigm of causal determinism. In the second half, we outline the agentic paradigm and present a structural model of health based on generalizable, group-level processes. We use the experience of the COVID-19 pandemic to illustrate the practical applications of our model. It will be important for future work to investigate the empirical and pragmatic applications of our structural model of population health.

Regression Model of Population Health in Russian Regions.

Brief results of a sociological study conducted in six border territories of modern Russian society are presented. The subject of the study was the components of the reproductive mechanisms of human capital, namely the attitude of the population to health and motivation to preserve it. The object of the study was the human capital of the Russian borderlands. The research methodology is based on an interdisciplinary complex analysis, including structural-functional, activity-based approaches in conjunction with a secondary analysis of the phenomenon of human capital in the field of various humanities and economic sciences. The specifics of the functioning of the reproductive components of human capital were measured based on the analysis of relevant regional statistics and questionnaire questions, expert survey. The novelty of the study lies in the regional specifics of the attitude of the population of six border regions of Russia to the potential of their health and motivation to use health-saving technologies in their lives. Territorial models of population health disorders are described. Conclusions are drawn that at the present stage of the development of Russian society, opposite trends are being realized. On the one hand, the negative consequences of the Covid-19 pandemic, the combination of structural disorders in the system of providing medical care to the population and the increase in morbidity of various kinds, which caused an unprecedented increase in mortality in all territories of Russia. The opposite and positive trend can be called the formation of the legislative framework of a new health protection strategy in Russian society. The main goal of this strategy is to preserve and increase the human capital of the country, including, first of all, the health of the nation, as well as its education and motivation for a long and fruitful life for the benefit of Russian society

CONNECTING THE DOTS: CHRONIC CARE MANAGEMENT PROGRAM IMPLEMENTATION IN RURAL PRACTICES

Abstract As the focus of healthcare changes from a “sick” care model to a population health model, primary care and specialty clinic practices have new opportunities supported through Medicare reimbursement. The incorporation of team-based care coordination programs into clinic practices is an important step towards value-based care and achieving the Triple Aim: better health for the population, better care for individuals, and lower costs through improvements. Since 2019, six rural Wyoming primary care practices have completed training to implement and expand care coordination programs. HealthTechS3 provides participating clinics with team-based training in the implementation of the Chronic Care Management Program, Behavioral Health Integration, and other billable care coordination services. To date, 301 patients have enrolled in care coordination services. These practices have generated $350,000 in revenue. Using a consolidated implementation framework as a guide, critical components of successful rural care coordination program implementation are discussed.

The observatory: a model for studies in health, society, and the environment.

The concept of an observatory for examining and monitoring trends for research in the social sciences and health arose from analogy with the facilities of astronomy and the realization that close and consistent observation was essential to understand interactions among determinants of health in a community. Their theoretical foundations are largely grounded in the “population health model,” an intellectual framework developed in 1974 and associated with a movement called “the new public health.” We developed an observatory for an affluent, unexceptional, suburban jurisdiction (“County 20”) in the province of Alberta, in western Canada, and used it to study and monitor both normative and emergent issues in environmental health. The observatory was conceived as a utility, or multi-purpose vehicle, for describing and responding to emerging community issues quickly and gathering data and qualitative findings as required. Case studies on issues of local importance allowed us to observe the dynamics of community response comprehensively, using quantitative and qualitative methods as appropriate. Valuable insights gleaned from the cases studied pertained to risk perception, the NIMBY syndrome, and reorganizing and auditing public health services. It did less well when the object of study was further removed from the community of interest, when there was no clear action item to be recommended, and when sponsors had expectations for certainty that could not be supported by available data sources. The observatory eventually was merged into a community health outreach program. The local observatory model is a practical, low-cost, and sustainable model for capturing generalizable and specifically local case study experience on a small scale but is limited in its effectiveness and by the scope of its coverage. It can be an initial step toward longitudinal and community monitoring studies on a larger scale. The observatory model can be used to elevate the level of case studies, impose rigor on analysis, and compile case studies for comparative and analytical studies.

A Novel Framework for Modeling Person-to-Person Transmission of Respiratory Diseases.

From the beginning of the COVID-19 pandemic, researchers assessed the impact of the disease in terms of loss of life, medical load, economic damage, and other key metrics of resiliency and consequence mitigation; these studies sought to parametrize the critical components of a disease transmission model and the resulting analyses were informative but often lacked critical parameters or a discussion of parameter sensitivities. Using SARS-CoV-2 as a case study, we present a robust modeling framework that considers disease transmissibility from the source through transport and dispersion and infectivity. The framework is designed to work across a range of particle sizes and estimate the generation rate, environmental fate, deposited dose, and infection, allowing for end-to-end analysis that can be transitioned to individual and population health models. In this paper, we perform sensitivity analysis on the model framework to demonstrate how it can be used to advance and prioritize research efforts by highlighting critical parameters for further analyses.

A reform proposal from 2019 aims to improve coordination of health services in Poland by strengthening the role of the counties

Numerous attempts have been undertaken over the past two decades to improve the coordination of health services in Poland. These have usually focused on specific groups of patients or conditions, usually encompassing various types of specialist care, with only a few initiatives including a wider range of health services or sectors. These efforts have not been helped by the fragmentation of responsibilities between the various levels of territorial self-government, which are the founding bodies for different types of public providers. In 2019, a new policy initiative of the Ministry of Health proposed the establishment of County Health Centres that would improve integration of primary health care with specialist outpatient care, inpatient care in the county hospitals (hospitals of the 1st reference level), and other services at the level of the county. This would constitute the so-called “core system of health security” and support reorientation of health services towards PHC and the community and away from specialist hospitals. With its focus on health promotion and disease prevention and tailoring provision to the needs of the local populations, the proposal resembles examples of population health models introduced in several other countries, and offers a chance to improve the allocation of resources and to reduce the persisting health disparities across the country.

Implementation of Cardiometabolic Centers and Training Programs.

Type 2 diabetes is frequently accompanied by obesity, nonalcoholic fatty liver disease, chronic kidney disease, and cardiovascular disease, which collectively contribute to the high burden of cardiometabolic disease. This review discusses cardiometabolic disease management, strategies to implement cardiometabolic centers to deliver care, and dedicated programs to train the next generation of cardiometabolic experts. Sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide 1 receptor agonists, and a nonsteroidal mineralocorticoid receptor antagonist have demonstrated beneficial effects across cardiometabolic conditions. However, utilization of effective pharmacotherapies is low in clinical practice, in part due to clinical inertia and traditional sharp delineation in clinical responsibilities of specialists. Multidisciplinary clinics and population-health models can provide comprehensive care but require investment in physical and information technology infrastructure as well as in training and accreditation. Post-internal medicine residency cardiometabolic health training programs have been proposed. Implementing cardiometabolic centers in health systems involves reshaping current practices. Training programs focused on cardiometabolic health are needed to address the growing burden of disease and specific training needs in this ever-expanding area.

Telehealth: Opportunities to Improve Access, Quality, and Cost in Pediatric Care.

The use of telehealth technology to connect with patients has expanded significantly over the past several years, particularly in response to the global coronavirus disease 2019 pandemic. This technical report describes the present state of telehealth and its current and potential applications. Telehealth has the potential to transform the way care is delivered to pediatric patients, expanding access to pediatric care across geographic distances, leveraging the pediatric workforce for care delivery, and improving disparities in access to care. However, implementation will require significant efforts to address the digital divide to ensure that telehealth does not inadvertently exacerbate inequities in care. The medical home model will continue to evolve to use telehealth to provide high-quality care for children, particularly for children and youth with special health care needs, in accordance with current and evolving quality standards. Research and metric development are critical for the development of evidence-based best practices and policies in these new models of care. Finally, as pediatric care transitions from traditional fee-for-service payment to alternative payment methods, telehealth offers unique opportunities to establish value-based population health models that are financed in a sustainable manner.

Addressing COVID-19 Vaccine Acceptance Within a Large Healthcare System: a Population Health Model.

BackgroundThe COVID-19 pandemic, and vaccine hesitancy, pose a significant public health threat. The Veterans Health Administration system is uniquely situated to provide insights into the implementation of a population health approach to vaccine acceptance.AimWe describe the VA Connecticut Healthcare System’s (VACHS) quality improvement project to improve rates of vaccine uptake.Setting and ParticipantsVACHS consists of eight primary care sites with 80 primary care providers delivering care to 47,000 enrolled veterans.Program DescriptionOur program involved identification of a local champion, education sessions, development of vaccine acceptance tools (including the templated “COVID-19 Prevention Letter” and the “COVID-19 Prevention Telephone Note”), and application of a population health approach (use of a prioritization scheme and playbook) by primary care patient-aligned care (PACT) medical home teams.Program EvaluationWe found increased rates of vaccination at VACT compared to the surrounding region 6 months after implementation (65.16% vs 61.89%). Use of vaccine acceptance tools were associated with a statistically significant increase in vaccination (24.1% vs 13.6%, P = 0.036) in unvaccinated veterans.DiscussionA population health approach to vaccine acceptance using EHR-based tools can impact vaccination rates, and this approach may be of practical utility to other large healthcare systems with EHR.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-021-07353-9.

50.2 JUST SAY YES: SUPPORTING PEDIATRIC PRIMARY CARE’S ASSESSMENT AND TREATMENT OF EARLY CHILDHOOD MENTAL HEALTH CONCERNS

Pediatric primary care providers (PPCPs) are often the first point of contact for young children and their families when behavioral health concerns arise. Pediatric Mental Health Care Access (PMHCA) programs have been developed to support PPCPs in assessing and treating behavioral health concerns presenting in primary care. This presentation will discuss strategies developed by one PMHCA program, the Colorado Pediatric Psychiatry Consultation & Access Program (CoPPCAP), to support PPCPs in assessing and treating perinatal concerns and early childhood mental health concerns including a description of the model, current funding and policy successes, and the integration of the program within the public health system in Colorado. The development and outcomes of core components of CoPPCAP will be presented including the peer-to-peer consultation, support for finding resources, training on a “disruptive behavior action plan,” and education via Extension for Community Health Outcomes (ECHO) and learning collaboratives. This presentation will include active audience participation of polling questions and discussion to understand participants’ own work with primary care supporting early childhood mental health initiatives and models of funding. Data will be presented with respect to: the proportion of consultations for ages 0 to 6 years vs ages 7 to 12 years vs ages 13 to 18 years; types and outcomes of consultation for ages 0 to 6 years; PPCP practice change secondary to CoPPCAP; and outcomes of evaluation of our learning sessions. Participants will understand how CoPPCAP, a PMHCA program, has included early childhood mental health as a core component for consultation, teaching, and partnering with public health departments and state agencies. Ensuring enduring funding requires persistence and input from multiple stakeholders, and it must ensure return on investment. For true, successful prevention efforts through a population health model, early childhood mental health consultation must be provided where patients and their families are seeking help, the pediatric primary care setting. Programs such as CoPPCAP address the capacity for PPCPs to assess and treat the younger child in the primary care setting.

Modeling the Population Health Impact of ENDS in the U.S.

Objectives: Our objective was to improve understanding of the population health impact of electronic nicotine delivery systems (ENDS) availability in the US via computational modeling. Methods: We present an agent-based population health model (PHM) that simulates annual smoking, ENDS use, and associated mortality for individual agents representing the US population, both adults and youth, between 2000 and 2100. Model transitions were derived from key population surveys and a large longitudinal study of JUUL purchasers. The mortality impact of ENDS is modeled as excess risk relative to smoking. Outcomes are compared between a cigarettes-only Base Case and a Modified Case where ENDS are introduced in 2010. Model validation demonstrates that the PHM simulates population-level behavior and outcomes realistically. Results: The availability of ENDS in the US is projected to reduce smoking and prevent 2.5 million premature deaths by 2100 in the Modified Case. Sensitivity analyses show that a significant population health benefit occurs under all plausible scenarios. Conclusions: Our results suggest the availability of ENDS is likely to result in a significant health benefit to the US population as a whole, after accounting for both beneficial and harmful uses.

A Scoping Review of Health Promotion in the Nursing Home Setting

Background Nursing homes in many countries continue to follow a traditional medical model of care. This study explored health promotion approaches in the nursing home setting, partly in order to move away from a medical model and to improve the well-being of residents and staff. Methods A scoping study was conducted to review the scientific literature. The Integrated Model of Population Health and Health Promotion was adapted for utilization with the literature analysis. Result A total of 64 publications met the inclusion criteria and were analysed. Five main approaches were shown to have applied health promotion in nursing homes, although gaps were present in the usage of systematically applied health promotion. Conclusion A variety of approaches do exist for the nursing home setting which apply health promotion; however, their usage is fragmented. This study revealed that a framework designed to support nursing homes in the systematic usage of health promotion, could improve the well-being for both residents and staff.

The population health model: A timely approach for mission hospitals

Mission hospitals have long provided a source of care, healing, and spiritual support for populations around the world, often serving the disadvantaged and rural residents not served by other facilities. Yet the future of mission hospitals has been thrown into doubt, and options for repurposing these institutions must be explored. The approach of mission hospitals to healthcare delivery has historically differed from those of other health systems (including many faith-based facilities) due to their isolated locations in lower-income countries. The multi-purpose attributes of mission hospitals make them excellent candidates for adopting a population health approach. The population health model, as now being developed in the United States, represents a radical departure from traditional clinical practice and reduces the system’s dependence on clinical care as a means to improving community health. The population health model emphasizes treatment of populations rather than individuals, a holistic approach to the provision of care (addressing social determinants in the process), and the involvement of the community in multi-sector collaboration for collective impact. Mainstream hospitals have had difficulty in implementing a true population health model for a variety of reasons, but mission hospitals appear to represent an effective vehicle for putting this model into practice. A population health approach appears to complement the philosophy of mission hospitals, and mission hospitals appear positioned to advance the population health movement.

More than the pandemic

More than the pandemic

A yearlong population health internship: Operationalizing an innovative model for population health nursing education.

In recent years, evidence has emphasized the critical role that nurses play as public health leaders and the urgent need to prepare nurses for interprofessional collaboration in fulfilling those roles. Sharing best practices in population health nursing education is especially critical now, in the era of COVID-19, when more nurses will be called to apply public health principles to patient care regardless of their work setting. Although evidence from national nursing education bodies outline several critical implications for nursing curricula, undergraduate nursing programs lack operational guidance for instituting effective curricular changes to population health nursing teaching and learning. The purpose of this paper is to outline the process by which a college of nursing translated this evidence into innovation through program development of a yearlong Population Health Internship (PHI) in its BSN program. The inaugural PHI cohort placed 81 nursing students in 19 population health agencies to work with 64 interprofessional mentors. The author details the six steps taken to operationalize the curricular innovation to enable replication by others. Initial student evaluation data show participation in the PHI enables positive mentor relationships and exposes students to roles of population health nurses and the scope of their activities. Community agency evaluation data indicate satisfaction with the yearlong model, noting that nursing intern contributions extended agency missions.

Recommendations to Improve Payment Policies for Comprehensive Dementia Care

Access to comprehensive dementia care is limited. Recent changes in billing for professional services, including new physician fee schedule codes, encourage clinicians to provide new services; however, current reimbursement does not cover costs for all needed elements of dementia care. The Payment Model for Comprehensive Dementia Care Conference convened more than 50 national experts from diverse perspectives to review promising strategies for payment reform including ways to accelerate their adoption. Recommendations for reform included payments for services to family caregivers; new research to determine success metrics; education for consumers, providers, and policymakers; and advancing a population health model approach to tier coverage based on risk and need within a health system.