The Importance of Population Health in Obstetrics and Gynecology Training

Learning objectives Understand how population health is part of the ACGME milestones. Define population health. Identify the health status within your community. Identify health disparities and inequities in the community of patients whom you serve Gain better understanding of the challenges many of our patients face and the system of resources in place within our community aimed to help improve health equity Recognize how as physicians we can advocate for our patients to ensure their social needs are met to ensure medical…continued gaps and our role in advocating for our patients

Is an understanding of population health necessary to be an ob/gyn physician? Produce competent physicians who can function in a complex health care delivery system. Ensure that the clinical learning environment is optimized. Graduate physicians who will meet the needs of the population they serve. Ensure our graduates know how to provide the highest quality and safest care in a cost conscious manner. The ultimate goal of all medical education programs is to improve headlt and health care outcomes, t continue faculty development and medical education. Challenge is how to align educational and clinical outcomes in GME and refocus attention on health and health care outcomes so that the physicians we train are prepared for health care practice. Many of us were not trained in any of these critical competencies…but we all need to learn them. IOM (Institute of Medicine). 2014. Graduate medical education that meets the nation’s health needs. Washington, DC: The National Academies Press.

We have to assess a resident’s ability to work within a complex health care delivery system The residents we train have to be able to work in a complex health care delivery system. PC 11 MK 5/7 SBP 2 PBLI 3 Pro 3 IPCS 3 How to teach

Population health is part of systems based care The answer is absolutely YES!!! Level 5 is really level 1 upon graduation as residents transition to attendings.

What is population health? Population health refers to the health outcomes of a group of individuals, including the distribution of such outcomes within the group”. Population health includes the range of personal, social, economic, and environmental factors that influence the distribution of health outcomes, and the policies and interventions that affect those factors.

Population health is part of the “Triple Aim” Improving population health Providing better care Lowering costs of care (value based care) www.IHI.org

Is an understanding of population health necessary to be an ob/gyn physician? Absolutely!!! AS shown in this picture, clinical care is only “the tip of the iceberg”. Physicians and other health care providers will be expected to move beyond traditional narrowly-defined roles to participate in collaborative teams as both leaders and supporting players, and perhaps most importantly, to contribute to a systems view of meaningful patient outcomes beyond disease-specific diagnosis and treatment. This expanded view means as medical educators we need to ensure our residents are able to meet the expectations as a collaborative team player within a health system.

Why the focus on population health? Only 10-20% of what impacts health is associated with clinical care. Fewer generalists and more subspecialists  more providers involved in care of complex patients. It is no longer enough to be an expert; physicians also need to understand how to work within a health care system. Care coordination Continuous quality improvement Understanding team science This is not the paradigm that many providers were exposed to during training.

How to approach population health

Model of Population Health Stiefel M, Nolan K. A Guide to Measuring the Triple Aim: Population Health, Experience of Care, and Per Capita Cost. IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2012.

What are your local needs? Education—literacy, parenting Diversity – understanding the unique needs of each culture/economic group in your community Nutrition – access to healthy food Access to health care – transportation, mental health, substance abuse support Geographic factors impacting care (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3704110/)

How can you learn about your population? Internet resources Community Health Needs Assessment (CHNA)(http://www.astho.org/Programs/Maternal-and-Child-Health/) http://www.countyhealthrankings.org/ Your own experience – what are the unmet needs of your patients that adversely impact their health? Access to mental health care. Resources for substance abuse Nutritional counseling Healthy food options Others?

Population Management Reducing waste by improving services for groups of patients, e.g., group prenatal care Shift in focus from care provided and paid for at an individual level to managing and paying for health care for defined groups, i.e., populations Understanding disparities associated with different population groups, e.g., ovarian cancer treatment in the central Appalachia. Considering impact of patients’ environment (work, home, outdoors) on their health.

Examples of a population health approach Think holistically about patient health needs Physical Mental Spiritual Social Consider care for groups of patients Refer patients to community resources Evaluate costs of care and seeking to improve value Engage patients and families Form community partnerships

A national initiative with local implications This is one example of a national initiative t

A national initiative with local implications

An important component of population health is knowing your community resources SNAP Food banks/pantries WIC Nutritional Support Passport transportation program Transportation Church/support groups Free/Discount daycare- Childcarecouncil , 4C Child Care Passport program (“Mommy Steps”) Family Health Center program Clothes banks, discount car seats Baby Supplies

A population health approach to stillbirths This video and the next slide are from the IHI module on the Triple Aim and is a great example how we apply the principles of population health in understanding and improving patient outcomes. https://youtu.be/Kn5xyct4Hd0 http://www.ihi.org/education/IHIOpenSchool/resources/Pages/AudioandVideo/Jason-Leitch-What-If-You-Take-a-Complex-Clinical-Challenge-to-the-Community.aspx

Discussion What were some of the factors affecting stillbirth rates that you heard in the video? Why couldn't obstetricians solve the problem on their own? Do you think it would be hard to convince staff and patients to participate in multidisciplinary rounds after a stillbirth? Why might people resist this, and how might you address their concerns? What other health care problems might be improved by addressing factors outside of health care, for example, living conditions? http://www.ihi.org/education/IHIOpenSchool/resources/Documents/Facilitator_Leitch_ComplexChallenge.pdf

Additional educational resources Institute for Healthcare Improvement (www.IHI.org) CDC 6/18 initiative (https://www.chcs.org/project/advancing-public-commercial-payers-implementation-cdcs-618-initiative/) American Medical Association (https://www.ama-assn.org/education/teaching-new-content-health-systems-science)