the role of lhds in improving population health laquandra s. nesbitt, md, mph director, lmphw khda...
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The Role of LHDs in Improving Population Health
LaQuandra S. Nesbitt, MD, MPHDirector, LMPHW
KHDA RetreatOctober 9, 2013
Agenda
• Improving “health”• Work of “public health”• Improving “population health”• Role of LHDs• How to transition• Discussion
IMPROVING HEALTH
What is Health?
“Health is a state of complete physical, mental, and social well-being and not merely the absence
of disease or infirmity.”
World Health Organization
What Determines the Population Health Status?
Policies &Programs
50% =
How Do We Improve Health?
THE “WORK” OF PUBLIC HEALTH
What is Public Health
“Public health is the science and art of preventing disease, prolonging life and
promoting health through the organized efforts and informed choices of society, organizations,
public and private, communities and individuals”
World Health Organization
Core Functions of Public Health
Food Hygiene, Public Facilities, Wastewater, Pools,Onsite Sewage,Smoke Free Ordinance
LMPHW Clinics (Family Planning, Immunization, STD, Tuberculosis)Obstetrical UltrasoundsBreast, Colorectal & Cervical Cancer ScreeningFamily Health CenterQuality Charitable Care Trust
Student Practicum OpportunitiesTraining (CEUs) for staffEvolving Partnership with U of L
Annual Performance PlanningResults Framework
Vital Statistics AnalysisBehavioral Risk Factor Surveillance System (BRFSS)EPSDT
Communicable Disease Investigation Epidemiology Site Assessments & EducationPublic Health Laboratory
Diabetes, Heart DiseaseNutrition (incl. WIC) & Physical ActivityMedicare FraudMaternal & Infant Home VisitationCenter for Health Equity
Center for Health EquityMayor’s Healthy Hometown Movement(Community Transformation Grant)
Mayor’s Healthy Hometown Movement Leadership TeamHealth Impact Assessments
Where Does the Money Come From?
All Funding Sources Combined
IMPROVING POPULATION HEALTH
What is Population Health?
“Population health is the health outcomes of a group of individuals, including the distribution
of such outcomes within the group”
Kindig D, Stoddart G. What is population health? American Journal of Public Health 2003 Mar;93(3):380-3
Improving Population Health
• Health care goal– The improvement of
individual patient outcomes through the provision of medical services
• Public health goal– Improving health
outcomes in the population as a whole through health promotion and disease prevention
Hardcastle et al. “Improving the Population’s Health: The Affordable Care Act and the Importance of Integration” Journal of Law, Medicine and Ethics Fall 2011
Improving Population Health
• Recognize the impact of the social determinants of health
• Collect population level data and use it to make program and policy decisions
• Close the chasm between public health and clinical medicine
Why Integration?
• Policy decisions may have unintended consequences
• Improves quality of care for patients• Avoids duplication and the resulting
unnecessary costs• Public health and individual health care
complement, but cannot replace, each other
Hardcastle et al. “Improving the Population’s Health: The Affordable Care Act and the Importance of Integration” Journal of Law, Medicine and Ethics Fall 2011
LHD’S AND POPULATION HEALTH
Role of Local Health Department
• Convener• Data collection and analysis• Establish priorities• Subject matter expert(s) for community• Research/review best practices• Advocate for local and state policy
Louisville Metro Example
• Issue: Current safety net funding levels are unsustainable– Convene “safety net” organization leaders– Identify high utilizer/cost patterns– What worked in Cincinnati, OH and Camden, NJ– Participate in policy discussions regarding system
reform
Louisville Metro Example
• Issue: Local hospital needs to decrease readmissions– Identify which patients are being readmitted more
frequently– Draw on strengths of hospital (nurse case
management/discharge planning) and local health department (community health worker/home visitation)
– Collect data and determine effectiveness of intervention
– Disseminate findings
HOW TO TRANSITION
Introspection
• Do I have the right staff?• Are we allocating resources appropriately?• Does our board of health have the right
composition?• Do members of my community recognize me
as a leader?• Am I prepared to get out of the business of
healthcare?
Introspection
• Does my team realize the field of public health is evolving?
• Is maintaining the current FTE levels in my organization a priority?
• Do I have a plan to teach my staff new skills?