Population Health Performance Research Articles

Monitoring the level of health and inequality over time using the Population Health Performance Index

Abstract Background The Population Health Performance Index (PHPI) is a composite measure that combines average health outcomes and their distribution within a population, thereby allowing for a comprehensive assessment of population health and inequality. The aim of this study is to examine the extent to which the PHPI adds value to monitoring of health and inequality over time in comparison to absolute and relative inequality. Methods Data from the WHO Equity Monitor database on under-5 mortality disaggregated by wealth quintiles for Nepal, Ethiopia, Peru, Rwanda, and Zimbabwe were analysed using different years between 1994 and 2020. Descriptive comparative statistics were employed to assess trends in the PHPI and conventional pairwise measures of absolute and relative inequalities, with consideration of different weights for inequality aversion. Results PHPI trends correspond to the trend of absolute inequality in all five countries, although they exhibit less volatility over time. Relative inequality follows the trend of the PHPI in only two of the five countries (Ethiopia and Zimbabwe), reflecting the methodology utilised for the PHPI. PHPI scores vary based on different inequality aversion weights, highlighting the sensitivity of the index to methodological adjustments. Conclusions The PHPI demonstrates notable convergence of trends with conventional methods, thereby substantiating its utility as a comprehensive tool for the simultaneous measurement of health and inequality. As it is able to consider both absolute and relative inequality within its own calculations, the PHPI allows for independent analysis of its two key components. The PHPI facilitates a more nuanced understanding of population health and may be more easily understood by policymakers and other stakeholders. As it does not address the underlying causes of changes in health inequalities, further research is necessary to supplement monitoring activities. Key messages • PHPI is a valuable tool for health and inequality monitoring by integrating both average health and disparity in a single index, facilitating communication of trends over time. • The dual focus complements conventional methods with its multidimensionality and may enable stakeholders to assess health and inequalities in alignment with broader health policy objectives.

4.I. Skills building seminar: Sharp Pencils, Clear Minds: Translating research to policy through effective policy briefs

Abstract National health information collect evidence on population health, health determinants and health system performance needed for designing public health interventions and decision-making. However, It can be difficult to ensure that routinely obtained data are suitable for use in decision-making. This can result in a large gap between research outputs and its utilization by policymakers. Over the course of the past years, a variety of knowledge translation initiatives supporting better use of research in policy-making processes have emerged. A popular strategy that has attracted attention as a tool to bridge the knowledge and policy gap between researchers and policy-makers is the policy brief. A policy brief is informative, credible and easy to grasp short document summarizing relevant studies. It is usually addressed to people working in government who may know little about a certain topic and need to express an opinion and make a quick decision. A policy brief's typical format includes a background synthesizing the problem, the stakeholders involved, and recommendations. It is intended to facilitate the use of evidence in the public policy process. Policy briefs have grown in popularity, especially among early career researchers and public health professionals, as a tool to disseminate their research and reach out to policy-makers, so that their research can have a tangible impact on policy design and implementation. In this interactive skills building seminar, we will share with the participants the knowledge, skills, and process of writing effective policy briefs. We will use the experience of the Belgian Cancer Centre of Sciensano as a case study. In the context of the Belgian Europe's Beating Cancer Plan (EBCP) Mirror Group, Sciensano developed a series of policy briefs outlining the major activities and initiatives related to cancer care. In these policy briefs, the gaps in cancer care and their consequences were analysed, and provide key recommendations to be taken by policy and decision-makers to improve the status quo and respond to the gaps were identified. This process of policy brief writing was conducted in a participatory approach with input from actors working in cancer care across Belgium. The seminar will start with a presentation on the Belgian EBCP Mirror Group experience. Based on the Belgian EBCP Mirror Group example, the seminar will include an interactive session exploring the key elements of an effective policy brief writing, followed by group work with the audience to co-produce policy briefs in their areas of expertise. Key messages • Policy briefs are informative, credible and easy to grasp short documents summarizing relevant studies. • Policy briefs are knowledge transfer tools that optimise evidence use and research uptake during the process of policy-making. Speakers/Panelists Marie Delnord Sciensano, Brussels, Belgium Gabrielle Schittecatte Sciensano, Brussels, Belgium

Mortality-based indicators for measuring health system performance and population health in high-income countries: a systematic review

Abstract Objectives Mortality-based indicators are commonly used as measures of population health but less frequently applied to measuring health system performance. This systematic review aimed to identify and describe mortality indicators relevant to the measurement of population health and health system performance in high-income countries. Methods We searched peer-reviewed databases (MEDLINE, Embase, CINAHL, Health Business Elite, Health Policy Reference Center, and POPLINE) and grey literature (government agencies, professional associations, and international/non-governmental health organizations). The search was limited to indicators identified for use in high-income countries. We extracted information on indicator characteristics and alignment with dimensions of effectiveness, efficiency, and equity. We assessed the applicability of the indicator to the context of population health, health system, or both settings, alignment with SMART criteria (specific, measurable, actionable, relevant, and timely), and potential for analyses of population subgroups. Health system was defined as encompassing both medical care and public health services and activities. Results We extracted 385 mortality-based indicators from 240 sources. Indicators were organized into six major domains: all-cause mortality (n = 12), premature mortality (n = 92), life expectancy (n = 23), cause-specific mortality (n = 127), infant, child, and adolescent mortality (n = 50), and hospital-related mortality (n = 81). The majority of indicators (86%) could be applied to measuring health system performance. Premature mortality indicators showed the most potential to measuring both population health and health system performance. Conclusions This review compiled a wide range of mortality indicators relevant to measuring health system performance in high-income countries. Indicators of premature mortality were most relevant to measuring both population health and health system performance.

Seroprevalence and trends of hepatitis B virus, hepatitis C virus and human immunodeficiency virus in Syrian blood donors at Damascus University Blood Center between 2004 and 2021.

Seroprevalence of transfusion-transmitted viral infections (TTVIs) is a valuable indicator for assessing blood safety, population health and health system performance in the times of peace and conflicts. Only scarce information is available on the impact of the decade-long violent conflict on the prevalence of TTVIs in Syria. Moreover, hepatitis B vaccine was introduced to the national vaccination program in 1993; however, no data is available on the vaccine effectiveness. In this retrospective cross-sectional study, we compiled the screening results for major TTVIs, namely hepatitis B virus (HBV), hepatitis C virus (HCV), and human immuno-deficiency virus (HIV), of volunteer donors at Damascus University Blood Center from May 2004 to October 2021. Prevalence was expressed in percentages for the entire study group and subgroups. Chi-square test and linear regression were used to examine the differences and describe trends in prevalence, respectively, based on demographic characteristics (i.e., age and gender) and time. P-value of <0.005 was considered statistically significant. Of the total 307,774 donors (82.27% males, median age 27 years), 5,929 (1.93%) had serological evidence of at least one TTVI, and 26 (0.0085%) had multiple infections. The lowest prevalence (1.09%) was detected in donors aged 18-25 years old, and a higher prevalence (2.05%) was evident in males in comparison with females (1.38%). The seroprevalence of HBV, HCV, and HIV was 1.18, 0.52, and 0.23%, respectively. Trend analyses revealed a significant regression in HBV and HIV prevalence from 2011 to 2021. HBV seropositivity depicted a temporal decline by ~80%, from 0.79% in 2011 to 0.16% in 2021 in those born in 1993 and thereafter. The seroprevalence of HBV, HIV, and to a lesser extent HCV dropped over the study 18-year period. Possible explanations may include implementation of the HBV vaccine, robust national health system, conservative sociocultural values, and isolation.

Unmasking a Vulnerable Patient Care Process: A Qualitative Study Describing the Current State of Resident Continuity Clinic in a Nationwide Cohort of Internal Medicine Residency Programs

BackgroundResidents serve as access points to the health care system for the most vulnerable patients in the United States. Two large academic medical centers have identified performance gaps between resident and faculty physicians. Our intent in this study was to measure the scope of resident-faculty performance gaps in a nationwide sample and identify potential targets for intervention. MethodsThis is a qualitative study of 12 residency programs representing 4 out of 5 US regions. Main measures include perceptions of population health performance in resident versus faculty populations, description of precepting model employed, perceptions of differences between resident and faculty patients, and handoff processes at the time of graduation. ResultsOf the 8 programs that routinely compare resident and faculty performance, half had confirmed the presence of outcome disparities on routine population health metrics. Seven out of 12 programs employ a 1:1 preceptor:resident comanagement structure. Ten of the 12 programs perceived that resident panels were more psychosocially complex; 2 had a formal process to measure this. Four of the 12 programs had a process to monitor patient loss to follow-up after resident transition. ConclusionsResident-faculty performance disparities may be a widespread problem nationally. Potential targets for intervention include increased preceptor engagement, improving access for empanelment in the faculty practice for vulnerable patient populations, and employing more robust handoff practices. Integrating a culture of quality improvement to continuously monitor important educational metrics such as outcome disparities, panel demographics, educational continuity, and patient loss in the resident panel should be a routine practice for academic health centers.

Coping with interoperability in the development of a federated research infrastructure: achievements, challenges and recommendations from the JA-InfAct

BackgroundInformation for Action! is a Joint Action (JA-InfAct) on Health Information promoted by the EU Member States and funded by the European Commission within the Third EU Health Programme (2014–2020) to create and develop solid sustainable infrastructure on EU health information. The main objective of this the JA-InfAct is to build an EU health information system infrastructure and strengthen its core elements by a) establishing a sustainable research infrastructure to support population health and health system performance assessment, b) enhancing the European health information and knowledge bases, as well as health information research capacities to reduce health information inequalities, and c) supporting health information interoperability and innovative health information tools and data sources.MethodsFollowing a federated analysis approach, JA-InfAct developed an ad hoc federated infrastructure based on distributing a well-defined process-mining analysis methodology to be deployed at each participating partners’ systems to reproduce the analysis and pool the aggregated results from the analyses. To overcome the legal interoperability issues on international data sharing, data linkage and management, partners (EU regions) participating in the case studies worked coordinately to query their real-world healthcare data sources complying with a common data model, executed the process-mining analysis pipeline on their premises, and shared the results enabling international comparison and the identification of best practices on stroke care.ResultsThe ad hoc federated infrastructure was designed and built upon open source technologies, providing partners with the capacity to exploit their data and generate dashboards exploring the stroke care pathways. These dashboards can be shared among the participating partners or to a coordination hub without legal issues, enabling the comparative evaluation of the caregiving activities for acute stroke across regions.Nonetheless, the approach is not free of a number of challenges that have been solved, and new challenges that should be addressed in the eventual case of scaling up. For that eventual case, 12 recommendations considering the different layers of interoperability have been provided.ConclusionThe proposed approach, when successfully deployed as a federated analysis infrastructure, such as the one developed within the JA-InfAct, can concisely tackle all levels of the interoperability requirements from organisational to technical interoperability, supported by the close collaboration of the partners participating in the study. Any proposal for extension, should require further thinking on how to deal with new challenges on interoperability.

The Impact of Point-of-Care Hemoglobin A1c Testing on Population Health-Based Onsite Testing Adherence: A Primary-Care Quality Improvement Study.

The hemoglobin A1c (HbA1c) is a gold-standard test to diagnose and monitor diabetes mellitus and has been incorporated into population health performance metrics for quality care. However, patients and practices remain challenged in completing timely HbA1c tests. Point-of-care testing (POCT) for HbA1c provides a quick, easy, reliable method for monitoring diabetes in the primary care office setting. The objectives of this quality improvement study were to evaluate the impact of HbA1c POCT on onsite HbA1c testing frequency as a component of population health performance, as well as to measure the utility of HbA1c POCT in identifying clinically meaningful change in disease. Prospective quality improvement cohort study among sequentially scheduled adult patients with diabetes due for HbA1c testing across three primary care practices. Practices with HbA1c POCT were 3.7 times less likely to miss HbA1c testing at the time of the visit compared with practices in which HbA1c POCT was not available (P < .001). Nearly one in four patients in each group were found to have clinically worsening diabetes (defined by an increase in HbA1c of ≥0.5% or 5.5 mmol/mol). Nearly half of those patients in the intervention group were identified by POCT. HbA1c POCT can improve population health-driven HbA1c testing adherence at office visits in primary care and may enable more timely intervention of diabetes management for patients with worsening disease.

Health Equity, Social Policy, and Promoting Recovery from COVID-19.

The COVID-19 pandemic has revealed starkly and publicly the close interconnections between social and economic equality, health equity, and population health. To better understand what social policies would best promote population health, economic recovery, and preparedness for future pandemics, one must look both upstream and abroad for inspiration. In this article, the author argues for a suite of near-term and longer-term interventions, including universal health insurance and paid sick leave; upgraded wage insurance policies; tax reform; investments in parental leave, childcare, and education; and upgraded government record systems. Policies that equalize the distribution of the social determinants of health and promote social solidarity also will improve population health and economic performance and allow everyone to confront future pandemics more successfully.

Experience-Based Swedish TTO and VAS Value Sets for EQ-5D-5L Health States.

Although value sets for the five-level version of the generic health-related quality-of-life instrument EQ-5D are emerging, there is still no value set available in the literature based on time trade-off valuations made by individuals experiencing the valued health states. The aim of this study was to estimate experience-based value sets for the EQ-5D-5L for Sweden using time trade-off and visual analogue scale valuation methods. In a large, cross-sectional, population-based, self-administered postal health survey, the EQ-5D-5L descriptive system, EQ visual analogue scale and a time trade-off question were included. Time trade-off and visual analogue scale valuations of the respondent's current health status were used in statistical modelling to estimate a single-index value of health for each of the 3125 health states. Ordinary least-squares and generalised linear models were estimated with the main effect within each of the five dimensions represented by 20 dummy variables reflecting the additional decrement in value for levels 2-5 when the severity increases by one level sequentially beginning from having no problem. Interaction variables representing the occurrence of severity levels in at least one of the dimensions were tested: severity level 2 or worse (N2); severity level 3 or worse (N3); severity level 4 or worse (N4); severity level 5 (N5). A total of 896 health states (28.7% of the 3125 possible EQ-5D-5L health states) were reported by the 25,867 respondents. Visual analogue scale (n = 23,899) and time trade-off (n = 13,381) responders reported valuations of their currently experienced health state. The preferred regression models used ordinary least-squares estimation for both time trade-off and visual analogue scale values and showed consistency in all coefficients after combining certain levels. Levels 4 and 5 for the dimensions of mobility, self-care and usual activities were combined in the time trade-off model. Including the interaction variable N5, indicating severity level 5 in at least one of the five dimensions, made it possible to distinguish between the two worst severity levels where no other dimension is at level 5 as this coefficient is applied only once. In the visual analogue scale regression model, levels 4 and 5 of the mobility dimension were combined. The interaction variables N2-N4 were included, indicating that each of these terms reflect a statistically significant decrement in visual analogue scale value if any of the dimensions is at severity level 2, 3 or 4, respectively. Time trade-off and visual analogue scale value sets for the EQ-5D-5L are now available for Sweden. The time trade-off value set is the first such value set based on experience-based timetrade-off valuation. For decision makers with a preference for experience-based valuations of health states from a representative population-based sample, the reported value sets may be considered fit for purpose to support resource allocation decision as well as evaluating population health and healthcare performance.

Premature Mortality in Canada

Introduction: Premature mortality (deaths before age 75) is a well-established metric of population health and health system performance. In Canada, underlying differences between provinces/territories present a need for stratified mortality trends.&#x0D; Methods: Using data from the Canadian Vital Statistics Database, a descriptive analysis of sex-specific adult premature deaths over 1992-2015 was conducted by province, census divisions (CD), socioeconomic status (SES), age, and underlying cause of death. Premature mortality rates were calculated as the number of deaths per 100,000 individuals aged 18 to 74, per 8-year era. SES was measured using the income quintile of the neighbourhood of residence. Absolute and relative inequalities were respectively summarized using slope and relative indices of inequality, produced via unadjusted linear regression of the mortality rate on income rank.&#x0D; Results: Premature mortality in Canada declined by 21% for males and 13% for females between 1992-1999 and 2008-2015. The greatest reductions were in Central Canada, while Newfoundland saw notable increases. CD-level improvements appeared mostly in the southern half of Canada. As of 2008-2015, Newfoundland, Nova Scotia, and Nunavut had the highest mortality rates. Low area-level income was associated with higher mortality. SES inequalities grew over time. Newfoundland’s between-quintile differences rose from 1292 to 2389 deaths per 100k males, or 1.33 to 2.12-fold, and 586 to 1586 per 100k females, or 1.24 to 1.74-fold. In 2008-2015, mortality rates of the bottom quintile in Manitoba and Saskatchewan were more than 2.5 times those of the top. Mortality increased with age, and varied regionally. Low mortality in Central Canada and BC, and high mortality in the Territories were consistent across eras and sexes. Cause of death distributions shifted with age and sex, with more external deaths in younger males.&#x0D; Conclusion: Improvements were seen in adult premature mortality rates over time, but were unequal across geographies. Evidence exists for growing socioeconomic disparities in mortality.

Regional variation of premature mortality in Ontario, Canada: a spatial analysis

BackgroundPremature mortality is a meaningful indicator of both population health and health system performance, which varies by geography in Ontario. We used the Local Health Integration Network (LHIN) sub-regions to conduct a spatial analysis of premature mortality, adjusting for key population-level demographic and behavioural characteristics.MethodsWe used linked vital statistics data to identify 163,920 adult premature deaths (deaths between ages 18 and 74) registered in Ontario between 2011 and 2015. We compared premature mortality rates, population demographics, and prevalence of health-relevant behaviours across 76 LHIN sub-regions. We used Bayesian hierarchical spatial models to quantify the contribution of these population characteristics to geographic disparities in premature mortality.ResultsLHIN sub-region premature mortality rates ranged from 1.7 to 6.6 deaths per 1000 per year in males and 1.2 to 4.8 deaths per 1000 per year in females. Regions with higher premature mortality had fewer immigrants and higher prevalence of material deprivation, excess body weight, inadequate fruit and vegetable consumption, sedentary behaviour, and ever-smoked status. Adjusting for all variables eliminated close to 90% of geographic variation in premature mortality, but did not fully explain the spatial pattern of premature mortality in Ontario.ConclusionsWe conducted the first spatial analysis of mortality in Ontario, revealing large geographic variations. We demonstrate that well-known risk factors explain most of the observed variation in premature mortality. The result emphasizes the importance of population health efforts to reduce the burden of well-known risk factors to reduce variation in premature mortality.

A Public Health Performance Excellence Improvement Strategy: Diffusion and Adoption of the Baldrige Framework Within Tennessee Department of Health.

In 2011, Tennessee was faced with poor state health rankings with newly elected officials promoting customer-focused government. To refocus, the Tennessee Department of Health chose a multiyear plan to adopt, diffuse, and integrate the Malcolm Baldrige Performance Excellence framework. Senior leaders changed the organizational culture using participatory strategic planning coupled with introduction of performance improvement initially led by departmental staff who volunteered for training by the state Baldrige affiliate. New tools and processes were diffused across the department's central and regional offices and county health departments. Departmental units documented performance improvement through hundreds of internal projects and more than 100 innovation-driven Baldrige achievement awards. Over time, performance improvement approaches were integrated into existing departmental programs and new initiatives, leading to additional successful process changes and population health improvements. The department's approach included multiple steps: adopt Baldrige Performance Excellence as means to promote culture change with a goal of improved organizational and population health performance; use the visual Baldrige framework and its categories to underscore inclusiveness, comprehensiveness, and synergies of desired change; choose, invest in, and implement multiple evidence-based management strategies to support culture change toward improvement; and continuously evaluate outcomes, linked to required reports to suppliers (governor and legislators) and customers (public, patients, and partners). The Baldrige Performance Excellence framework was found to be an effective approach to promote culture change through emphasizing improvement in a public health organization.

Population Health Management: Are Existing Tools Fit for Purpose?

Background : As part of the global move towards value-based care, many health systems are experimenting with new forms of population health management. Population health management assumes an organization taking over responsibility to assess the needs of a population in, while identifying groups of patients at risk that might benefit from an intervention to alter the natural cause of their disease. Population health management also often provides aggregate or provider specific performance data to track performance and identify opportunities to improve clinical and financial outcomes Groene, Pimperl & Hildebrandt 2017. Historically, data utilised for population health management has been dispersed at a range of institutions, such as GP practices, hospitals, municipalities, registries or statistical offices. Furthermore, data has mostly been limited to administrative data data collected for billing purposes. The linkage of health care data to other data sources, such as demographic or census data has been an exception Chadwick, Varagunam & Groene 2015. With health systems increasingly focusing on population health management, commercial providers have developed a suite of tools that aim to extract data from a range of sources, link them in a data warehouse, apply tools for patient segmentation and construct performance dashboards to guide population health management. Aim : We will a describe reporting requirements for population health management such as CMS indicators for Accountable Care Organizations, b compare the data sources, functionality and indicators included in existing population health management tools and c map these on established frameworks of population health and health system performance. After an input presentation covering these aims, we will d engage a panel of three experts to discuss the implication of the work. Initial findings : Our initial findings suggest that existing tools for population health management are underutilized in many health systems. USA based Accountable Care Systems have to report on a minimum set of performance indicators, thus driving IT providers to produce appropriate tools. Elsewhere, in absence of similar standardized requirements, a more heterogeneous approach to assessing and managing population health can be observed. Second, population health management suites represent a rather wide range of services, from simple reporting tools, over business intelligence including patient segmentation tools and predictive modelling, to tools that provide nudges to improve individual patients´ care management. Third, and more importantly, the mapping of existing population health management tools on OECD and WHO frameworks suggests that they are insufficient to address to wider determinants of population health. Rather, existing tools are naturally build around formal reporting requirements and limited to well-established disease-focused care programmes. Implications : With the increasing focus on rewarding the value of service delivery health systems need to apply population health management tools much more coherently than in the past. Various IT providers have prepared tools with compelling functionality, however, existing tools still map poorly on the conceptual frameworks of population health as proposed by OECD and WHO. The presentation will outline which steps are required to ensure that future upgrades address the determinants of population health in a more consistent manner.

Considering mean and inequality health outcomes together: the population health performance index

BackgroundThe purpose was to develop and test a population health measure that combines mean health outcomes and inequalities into a single GDP-like metric to help policymakers measure population health performance on both dimensions in one metric.MethodsThe Population Health Performance Index is a weighted average of a mean index and an inequality index according to the user’s inequality aversion. We deploy this methodology for two combinations of health outcome and disparity domain: infant mortality by race and unhealthy days by education.ResultsThe PHPI is bounded between 0 and 1, and is comprised of a weighted average of two separate indices: a mean index and an inequality index, with 1 representing the ideal state of no ill health and no inequality and 0 representing the worst state in the U.S. PHPI values across states (neutral 50:50 weighting) vary between 0.60 (Massachusetts) to 0.17 (Delaware) for infant mortality by race and between 0.65 (North Dakota) to 0.00 (West Virginia) for unhealthy days by education. For some states, the choice of inequality aversion significantly impacts their PHPI value and state rank.ConclusionsMean and inequality health outcomes can be combined into a single Population Health Performance Index for use by public and private policy makers, like the GDP is used as a summary metric to measure economic output. The index can allow for varying degrees of inequality aversion, an individual’s or jurisdiction’s value choice that can substantially impact the value of this new summary population health metric.

PopHR: a knowledge-based platform to support integration, analysis, and visualization of population health data.

Population health decision makers must consider complex relationships between multiple concepts measured with differential accuracy from heterogeneous data sources. Population health information systems are currently limited in their ability to integrate data and present a coherent portrait of population health. Consequentially, these systems can provide only basic support for decision makers. The Population Health Record (PopHR) is a semantic web application that automates the integration and extraction of massive amounts of heterogeneous data from multiple distributed sources (e.g., administrative data, clinical records, and survey responses) to support the measurement and monitoring of population health and health system performance for a defined population. The design of the PopHR draws on the theories of the determinants of health and evidence-based public health to harmonize and explicitly link information about a population with evidence about the epidemiology and control of chronic diseases. Organizing information in this manner and linking it explicitly to evidence is expected to improve decision making related to the planning, implementation, and evaluation of population health and health system interventions. In this paper, we describe the PopHR platform and discuss the architecture, design, key modules, and its implementation and use.

Delivering Rural Health in a Changing Health Model

An exploratory examination of rural hospital staff experiences to determine whether the physical state of rural healthcare facilities influence the healthcare experience and perception of care quality. Rural hospitals have served as the backbone of rural communities in the United States. Over time, these facilities have witnessed enhanced expectations, expanding their scope of operations from acute care to diversified services through linked provider networks and disaster management. Simultaneously, financial challenges, increasing emphasis on safety and quality, and the Affordable Care Act have introduced new challenges for rural hospitals. Currently, there is little empirical knowledge in this domain from a facility perspective. An exploratory qualitative study was conducted, involving semistructured interviews of upper and mid-level administrators in four rural hospitals located in West Texas. All questions attempted to obtain the subject's knowledge, ideas, and opinions concerning the physical design of the hospitals and the hospital experience. According to data on staff experiences, two classes of factors surfaced as potential influencers of hospital experience and care quality: (1) care configuration and (2) outdated building. Care configuration pertains to positioning facilities designed with inpatient care focus to a market expanding in outpatient services. Outdated buildings affect several issue including perceived provider quality and spatial accommodations for safe/efficient care and thereby also affecting the healthcare experience. Physical infrastructure of rural hospitals may have important and meaningful implications for population health performance in rural America.

Population health performance as primary healthcare governance in Australia: professionals and the politics of performance

ABSTRACTA range of institutional and financial instruments has been used to drive population health outcomes in primary health care in Australia. However, GP sovereignty and the corporatized nature of general practice have generated major challenges. The core of government reform strategy since 1992 has been the creation and financing of Primary HealthCare Organizations (PHCOs), in various forms, to provide an organizational basis to connect GPs to population health performance, and a closer link between the state and GPs. The shift from Divisions of General Practice, the first PHCO, to Medicare Locals (MLs) in 2011 was notable. The latter constructed the object of performance as a raft of broader population health goals, which were framed in terms of accountability to communities through public reporting. Drawing on interviews with Federal government, health professional associations, ML executives and GPs, this paper examines the ways in which such performance instruments were imagined and understood, and areas of contestation. The findings show the different rationalities at play and how different actors seek control of the policy space. They also demonstrate the political precariousness of PHCOs, and the wider difficulty of steering market-based professionals in the achievement of population health objectives.

Innovation Practice Using Pervasive Mobile Technology Solutions to Improve Population Health Management: A Pilot Study of Gestational Diabetes Patient Care in Australia.

Healthcare service delivery is moving forward from individual care to population health management, because of the fast growth of health records. However, to improve population health performance, it is necessary to leverage relevant data and information using new technology solutions, such as pervasive diabetes mobile technology solution of Inet International Inc., which offers the potential to facilitate patient empowerment with gestational diabetic care. Hence, this article examines the pilot study outcomes of a small clinical trial focusing on pregnant patients affected by gestational diabetes mellitus, in an Australian not for profit healthcare context. The aims include establishing proof of concept and also assessing the usability, acceptability, and functionality of this mobile solution and thereby generate hypotheses to be tested in a large-scale confirmatory clinical trial.

Top “5 in 5” CNA responds to the National Expert Commission

In our last column (Villeneuve and Mildon 2013), we shared the topics of 11 project charters developed by the Canadian Nurses Association to respond to the nine-point Call to Action of the National Expert Commission (NEC 2012). The lead recommendation of the NEC was to move Canada’s ranking on five key population health and health system performance indicators into the “top five” internationally in five years. That recommendation by the NEC was intended to respond to Canada’s mediocre (and in some cases deteriorating) ranking on a number of influential, internationally comparable population health and health system performance indicators. Throughout the tenure of the NEC, its members were troubled by those outcomes when set against constantly rising healthcare spending. Its place as the first recommendation reflects the determination of the commissioners that nurses must join with others to lead efforts required to shift that paradox.

Canada’s Top 5 in 5

In 2011, the Canadian Nurses Association made a decision to establish and fund a national commission focused on health system transformation, the National Expert Commission. In 2012, the commission presented an action plan, the lead recommendation of which was to ensure that Canada ranks among the top five nations on five key population health status and system performance indicators in the next five years. In this article, the authors outline the selection of the these indicators and the associated goals for improvement.