Population Health is About More Than Just Treating the Body
December 8, 2017
While healthcare is increasing its dependence on data, exactly which data matters to the quality of care remains in limbo.
Population health is about data and people. It is about the “collective” and the “individual.” And, in both cases, the question is about which data helps the patient that is in your clinic, emergency room, or hospital.
At this point, clinicians have jumped over many of the hurdles to arrive at evidence-based practice using the best available research.
Yes, research is invaluable. However, it has no exclusive claim on evaluating what is actually going on with a patient at the moment in time when patient and physician meet.
Value-Based Care Has Evolved
In a 2010 article in the New England Journal of Medicine, Harvard Professor Michael E. Porter, Ph.D. outlines the challenge of defining value-based care. “Providers tend to measure only what they directly control in a particular intervention and what is easily measured…”
And while Porter does address the need to focus on patient outcomes, he doesn’t consider the life-world that surrounds and defines the patient.
The burden sits with the providers who are forced to assume responsibilities for their patients without really knowing them. Dr. Porter points to survival, quality of recovery, and sustainability of health as tiers of measurement.
However, in 2010, we were still thinking in an outdated paternalistic system with the patient continuing to be an object of the system.
The good news is that the continuing search for ways to reduce the cost of healthcare has pointed us to more than genetics, more than a given medical/familiar history, and more than attitude.
Modern medicine is finally moving deeper into the patient experience and into the person who is the patient.
Mood of a Population Informs Its Health
A recent study by Humana shows that patients’ emotional/mental state informs their health, recovery, and longevity. And, so it is with communities.
The social and economic “mood” of a population informs its collective health. It impacts the morbidity and mortality of its members who suffer from diabetes, COPD, obesity, depression, and other chronic conditions.
The World Health Organization defines social determinants as “the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.”
Psychosocial risk factors include pressure from economic disparity, food insecurity, as well as pressure at work or home, unsafe living environments, and community/collective distress. (See my prior post on the social determinants of health.)
Pain Management and Population Health
The current focus of the Joint Commission on pain management also relates to population health. Its latest standards push for more diligent and purposeful practices for each patient, including “identification of psychosocial risk factors that may affect self-report of pain.”
Ron Melzak and Hans Selye’s work also identified these same risk factors in managing pain, including beliefs, cultural norms and expectations, and personal history.
Considering and addressing these underlying issues is critical to effectively encourage patients to participate in their own treatment plan, set realistic expectations, and fully understand how pain may impact how they function.
The Joint Commission has brought us back to the importance of the emotional and cognitive factors in managing pain. And, the World Health Organization has moved us further into practicing Whole Person Care.
As a meta-analysis of the research literature indicates, addressing population health demands that the relationship between each patient’s health and the socioeconomic factors, cultural norms, beliefs, and attitudes which define their lives also be acknowledged.
Today, the healthcare industry is focusing on the patient experience, trying to define and narrow the field so that it is a manageable concept. However, we must be careful not to miss the most significant factors that influence the patient’s perceptions, expectations, fears, and beliefs which ultimately determine their health trajectory.
This is the key to population health.
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