Health care is evolving in two seemingly contradictory directions: the exclusive and the inclusive. Medical services are becoming increasingly tailored to the needs and preferences of the individual. In the current consumer-driven market, patients want to be viewed as people by their care providers, not as just names on charts, which requires greater personalization. And with gene therapy and other medical advances, treatment is becoming more closely designed to each unique case.
At the same time, the growing field of population health looks at treatment and preventative care on the community level, creating strategies that target large groups simultaneously. The National Advisory Council on Nurse Education and Practice points to two definitions in its explanation of population health:
- The Institute of Medicine (IOM, 2014) describes the strategy as “an approach that treats the population as a whole (including the environmental and community contexts) as the patient.”
- As far back as 2003, Drs. David Kindig and Greg Stoddart published a paper describing population health as “the health outcomes of a group of individuals, including the distribution of such outcomes within the group.”
Though many nurses are responsible primarily for providing clinical care to individual patients, population health is becoming an increasingly important part of health care in general, as well as the practice of nursing. In line with this trend, nurses should be familiar with a number of specific applications for population health, including how it is used to treat substance abuse, diabetes and mental health.
From alcohol to opioids, substance abuse takes a heavy toll on the U.S. health care system. Not only does substance abuse destroy the lives of the affected individuals and their loved ones, but the economic impact also is significant. According to the National Institute of Drug Abuse, the abuse of alcohol, illicit drugs and tobacco costs the nation more than $740 billion each year.
Population health strategies are seen as one way to help individuals struggling with substance abuse.
A yearlong study by health and wellness company Humana found that the addition of population-based behavioral care to a substance abuse treatment program both improved outcomes for patients and decreased costs. Study participants who were involved in the population health-based care had 16 percent fewer visits to the emergency room, as well as 67 percent fewer inpatient hospitalizations, compared to the time before beginning the program.
The researchers also saw economic advantages to this strategy. Health care costs fell 46 percent on average for participants. This decrease is even more significant when compared to the non-participant costs, which increased an average of 14 percent.
“The improved health outcomes results clearly reflect the benefits that population health can achieve by integrating substance abuse programs,” said Dr. Larry Weinstein, chief medical officer for LifeSynch, a wholly owned subsidiary of Humana. “By taking a proactive approach, as opposed to a reactive one, we were able to reach people at risk for medical and psychiatric complications from substance use disorders. This enabled us to take the necessary steps to help people improve their health.”
Chronic conditions are another area of health care taking an increasing economic toll on the U.S. Among the most significant of these chronic conditions is diabetes. According to the Centers for Disease Control and Prevention, more than 29 million adults were living with diabetes in 2016, and a quarter of the individuals in that group were unaware that they even had the condition. Even more people — about 86 million — had prediabetes, with 90 percent unaware of the fact. These numbers illustrate not only the prevalence of the condition but also the extent of a second problem: the high number of patients living with diabetes who are undiagnosed. When people do not know that they are sick, they are very unlikely to take appropriate measures to prevent complications until it is too late.
Because of the wide spread of diabetes, population health is an efficient approach to this national problem. The first step is identifying at-risk individuals. Though diabetes cannot be reversed once it has developed, prediabetes can reduce the risk of developing Type 2 diabetes if the appropriate preventive measures are taken. Early intervention is critical. One way to accomplish this goal of treating patients earlier is through the establishment of a database that uses data analytics to identify individuals who show risk factors, such as high blood pressure or triglyceride levels.
Among the lifestyle changes that patients should make to avoid diabetes, the most significant are weight management, physical activity and proper nutrition. According to Sharon Watts, DNP, FNP-BC, CDE, and Jino Y. Howard, MSN, FNP-BC, BC-ADM, CDE, CPT, in an article published in The American Journal of Nursing, at-risk patients may be able to delay the onset of the disease — or even prevent it entirely — simply by making changes to their diet and activity level. Additionally, the Obesity Society reported that studies have shown that weight loss of 5–10 percent can delay or prevent the onset of diabetes in high-risk adults.
As diet is also important in preventing — and managing — diabetes, classes about nutrition and healthy cooking in schools and community centers are prime opportunities to proactively engage with large numbers of at-risk people in a single setting.
Physical conditions are not the only concerns that can be treated by population health. Mental health is another area that is now being viewed through this lens. The medical world is increasingly recognizing that mental health and physical well-being are closely related and that patients benefit from integrating the two. Including behavioral health strategies in population approaches is important for addressing specific mental health challenges and some physical ailments, as well.
“I think behavioral health needs to be a foundational core strategy for any population health program for an integrated delivery system,” Dr. Lee Hammerling, chief medical officer of ProMedica, a Toledo, Ohio-based health system, told Health Leaders Media. “Without it, you will never be as successful as you need to be. Behavioral health is pervasive and impacts so many conditions, like diabetes, cancer and congestive heart failure, and the increase in [emergency department] use and admissions can be as high as 60 percent.”
According to Partners Healthcare, nearly 25 percent of American adults live with an undiagnosed mental health disorder. Nurses and other health care professionals should be familiar with the behavioral health programs in the community that they can refer patients to and look for ways to partner with these groups when possible.
For the benefits of population health strategies such as these to be as effective as possible, organizations need nurses with higher degrees who are willing to take the lead.
If you are interested in playing a nursing leadership role in your community, consider enrolling in Bradley University’s online Doctor of Nursing Practice degree program. Through the leadership track, you will complete courses on topics such as health promotion in populations, data management and health care policy that will help you shape the way your organization treats patients at both the individual and population levels.
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