1. The Importance of Population Health in Obstetrics and Gynecology Training

2. 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

3. 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) Graduate medical education that meets the nation’s health needs. Washington, DC: The National Academies Press.

4. 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

5. 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.

6. 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.

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

8. 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.

9. 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.

10. How to approach population health

11. 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.

12. 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 (

13. How can you learn about your population?
Internet resources
Community Health Needs Assessment (CHNA)(
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?

15. 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.

16. 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

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

18. A national initiative with local implications

19. 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

20. 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.

21. 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?

22. Additional educational resources
Institute for Healthcare Improvement (
CDC 6/18 initiative (
American Medical Association (