How to successfully implement population health management: a scoping review

Qualitative study of UK health and care professionals to determine resources and processes that can support actions to improve quality of data used to address and monitor health inequalities

INTRODUCTION

Health inequalities in the UK are investigated and addressed by analysing data across socioeconomic factors, geography and specific characteristics, including those protected under law. It is acknowledged that the quality of data underpinning these analyses can be improved. The objective of this work was to gain insights from professionals working across the health and care sector in England into the type(s) of resource(s) that can be instrumental in implementing mechanisms to improve data quality into practice.

DESIGN

Qualitative study based on semistructured interviews involving health and care professionals.

SETTING

England.

PARTICIPANTS

A total of 16 professionals, mainly from the East of England.

RESULTS

Awareness of mechanisms that could be put in place to improve quality of data related to health inequalities was high among interviewees. However, logistical (eg, workforce time, capacity and funding) as well as data usage (eg, differences in data granularity, information governance structures) barriers impacted on implementation of many mechanisms. Participants also acknowledged that concepts and priorities around health inequalities can vary across the system. While there are resources already available that can aid in improving data quality, finding them and ensuring they are suited to needs was time-consuming. Our analysis indicates that resources to support the creation of a shared understanding of what health inequalities are and share knowledge of specific initiatives to improve data quality between systems, organisations and individuals are useful.

CONCLUSIONS

Different resources are needed to support actions to improve quality of data used to investigate heath inequalities. These include those aimed at raising awareness about mechanisms to improve data quality as well as those addressing system-level issues that impact on implementation. The findings of this work provide insights into actionable steps local health and care services can take to improve the quality of data used to address health inequalities.

Assessing the Strengths and Weaknesses for Implementing a Place-Based Model of Care for Older People on the Central Coast, Australia: Results of a Pilot Project Using the Population Health Management Maturity Index (PHM-MI) Tool

Introduction

Population health management is increasingly being used to support place-based models of care. This case study provides an account of the use of the Population Health Management - Maturity Index (PHM-MI) tool to inform the future development of a neighbourhood model of care for older people in the Central Coast region of Australia.

Description

The PHM-MI tool comprises a set of six evidence-informed elements known to be important in enabling PHM in practice. As part of a joint strategic needs assessment, 17 selected stakeholders from key regional organizations were invited to undertake the PHM-MI tool survey. Three follow-up workshops were held to interpret the results and determine priority actions.

Discussion

The PHM-MI scores revealed that the overall maturity of the Central Coast to successfully deliver PHM was low across all six elements, findings that were corroborated through participant workshops. Systemic fragmentations, most pertinently of funding and regulation, incentivised silo-based working. The need to formalise and strengthen regional collaborations, enable data integration, find creative ways to use existing funding streams, and promote community engagement were highlighted as core priorities.

Conclusion

Using the PHM-MI tool was enabled by it being embedded within a pre-existing regional strategic process. The results were used to inform future regional priorities. The PHM-MI tool has the potential for use across regional or national contexts.

Assembling a population health management maturity index using a Delphi method

BACKGROUND

Although local initiatives commonly express a wish to improve population health and wellbeing using a population health management (PHM) approach, implementation is challenging and existing tools have either a narrow focus or lack transparency. This has created demand for practice-oriented guidance concerning the introduction and requirements of PHM.

METHODS

Existing knowledge from scientific literature was combined with expert opinion obtained using an adjusted RAND UCLA appropriateness method, which consisted of six Dutch panels in three Delphi rounds, followed by two rounds of validation by an international panel.

RESULTS

The Dutch panels identified 36 items relevant to PHM, in addition to the 97 items across six elements of PHM derived from scientific literature. Of these 133 items, 101 were considered important and 32 ambiguous. The international panel awarded similar scores for 128 of 133 items, with only 5 items remaining unvalidated. Combining literature and expert opinion gave extra weight and validity to the items.

DISCUSSION

In developing a maturity index to help assess the use and progress of PHM in health regions, input from experts counterbalanced a previous skewedness of item distribution across the PHM elements and the Rainbow Model of Integrated Care (RMIC). Participant expertise also improved our understanding of successful PHM implementation, as well as how the six PHM elements are best constituted in a first iteration of a maturity index. Limitations included the number of participants in some panels and ambiguity of language. Further development should focus on item clarity, adoption in practice and item interconnectedness.

CONCLUSION

By employing scientific literature enriched with expert opinion, this study provides new insight for both science and practice concerning the composition of PHM elements that influence PHM implementation. This will help guide practices in their quest to implement PHM.

From Health-in-All-Policies to Climate-in-All-Policies: Using the Synergies between Health Promotion and Climate Protection to Take Action

The climate crisis is developing into a life-changing event on a global level. Health promotion with the aim to increase the health status of individuals, independent of the present health status, has been developed on a scientific basis at least for the last eight decades. There are some basic principles which are prerequisites for both health promotion and climate protection. Those principles include (1) sustainability, (2) orientation on determinants, and (3) requirement of individual as well as community approaches. People are generally aiming to protect their lifestyle habits (e.g., traveling and consumer habits) and personal property (e.g., car and house) with easy solutions and as little effort as possible, and this can affect both health and climate. To reduce the emission of greenhouse gases and to protect our environment, changes towards a sustainable lifestyle have to be embedded into everybody's mind. Examples for domains that need to be addressed in health promotion as well as in climate protection include (health and climate) literacy, physical activity and active mobility, and nutrition and dietary habits. If health promotion fails to tackle those domains, this will continue to drive the climate crisis. And climate change, in turn, will affect health. On the other hand, developing and promoting health resources in the domains mentioned could help to mitigate the health-damaging effects of climate change. Success in the joint efforts to promote health and protect the climate would improve the One Health approach, the health of people and the environment.