People and institutions need to work together to initiate healthy programs beyond clinical healthcare settings. Partnerships, joint efforts, and effective strategies need to be established among providers, payers, clinicians, consumers, public health community, policymakers, and many others to change the health of all Americans.
The “National Forum on Hospitals, Health Systems and Population Health: Partnerships to Build a Culture of Health” Conference www.populationhealthandhospitals.com sponsored by the Robert Wood Johnson Foundation (RWJF) www.rwjf.org October 22-24, 2014 in Washington D.C. explored new ideas on how to enable all Americans to live longer healthier lives now and for generations to come.
This ground breaking event attended by hospital staff and board members, nurses, physicians, allied clinicians, insurers, public health professionals, community stakeholders, and others was Co-Chaired by David C. Colby PhD, Vice President for Policy at RWJF, and Susan Dentzer, Senior Policy Advisor to RWJF.
An important requirement in dealing with population health challenges, requires many communities to develop and use the right data and information tools, provide the resources for health professionals and community populations to use, and find ways for the projects to become sustainable.
One of the Conference Sessions titled “Data and Information Tools to Tackle Population Health Challenges in Your Community” was held to discuss several collaborations that are producing good results for communities
Stacy Lindau, MD, Associate Professor Obstetrics/Gynecology and Medicine Geriatrics, at the University of Chicago, described how the Chicago project “CommunityRx” www.HealtheRx.org operates. This project is a new patient-centered health IT system operating with funding for $5.86 million from a CMS/CMMI Health Care Innovation Award to promote the use of community resources for wellness, self-care, and independent living.
CommunityRx provides a personalized referral list for self-care resources generated in the clinical setting via an EMR with information delivered by Community Health Information Specialists to help the people in the community. In addition, MAPSCorps, a community mapping program employs and trains local youth while promoting physical activity, health awareness, and STEM careers.
Another project taking place in New York City within the Department of Health and Mental Hygiene was described by Katharine H. McVeigh PhD, Lead Epidemiologist for NYC Macroscope, a project within the NYC Department of Health and Mental Hygiene. She is developing a mechanism for monitoring population health called the NYC “Macroscope Electronic Health Record Surveillance System” www.nyc.gov/doh/html/data/nycmacroscope.shtml.
The NYC Macroscope aggregates data from primary providers at about 700 ambulatory practices located throughout the city to help estimate the prevalence of selected health conditions in adults who visited a doctor in the past year. The goal is to use these estimates efficiently so that data on costs and the burden of disease in NYC can be more accurately determined.
Currently, the project is evaluating the validity of NYC Macroscope data across 10 outcomes in 7 domains by comparing the data to the 2013-2014 NYC Health and Nutrition Examination Survey (NYC HANES) a population-based examination survey that was jointly carried out by the NYC Department of Health and Mental Hygiene and CUNY School of Public Health.
Funding for NYC Macroscope and NYC HANES programs are jointly being carried out by the NYC Department of Health and Mental Hygiene, CUNY School of Public Health with additional funding from the deBeaumont Foundation, RWJF, Robin Hood Foundation, Doris Duke Foundation, NY State Health Foundation, and CDC.
Anand Shah, MD IEP Dallas Executive Director http://iep.pccipieces.org with $12 million in funding from the W.W. Caruth, Jr. Foundation at Communities Foundation of Texas, described how the Dallas Information Exchange Portal (IEP) operates. IEP, an electronic platform enables healthcare providers, community groups, and social service agencies to share medical and social information via an information exchange network.
Eric Fleegler, MD, Assistant Professor of Pediatrics, Harvard Medical School, Boston Children’s Hospital, discussed how the project called www.HelpSteps.com operates as an assessment and referral system for families and individuals to help find resources related to domestic violence and safety equipment.
The system primarily focused on issues affecting lower socioeconomic families includes services specifically related to food, insecurity, housing, income resources, and other issues. The program is able to assess need in 13 areas and provides access to resources related to over 100 social programs.
Initial funding came from a $2,500 AMA Foundation seed grant but over the first 5 years, $400,000 was raised to further develop the system. Support for the database is now coming from Boston Children’s Hospital, Boston Public Health Commission, plus other small grants contribute to the funding.