The Importance of Population Health in Obstetrics and Gynecology Training

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. IOM (Institute of Medicine). 2014. 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

5. Population health is part of systems based care

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) www.IHI.org

8. Is an understanding of population health necessary to be an ob/gyn physician?

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

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 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3704110/)

13. 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?

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

18. A national initiative with local implications

19. An important component of population health is knowing your community resources

20. A population health approach to stillbirths 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

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? http://www.ihi.org/education/IHIOpenSchool/resources/Documents/Facilitator_Leitch_ComplexChallenge.pdf

22. 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)