the ut system population health initiative

Population Health

March 29, 2016David Lakey, M.D.

Senior Vice President for Population HealthIsadore Roosth Distinguished ProfessorThe University of Texas Health Science Center Tyler

Chief Medical OfficerAssociate Vice Chancellor for Population HealthThe University of Texas System

What is Population Health? Confusing Terminology

• Public health• Community health • Healthcare• Health Services Research • Population health

– Population health management– Population medicine– Population health sciences

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Population Health • The health outcomes of a group of individuals, including

the distribution of such outcomes within the group. – These groups are often defined by geographic region, age, gender,

ethnic and racial background, disability, or other defining characteristic. • Concerns include

– the overall health of a population– the distribution and determinants of health and health disparities within

the population. • The population health perspective bridges the divide

between traditional public health and the medical care sectors to focus on improving the health outcomes throughout a community.

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Kindig, DA, Stoddart G. (2003). What is population health? American Journal of Public Health, 93, 366-369.

Overall State Health Rankings

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Source: America’s Health Rankings, United Health Foundation 2015 Annual Report

Core Measure ImpactShows the impacts of core measures on a state’s overall ranking

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Texas – 2015Overall Ranking

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Source: America’s Health Rankings, United Health Foundation 2015 Annual Report

Leading Causes of Death-Texas 2012

Chronic Liver Disease and Cirrhosis

Nephritis, Nephrotic Syndrome, Nephrosis

Septicemia

Diabetes Mellitus

Alzheimer's Disease

Accidents

Cerebrovascular Diseases

Chronic Lower Respiratory Diseases

Malignant Neoplasms

Diseases of the Heart

0.0 40.0 80.0 120.0 160.0 200.0

12.7

13.5

13.9

19.7

19.8

35.6

35.7

36.5

146.2

149.6

Deaths per 100,000 Population

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Data Source: Vital Statistics Unit, Center for Health Statistics, DSHS

Actual Causes of DeathShaped by Behavior

Sexual Behavior

Homicide

DWI

Suicide

Drugs

Auto Accidents

Alcohol

Overweight/Obesity

Tobacco

0 5000 10000 15000 20000 25000 30000

7Source: Chronic Disease in Texas 2007, DSHS

5 Leading Causes of Death for Males, number of deaths and rates

(numbers per 100,000), Texas 2010

Age Group 1-14 15-24 25-34 35-44 45-54 55-64 65-74 75+1 Accidents

(Injuries) 200 (7.3)

Accidents (Injuries) 844 (44.4)



Diseases of the Heart1,916 (112.5)

Malignant Neoplasms (Cancer) 4,264 (339.2)


Diseases of the Heart 9,989 (2,227.1)

2 Malignant Neoplasms (Cancer) 63 (2.3)

Intentional Self-Harm (Suicide) 332 (17.5)


Diseases of the Heart 579 (33.6)


Diseases of the Heart 3,596 (286.1)

Diseases of the Heart 3,833 (557.8)

Malignant Neoplasms (Cancer) 7,501 (1,672.4)

3 Assault (Homicide) 36 (1.3)

Assault (Homicide) 292 (15.4)

Assault (Homicide) 277 (15.2)

Malignant Neoplasms (Cancer) 420 (24.4)



Chronic lower Respiratory Diseases 1,136 (165.3)

Chronic lower Respiratory Diseases 2,549 (568.3)

4 Congenital Malformations 26 (0.9)




Chronic liver Disease & Cirrhosis 574 (33.7)

Chronic liver Disease & Cirrhosis 661 (52.6)

Cerebrovascular Disease (Stroke) 729 (106.1)

Cerebrovascular Disease (Stroke) 2,127 (474.2)

5 Diseases of the Heart 17 (0.6)



HIV 162 (9.4)


Diabetes Mellitus 569 (45.3)

Diabetes Mellitus 588 (85.6)

Alzheimer's Disease 1,445 (322.2)

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5 Leading Causes of Death for Females, number of deaths and rates

(numbers per 100,000), Texas 2010

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Annual potentially preventable deaths based on average death rates for the three states with the lowest rates for each cause

Potentially Preventable Deaths in Texas

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• http://www.americashealthrankings.org/reports/annual

The Health Impact PyramidA Framework for Public Health Action

14Source: Thomas Frieden, MD, MPH, American Journal of Public Health, 04/2010, Vol. 100, no. 4

Counselingand Education

Clinical Interventions

Long-lasting ProtectiveInterventions

Changing the Context to Make Individuals’ Default Decisions Healthy

Socioeconomic Factors

Increasing Individual Effort

Needed

Increasing Population Impact

Partnerships to Improve Health

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Currents Projects and Contracts

Texas Health Improvement Network

HB 3781 by Crownover/ Coleman/ Zerwas/ Ashby/ CollierSenate Sponsor Watson/ ZaffiriniSigned by Governor Abbott 6/19/2015

Purpose• 1) Establish a network of academic and health science

institutions whose mission is to improve the health and well-being of all Texans through the identification, evaluation, discovery, dissemination, and implementation of data-driven population health best practices.

• 2) The goals of the network are to reduce the per capita costs of health care, improve the individual experience of health care (including quality and patient satisfaction); and improve the health of Texans.

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THIN (HB 3781)

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THINStructure• Multi-disciplinary and multi-institutional• The network shall include faculty that represents not only the traditional

public health and medical fields, but also expertise on mental health, nursing, pharmacy, social work, health economics, health policy and law, epidemiology, biostatistics, health informatics, health services research, engineering and computer science.

• The network is administratively attached to the University of Texas System• External Advisory Committee

Funding • No direct state appropriation• The statute provides authority of the network to accept and administer gifts

and grants to fund the network from any individual, corporation, trust, or foundation or the United States, subject to limitations or conditions imposed by law.

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Texas Collaborative for Healthy Mothers and Babies

UT Health Northeast in partnership with UT System is providing support to the Texas Collaborative for Healthy Mothers and Babies (TCHMB).

Over 150 healthcare providers, scientists, hospitals, state agencies, advocates and insurers will:

• design projects, • collect research data,• develop strategies, and• evaluation plans to improve birth outcomes in Texas

Contract with the Texas Department of State Health Services – 3 Years

Texas Collaborative for Healthy Mothers and Babies

Support functions for the collaborative include:– Establish a TCHMB website – Organize effective coalition meetings– Provide a comprehensive evaluations of the research

findings– Coordinate and collaborate on publishing findings in

peer-reviewed scientific journals– Manage the project– House and analyze the TCHMB data – Assess the data quality– Produce evaluation and health outcome reports

Safe Babies

UT Health Northeast in partnership with UT System will evaluate hospital-based interventions that are designed to prevent abuse, especially abusive head trauma, in the first year after birth.

Contract with the Department of Family Protective Services - 5 years

Safe Babies

Three main projects that will be implemented in the first two and half years of funding:1. Population-level investigation of whether there has

been a change in infant abuse rates among those infants born at hospitals using the Periods of PURPLE Crying intervention.

2. Randomized control trial evaluating the PURPLE intervention with fathers.

3. Evaluate value added effects of several prevention designed to reduce maltreatment in infancy.

UT Collaborative for Population Health Innovation and Improvement (UT-CoPHII)• Consortium of UT Health Institutions

representatives to identify community, regional, and system-wide needs and priorities through a population health strategic plan.

• Collaboration of the UT Health institutions to address the identified priorities and needs.

UT-CoPHII

Year 1:• Each health institution develops their

population health strategic plan. – The strategic plan will address specific risk

factors that relate to multiple health areas, specifically obesity, tobacco, and behavioral health (including mental health).

Components of Strategic Plan• Catchment area • Data on health of the population (health outcomes) and health

disparities• Community needs and priorities assessment• Identified resources in the community• Identify health priorities• Availability and gaps in technology and infrastructure to support

population health at the health institution• Identified availability and gaps in the population health workforce at

the health institution• Assessment of additional needs • Plan and strategy to implement population health• Environmental Impact Assessment

UT-CoPHII

Year 2:• Implementation of the health strategy with

the identified health priority. • Collaboration by health institutions on

common health priorities. • Develop UT System Population Health

Strategic Plan

Behavioral HealthMeeting of the Chairs of the Psychiatry Department at the UT Health Institutions, non-UT Institutions*, local and state health department representatives

Goals:1. Learn from one another2. Coordination with Community Mental Health3. Coordination with State Hospitals4. Research collaboration opportunities

* Texas Tech, UNT, and TX A&M

UT Eliminate Tobacco Use

Representatives from each of UT System’s 14 institutions met On February 22-23, 2016 at an “Eliminate Tobacco Use Summit” to discuss creating a system-wide tobacco-free culture.

Summit participants collectively shared:• tobacco control policies• public education and prevention programs• cessation services

UT Eliminate Tobacco Use

• Representatives developed their own comprehensive plans to bring back to their institutional campus leadership.

• By inventorying available resources, UT System academic and health institutions identified areas to take collective action toward measurable reductions in the tobacco burden in Texas.

• The UT institutions will continue to convene and work together on addressing tobacco policies, prevention and cessation.

Data Systems

Large Data Systems

1. Use of Public Use Data Sets to identify needs2. Population Health Data (with required DUAs and

IRB):a. Vital Statistics (Births, Deaths)b. Hospital Discharge Datac. Child Protective Services Administrative Data

3. Research Survey Data a. Pregnancy Risk Assessment Monitoring Survey

(PRAMS)b. Behavioral Risk Factor Surveillance System (BRFSS)c. School Physical Activity and Nutrition (SPAN)

Linking across population data: Example

(1) Identify babies born at hospitals using universal prevention program

(2) Identify if any babies born at target hospitals were involved in CPS before third birth day

(3) Identify if any babies born had been hospitalized anywhere in the state with head injuries before third birthday

From linked set: what is the rate of maltreatment? Did this rate change after implementing universal prevention program?

CPS Data

Hospital Discharge

Data

Birth Data(1)

(2)

(3)

Infrastructure and Software Solutions

UT System Population Health Office plans several ‘big data’ projects leveraging the computing power of UT Austin’s Texas Advanced Computing Center (TACC)

Secure web application for building and managing online surveys and databases.

UT System is currently building the infrastructure to house, receive and process these large data sets

Population Health Services

Expertise within the Population Health at UT System

• Public health needs, issues and initiatives• Community health assessments• Strategic Health Plans• Expertise with public health data systems• Health analytics• Research design• Publications• Grant proposals and management

UT System Population Health Services

• At costs services• Employ graduate students to:

– leverage resources– promote population health with students– train next generation of health professionals

• Identify expertise in the health field• Incorporate UT and non-UT academic institution

support• Collaboration and partnership with health state

and local agencies

• Nagla Elerian, MS, Senior Program Manager for Population Health• Jay Morrow, DVM, MPH, Director, Texas Health Improvement Network

(THIN)• Eileen Nehme, PhD, Assistant Professor for Population Health and THIN• Ella Puga, MPH, Program Manager for TCHMBC• Dorothy Mandell, PhD, Assistant Professor for TCHMBC and Safe

Babies• Divya Patel, PhD, Assistant Professor for TCHMBC• Lark Needham, Administrative Specialist for Population Health

Population Health Team

Conclusions• Texas faces many health and heath care challenges

– This is very costly to the nation, Texas, communities and individuals

• To improve health and decrease healthcare costs in Texas we must:– Understand health outcomes are driven by more than just

clinical care– Focus on:

• Prevention• Triple Aim• Base of the “Health Impact Pyramid”• Health Priorities of Texas• Disparities

– Develop and use Evidence Based Programs / data driven decision making

– Work with multidisciplinary partnerships44

Improving the Health of Texans

QUESTIONS?

Measures That Achieved Benchmarks

• Top 3 are Vaccine related• Adult hospital patients communication on

medications they received in the hospital• Use of ACE inhibitors at hospitals discharge • Blood cultures for pneumonia patients before

antibiotics• Hospitalized patients with pneumonia who

received appropriate antibiotics• Breast cancer diagnosed at advanced stage

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Measures Far From Benchmarks

– Ability to access care a soon as wanted– Avoidable admissions for bacterial pneumonia– Infant mortality birthweights 1,500-2,499

grams– Smokers advised to stop smoking from their

physicians– New AIDs cases– Hospital admissions for uncontrolled diabetes

without complications

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Health Priorities For Texas Prevention • Prematurity / Infant

Mortality• Chronic Diseases

– Obesity and Diabetes– Heart Disease

• Cancer • Infectious Diseases

– Vaccine Preventable Diseases

– HIV / AIDS– Emerging Infectious

Diseases• Injury Prevention

Access to Care • Women’s health• Mental Health

– Improve Community Services

– Replace and Increasing Inpatient Capacity

• Substance Abuse• In general through

waivers• Increasing healthcare

quality

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Population Health Goals Population health strategic plans Community health needs assessments Data driven health priorities and priority populations Collaboration with experts to address priorities and needs:

Health Experts Multi-disciplinary Multi-institutional

Inventory related to specific health area: Resources Organizations

Implementation and evaluation of health initiatives Identifying both philanthropic and grant funding Graduate students:

assist in these functions develop and train workforce

Services Provided by Population Health at UT System

1. Consultation on population health projects 2. Consultation and coordination on population health strategic plans3. Consultation and coordination on community health assessments 4. Population/public health research design5. Population Health data analysis and reports6. Research and evaluation of evidence based practices7. Assistance, coordination and collaboration on population health

grants8. Coordination and assembly of legislative evaluation and research

reports9. Assembly, coordination, and facilitation for collaborations on

health issues and initiatives

the ut system population health initiative

Documents