The best way to improve health outcomes of communities, agreed panelists at a recent event aimed at helping primary care physicians and public health officials pursue this goal in concert, is for both sides to overcome institutional communication barriers and clearly define their respective roles.
Julie Wood, M.D., AAFP senior vice president of health of the public and interprofessional activities, and LaMar Hasbrouck, M.D., M.P.H., executive director of the National Association of County and City Health Officials, discuss successful population health projects during the inaugural Practical Playbook National Meeting in Bethesda, Md., on May 23.
Julie Wood, M.D., AAFP senior vice president of health of the public and interprofessional activities, participated in a panel discussion here last week during the first national meeting of the Practical Playbook,(www.practicalplaybook.org) an organization that works to improve population health.
But agreeing on how to define population health is complicated. Panel moderator John Auerbach, M.B.A., associate director for policy at the CDC, defined it as prevention on scales ranging from a single clinic to an entire population.
Physicians and public health officials often use different terms to describe similar efforts, and this communication barrier creates confusion and inefficient collaboration between groups that share the same goals.
"I am bilingual," said LaMar Hasbrouck, M.D., M.P.H., executive director of the National Association of County and City Health Officials, to laughter from the audience. "I speak both public health and primary care."
Hasbrouck likened population health programs to athletic teams. They need a coach, players who know their roles and a quarterback. One way to delineate these roles is to create a chief community health strategist position, someone who is responsible for data collection and annual performance measurements.
- Primary care physicians and public health officials have a language gap that hinders their cooperation to improve population health, said panelists at the recent Practical Playbook National Meeting.
- Panelist Julie Wood, M.D., AAFP senior vice president of health of the public and interprofessional activities, said roles in population health projects must be clearly laid out.
- Speakers suggested ways to show short-term success while projects aim for more long-term improvements.
Wood agreed that roles must be clearly laid out. She said that when population health initiatives are launched, primary care physicians and their staffs often are unclear about what their specific contributions should be and how they should work with members of the public health community.
"I would like to see us reach the point where we know how to enter into or sustain integration of public health and primary care," Wood told AAFP News after the meeting. "Resources and ideas should be available so family physicians can get involved with public health initiatives."
Auerbach asked the panelists what a successful population health initiative looks like. Esther Dyson, executive founder of a project to improve the health and economy of five communities called Way to Wellville,(www.hiccup.co) said a successful initiative achieves results over the long term, but elected officials and insurers typically are unwilling to wait that long. She said measures such as improved graduation figures, lower obesity rates and lower early death rates are reasonable goals to begin with.
"Success will happen in 10 years, not now," Dyson said. "Health should be viewed as an asset that you invest in instead of waiting for it to decline and making repairs."
To counter the pressure for immediate results, Hasbrouck said public health officials can demonstrate progress by showing politicians data on "low hanging fruit" such as ER usage, preventable asthma hospitalizations, diabetes compliance or air pollution, all of which can be measured over a shorter term while more long-range projects continue to work.
With an eye on long-term goals, Dyson said health officials should be involved in projects that traditionally would fall outside their scope. When Spartanburg, S.C., wanted to boost the number of college graduates, for instance, public health officials realized the project needed groundwork in early childhood education programs and even in prenatal care. But when they asked educators about children's diets the response was, "We do education, not nutrition," according to Dyson.
Wood described a successful population health grant program in Annapolis, Md., that addressed overutilization of the emergency department. Public health officials used hospital data to identify a single building of 184 adults with disabilities and seniors that generated 220 medical emergency calls in a year. Health officials opened a primary care medical home in the building to address residents' health needs.
Hasbrouck cited a success(www.rwjf.org) scored by the Kansas City, Mo., Health Department that focused on health equity. Vital statistics showed that life expectancy for white residents was 6.5 years longer than that for black residents, and homicide rates were significantly higher for ethnic minorities.
Focusing on low-income populations, officials worked to improve early child care, introduce preventive health, reduce tobacco and drug use, and address violence. Other social factors identified for improvement included food access, housing quality and a need to increase the minimum wage. City officials passed a community health improvement plan in 2001 to start the initiative, and by 2015, the life-expectancy gap between black and white residents had been reduced to five years.
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