Criterion 27-28: Getting Started with Population Health
Steve Singer, ACCME Vice President for Education and Outreach, interviews Carolyn Lopez, MD, President, Chicago Board of Health, about how CME professionals can begin to address population health issues with CME.
>>SINGER: Hello, my name is Steve Singer, I'm the Vice President for Education and Outreach at the Accreditation Council for Continuing Medical Education. Today, we're going to talk with Dr. Caroline Lopez who is the president of the Chicago Board of Health and we're going to talk about addressing population health issues with CME.
>>LOPEZ: Good morning.
>>SINGER: Thanks for joining us today.
>>LOPEZ: My pleasure.
>>SINGER: So what I would like to do now is to take a rather specific approach to try to prepare the CME professional who is trying to meet our new accreditation with commendation criteria, and in those new requirements that we have, there are a group of requirements focused on moving the needle for population health. And two of those requirements, one; rewards providers for addressing factors beyond clinical care that impact on population health; things like social factors, healthy behaviors, the environmental things that you talked about. But the other is about collaboration and working with other entities, other organizations, to do the same. So to make this personal, what I would like to do since I'm a CME professional in a way and you're a public health professional is I'd like to sort of get inside your head a little bit about what are the ways in which you approach defining the problems that you as a public health professional are trying to solve and then how would you look at... What's the problem that the CME professional could help you address?
>>LOPEZ: Sure. There are actually two strategies that as a clinician may be used in order to make the determination. And I say two that don't involve the physician doing their own personal survey of this.
>>LOPEZ: One is looking at the local health department, because the local health department is required to come up with a plan to make an assessment of what's happening in their communities. What are the needs, what are the problems that they're seeing that are creating issues for their communities? And then coming up with a plan to begin to address those kinds of issues.
>>SINGER: So they publish a plan?
>>LOPEZ: They do publish a plan...
>>LOPEZ: In Chicago, we have published Healthy Chicago 2.0. It's Healthy Chicago 2.0 because it is the second major plan. The initial one that was published four years ago had well-defined metrics and it included things like reducing food deserts in Chicago and a number of other milestones- reducing youth smoking, things of that sort. And so that's part of what drove many of these efforts that the department took over the years. We now have a new plan that is available online, and it's really open to anyone from any part of the country who may want to take a look at it, and just get an idea of what kinds of things are undertaken, and that can begin to form the basis of a dialogue that people have with their local health department.
I think too often local health departments and individual providers, practitioners are from a distance and they don't talk to each other often enough from the provider's perspective, from the doctor's perspective, too often. And it's the nuisance of forms that I have to complete that I don't have time for in my very busy day. And from the public health provider's perspective, it's not really having the on the ground information that could be very useful for identifying early warnings of outbreaks, for example.
>>SINGER: Now, let me just sort of scratch at that a little bit.
>>SINGER: So when you said not having the on the ground information, are you saying that the individual clinician won't have that, or...
>>LOPEZ: I'm saying the public health, that the individual clinician will have information that, again, because they're paying attention appropriately to what's going on with the individual patients, they may notice that, gosh, they've seen a couple of people with similar types of symptoms over the course of the day or the week. The public health department doesn't notice that. Unbeknownst to both, this physician is seeing a few patients with those symptoms. A couple of streets away there's another physician who's seeing similar patients with similar complaints, and they're different patients, and the health department still doesn't know about it. And that's the first outbreak of whatever...
>>LOPEZ: Something. So there's this information gap that if they worked a little more closely together, had a way of easily linking in patterns of communication without overburdening, because I understand that offices are overburdened with a lot of work that everybody's asking to be done. So finding a way of doing that and at the same time, the public health department can provide, might be able to provide, information back that says, "Here's what's happening so now be on the lookout for." The other source of information though for these kinds of things that may feel more comfortable to access is the hospitals, because hospitals are required to do community needs assessments. So they themselves for the people who are utilizing their services, they're required to find out more about what's happening, what are the patterns that they're seeing, and they're also being asked to, "Okay, now you've determined that you're seeing a lot of patients with uncontrolled diabetes, a lot of seniors who are coming in and out for problems with congestive heart failure," whatever those issues are that they're seeing patterns of, that they develop a plan to address those problems.
>>SINGER: Within the hospital?
>>LOPEZ: Within the hospital and within the group of physicians who are utilizing their hospital. So this is I think another easy opportunity, first of all, for making sure that anybody who's taking care of patients knows that there are two sources of information that may provide an opportunity, number one, and then building the bridge in terms of how you work with them. I would hazard a guess that many physicians who are working in the hospitals don't necessarily know what is going on with their own hospital's community needs assessment, although they are required to publish it on their website as well. Okay? And for physicians who may be practicing within a hospital or making referrals to the hospital, again, are they seeing the opportunities that may be available for helping their population of patients by working more closely with the hospital on figuring something out, and that something can be a variety of things, better communication, working on the handoffs with so many doctors not seeing their own patients in the hospital but the use of hospitalists instead.
Sometimes those handoffs become tricky. The more complicated the patient, the trickier the handoff is. And so patients get confused, easily lost in the shuffle and even people that you wouldn't expect to have problems are having problems. And I'm talking for patients are having problems with, first, hearing and understanding everything that's been told to them by the very many by people that they're seeing, and understanding where it fits in their overall care.
>>SINGER: So, you've laid out two different opportunities, both one that is sort of a central public, or almost government, or city, or community-based publication of a plan. You've talked about the hospital or community hospital's responsibility to do its own needs assessment of population health issues, so that those are two areas of resource for physicians and CME professionals to plug in. And then you mentioned several specific examples of practice gaps, whether it's sort of a big gap of, I'm a community physician but I'm not aware of what's happening in my community. So some very specific issues having to do with handoff that are I'm sure frustrated or complicated by population health issues. So, this is great and what I'd like to do is I want to bring you close to this conversation and then I would like to do a second video where we'll talk a little bit more about the relationship between CME content and public health content and the way that public health issues are crosscutting and impact on care provided in the hospital. The other thing I'd like to understand is the way that different kinds of CME providers because not everyone is providing CME through a clinical environment might be able to have a part in advancing population health. So thank you very much.
>>LOPEZ: You're welcome.