Population Health Needs Patterns of Service Usage

1
Session 2
2

National Requirements
Learning from Others
Resources/ Costs
Population Health Needs Patterns of Service
Usage
Where want to be (Strategy)
Where are now
Commissioning Cycle
How get there (Transition Plan)
Review Impact and quality
Putting into operation
3
Understanding Where We Are Now Where We Want to
Be Make a Difference in Health Care Delivery
Broad Street Pump
John Snow 1883
4
Strategic Planning for SHAsA blend of two
perspectivesMedicine/Public Health
Asklepios First physician Greek legend
Hygeia Daughter of Asklepios
5
Knowledge Management

• 
  Social/Health
• 
  Indicators
• Evaluation
  Data Analysis
• Implementation
  Useful Information
• Operations Planning
  Knowledge Management
• 
  
• 
  Strategy
  

Planning Cycle
6
Health System Program PlanningThe
PRECEDE/PROCEED FrameworkLawrence W. Green
Marshall W. Kreuter

• PRECEDE
• P predisposing
• R reinforcing
• E enabling
• C constructs
• E educational
• ecological
• D diagnosis
• E evaluation

• PROCEED
• P policy
• R regulatory
• O organizational
• C constructs
• E educational
• E environmental
• D development

7
Hallmarks of thePRECEDE/PROCEED Framework

• Flexible, Comprehensive, and Scaleable
• Evidence-based and Easy to Evaluate
• Participatory Process
• Platform for Best Practice

8
Influences on the Population's Health
Place Time
Context
Community Attributes
Biological Characteristics Age Gender
Genetic makeup
Social Cohesion Social support Social change
Natural Environment Air quality Water
quality Contaminants
Built Environment Housing Workplace
School
The Populations Health Disease
Functional Status Well-being
Health Services Structure Cost Access
Quality
Cultural Context Race Culture Religion
Discrimination
Economic Employment Income Income
inequality Economic change Education
Political Context Public policies Health
policies Laws Participation
Lifestyles and Health Practices Smoking
Diet Physical Activity Safety Violence
Sexual Practices
Population-based Health Programs Water supply
Waste disposal Public health programs School
programs
9
Nine Phases cont

• 3. Genetics, Behavioral Environmental
  Assessment Identify health practices linked to
  the health problems - vital indicators.
• e.g.,compliance, consumption patterns,preventive
  actions,utilization,
  self-care, frequency, lifestyle,
  economic, family, access, affordability, housing
• /-foods, high stress
  jobs,smoking in public places

10
safety issues
literacy
values
economics
pollution
hygiene
parenting skills
infection control
cultural issues
health care
social policy
communication
waste disposal
approval
mental health issues
water
DESCENDANTS
food safety
ADAM
EVE
FAMILY
shelter
grief issues
love
contraception
access to healthcare
higher level communication negotiation skills
interpersonal skills
law and order
roads transport
food storage
food storage and transportation
education
larger quantities of food water
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Proportions of premature mortality attributable
to genetic predisposition, behavior, and
environment (social, physical, and health care).
Social circumstances15
Genetic predisposition 30
Physical environment5
Health care 10
Behavior 40
Source McGinnis JM, Russo PG, Knickman, JR.
Health Affairs, 21(2), April 2002.
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Epidemiology of COPD

• Previously more common in other countries than UK
• Over 3 million people in UK suffer from COPD
• Male mortality from COPD decreasing for 30 years
  while female mortality has been steadily rising
  for 30 years
• COPD responsible for 10 emergency admissions
• Emergency hospital admissions for exacerbations
  and home oxygen account for a large proportion of
  healthcare costs in the UK

13
Epidemiology of COPD

• COPD responsible for gt30,000 deaths in UK yearly
• COPD care costs NHS an estimated 500
  million/year (2001)
• 6th leading cause of adult deaths worldwide
• 80-90 of all COPD cases can be directly
  attributed to smoking

14
Groupwork

• Consider COPD
• What data (actual and tacit) do you have to
  determine where you are now?
• How do you source this data inside and outside
  your own organisation?
• How is information used in your patch?

15
Using data

• What has this confirmed for you?
• What might you do differently
• As an individual?
• As a team?