NURS 503 Week 1 Discussion Board Forum 1 on Defining Population Health Example

Discussion Board Forum 1: What Population Health Means for Advanced Nursing Practice

NURS 503 Managing Population Health, Discussion Board Forum 1

Thread by [Student Name]

The clinic example and the classmates replied to are composites written for a model discussion.

Last month our family practice ran a report of every patient with diabetes on our panel. Of about 900, more than 140 had not had a visit or a hemoglobin A1c in over a year. None of them appeared on any day's schedule, so in visit-based care they were invisible. The report raised the question this week's readings ask: is our clinic responsible for the health of the patients who come in, or for the health of everyone on our list?

Population health answers that question in favor of the whole list. Kindig and Stoddart (2003) proposed that population health be understood as what happens to the health of a defined group, both on average and across its members, and they argued that the field should study both the outcomes and the factors that produce them. The emphasis on distribution matters: a clinic whose average A1c is acceptable may still have a group of patients, often those with the least money or transportation, whose diabetes is poorly controlled and unmeasured. Nash et al. (2016) describe population health as a shift from managing illness one encounter at a time toward improving the health of defined groups through prevention, care coordination and attention to social conditions.

Population health is related to public health but not the same. Public health agencies serve whole communities, often through policy and programs such as vaccination or clean water. Population health, in the sense used in our textbook, is usually practiced by health systems and clinics for a defined population, such as a panel of patients or the members of a health plan. The Triple Aim named the three results this work should pursue together, a better patient experience, healthier populations and a lower cost per person (Berwick et al., 2008).

For a nurse, the shift is from asking "who is on my schedule today" to asking "who is missing from it." In practice that means three changes for me as a future advanced practice nurse: reviewing panel data regularly, not only individual charts; reaching out to patients who have fallen out of care, by phone or text or through community health workers; and asking about the practical obstacles, a car that broke down, a job that will not give time off, a pantry that runs out at month's end, that often explain why patients disappear.

Jesus' parable of the shepherd who leaves the ninety-nine to find the one lost sheep (English Standard Version Bible, 2001/2016, Luke 15:4-7) describes this kind of care. The shepherd does not wait for the sheep to come back to the fold; the shepherd counts, notices who is missing and goes out. Population health asks nurses to count in the same way.

Reply to Kayla

Kayla, your point that population health depends on good data is important, and your example of a hospital that could not tell how many of its patients were homeless shows the problem well. I would add that the data we lack are often exactly the data that explain outcomes. Kindig and Stoddart (2003) argued that population health must include the determinants of health, such as income, education and the physical environment, not only medical care, yet most clinical records capture little of that. Nash et al. (2016) describe the growing use of social needs screening and community data to fill those gaps. One practical step your hospital could take is adding a short social needs screening to admission and linking the results to the community resources a case manager can offer. Without that information, a population health program can measure who is sick but not why. Did your hospital's leaders say why homelessness was not being recorded? Sometimes the reason is technical, such as a missing field in the record, and sometimes it is a worry that asking will raise needs no one has funded, which calls for a different kind of fix.

Reply to Jordan

Jordan, I agree with your distinction between public health and population health, and your experience as a school nurse sits right at the point where they meet. A school nurse serves a defined population, the students, in a way that resembles a clinic's panel, yet also carries out public health functions such as immunization compliance and outbreak response. Berwick et al. (2008) noted that achieving the Triple Aim requires an organization willing to take responsibility for a defined population, and a school district can be that organization for children's health. The textbook's description of population health as coordinated work across sectors fits your role well (Nash et al., 2016). One question your post raised for me is how school nurses share data with the clinics where students receive care. If a school nurse knows that a student with asthma has missed ten days, does that information reach the student's primary care provider? Closing that loop could be a strong population health project for an MSN student, and it would test how far the Triple Aim can stretch beyond the walls of a health system.

References

Berwick, D. M., Nolan, T. W., & Whittington, J. (2008). The triple aim: Care, health, and cost. Health Affairs, 27(3), 759-769. https://doi.org/10.1377/hlthaff.27.3.759

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Kindig, D., & Stoddart, G. (2003). What is population health? American Journal of Public Health, 93(3), 380-383. https://doi.org/10.2105/AJPH.93.3.380

Nash, D. B., Fabius, R. J., Skoufalos, A., Clarke, J. L., & Horowitz, M. R. (2016). Population health: Creating a culture of wellness (2nd ed.). Jones & Bartlett Learning.