By Scott Howe
A growing number of health care professionals are looking at their patients not just as individuals with unique concerns but also as members of larger groups with common problems and needs. This broader, population-based framework could lead to better health outcomes for more people, according to Jonathan Finkelstein, MD, MPH of Boston Children’s Hospital.
"The health care system is changing from one that’s more reactive to illness – you come see the doctor when you’re not well – to one that’s more responsible for the promotion of health for defined groups of people," he explains. While individual patients will always be treated as, well,individuals, the concept of population health can help providers "figure out the most appropriate services within a set of limited resources for specific groups."
What is "population health"?
Population health has been around for a long time. Measures like infant mortality and life expectancy have always been presented for geographically defined groups in terms of characteristics like age, gender and economics. In addition, health insurers responsible for their own "defined populations" often have organized their programs to address needs shared by specific groups, like those with diabetes or asthma.
Public health programs and prevention efforts have, historically, been singularly focused on population-based approaches to tackling health needs. Finkelstein points to community-based immunization programs for influenza and efforts to eradicate lead paint in specific communities as examples of successes.
"What’s different now," Finkelstein reports, "is that people who deliver care are starting to think in terms of population health."
This difference is the focus of an article by Finkelstein and his colleague, Emma Eggleston, MD, in this week’s JAMA. The title, "Finding the Role of Health Care in Population Health," is intended to highlight the idea of partnerships between medical providers, payers and others in the community responsible for population health.
This partnership can be seen in recent efforts to improve health quality and curb costs, including some of the provisions found in the Affordable Care Act. "Part of the goal of the ACA is to help systems take responsibility for defined populations," Finkelstein states. "We have to be concerned with the optimal use of resources, and the ACA is pressuring us to evolve in that direction."
IT leads to a new view of patient populations
Improved technology is also leading health care professionals to embrace population health – such as an effort to use biosurveillance data to learn "what’s going around." The reverse is also possible: taking patient data and extrapolating to the larger care population.
"Years ago, looking at a large group of patients as a population was absurd," Finkelstein asserts. But using new technology, "I should be able to tell you what fraction of my population hasn’t received a booster shot for diphtheria, tetanus and pertussis, or what fraction of children have lead levels greater than 5. I should be able to map where they live and find a better approach to address their problems." In the past, he says, "all that information was buried in manila folders sitting in my file room."
Population health at work
Finkelstein’s research on antibiotic prescribing shows how focusing on population-level impacts can lead to substantial improvements in medical care. "When we prescribe an antibiotic for a child, she is going to go to daycare and interact with other children," he says. "All of those children are at increased risk of harboring a resistant organism, and the next kid who comes through our door may have a resistant infection."
But today, Finkelstein reports, "pediatricians and parents alike understand that we have to be careful with antibiotics for individuals, accounting for impacts on a population level." As a result, antibiotic use in young kids has dropped 25 to 30 percent in the past 10 to 15 years.
Such success stories point to the potential of population health thinking in addressing large problems. More work, however, needs to be done for the health care system to fully embrace a population view along with an individual-patient focus. "I don’t think its ‘either-or,’" Finkelstein states. "The question is: When does taking a population view allow us to more effectively partner with others to improve health?"