Population health management: Taking a broader look

By Mark Thill

Population health management is the future of healthcare. At least that’s what experts tell us. And I believe it’s true. A speaker I saw at the recent IMDA conference for specialty distributors made the point that the 19th Century saw the fight against infection; the 20th Century the fight against acute conditions (heart attack, stroke). And the battleground for the 21st Century? Chronic conditions.

When I hear the phrase “chronic conditions,” I think about things like diabetes, chronic obstructive pulmonary disease, obesity, and even some behavioral things, such as cigarette smoking. But a recent publication – “Hospital Approaches to Interrupt the Cycle of Violence.” – issued by the American Hospital Association, Health Research & Educational Trust, and the Association for Community Health Improvement, forced me to broaden my thinking on the subject.

Reading the paper and watching the news every day, I can’t escape reading stories about kids getting shot while sitting in their living room or even in their mother’s arms. Drive-by shootings. Domestic violence. Sexual violence. Armed robbery. We read so much about violence, we come to believe it is an intractable fact of life.

Some hospitals and IDNs are thinking differently. They acknowledge that violence is deep-seated, but they are choosing to view it as a community health problem, one which they can – and should – address. And why not? As the authors of the report point out, violence prevention is aligned with:

  • Hospital mission statements to improve the health of individuals and communities.
  • Community benefit commitments for not-for-profit hospitals to improve the health of communities and increase access to care.
  • Community health needs assessments that have identified violence prevention as a priority need.
  • Opportunities to reduce hospital recidivism for repeated violent injuries, thereby improving health and reducing costs.

For better or worse, hospitals are a prime location for violence to be addressed. As the location where many victims of violence seek medical treatment, “[h]ospitals are uniquely positioned to excel at secondary prevention by providing trauma-informed care to capitalize on the ‘second golden window,’ when victims of violence may be most likely to make changes in order to prevent a repeated violent injury,” according to the authors.

It calls for long-term thinking, hard work, and partnering with community stakeholders. But some providers are moving forward…with success. Evidence shows that hospital-based violence intervention programs reduce violence, save lives and decrease healthcare costs, according to the report. Four programs are offered as case studies:

  • University of Maryland Medical Center’s ShockTrauma Center, which pioneered a hospital-based violence intervention program to provide social and medical assistance to victims of violence.
  • Children’s Hospital of Philadelphia, which applied evidence-based violence prevention programs to design a comprehensive, multilevel approach to preventing violence and rehabilitating victims.
  • Children’s Hospital of Wisconsin, which partners closely with community stakeholders to provide home-based services and co-locates medical services with social and legal services.
  • Cincinnati Children’s Hospital, which is addressing poverty – a root cause of violence – by investing in and buying produce from an urban farming company that employs individuals who have been involved with the criminal justice system.

I can’t really say how supply chain fits into all this. (Maybe some of you can weigh in on this point.) Preventing violence in the community seems far away from contracting, logistics, and the like. Still, it does seem appropriate that violence prevention take its place as a core hospital mission.

Readers can view the document “Hospital Approaches to Interrupt the Cycle of Violence” at www.hpoe.org/resources/hpoehretaha-guides/1824.

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