The Health Systems Administration program at Georgetown has its students complete case projects for a fictional community, Middleboro. Throughout the program we created several deliverables: Community Profile, Community Health Assessment, Strategic Plan, Marketing Plan, and Business Plan.
2. POPULATION HEALTH
 Concerns the health outcomes of a group of
individuals including the distribution of such
outcomes within the group (Kindig and Stoddart)
 Objective: to describe, explain, predict, control
3. HEALTH INDICATORS
 A limited yet comprehensive set of coherent and
significant indicators that can be monitored over
time and disaggregated to relevant social units
(Stoto)
 Intended to help everyone more easily
understand the importance of health promotion
and disease prevention and to encourage wide
participation in improving health in the next
decade (Healthy People 2010)
4. SUSA HEALTH INDICATORS FRAMEWORK
Social and Physical
Environment
Health-Related Health
Behaviors Outcomes
Health Systems
5. HILLSBORO’S HEALTH STATUS
 Comparatively similar health status as other
communities
 Within the community, chronic disease
prevalence is an issue:
ď‚— Cardiovascular health
ď‚— Malignant neoplasm
6. HILLSBORO MORTALITY RATES
Comparative Mortality Rates
30
Rate per 10,000 People
20
10
0
Hillsboro County Capital City USA
7. HILLSBORO COUNTY
Hillsboro County Cause Adjusted Mortality
40
Cause of Death Rate per 100 Deaths
35
30
25
20
15
10
5
0
8. SUSA HEALTH INDICATORS FRAMEWORK
Social and Physical
Social and Physical
Environment
Environment
Health-Related Health
Behaviors Outcomes
Health Systems
9. SOCIAL AND PHYSICAL ENVIRONMENT
 Key indicators as they relate to chronic disease
ď‚— Demographics
 Age
 Population
 Employment market
10. AGE ADJUSTED MORTALITY
RATE
Age Adjusted Mortality Rate
40
Rate per 1,000 People (65+ years)
30
20
10
0
Hillsboro County Capital City
11. POPULATION TRENDS
Hillsboro County Population Comparison
Population Trends 200000
50000
180000
40000
30000 160000
People
People
20000
140000
10000
120000
0
CY-25 CY-20 CY-15 CY-10 CY-5 CY
100000
Middleboro Jasper Harris City
CY-25 CY-20 CY-15 CY-10 CY-5 CY
Statesville Mifflenville Carterville
Minortown Boalsburg Hillsboro County Population Capital City
12. EMPLOYMENT TRENDS
Employment Trends
60
45
Percentage of Population
30
15
0
Hillsboro County Capital City State Wide
13. SUSA HEALTH INDICATORS FRAMEWORK
Social and Physical
Environment
Health-Related Health
Behaviors Outcomes
Health Systems
Health Systems
14. HEALTH SYSTEMS
 Access and coverage as they relate to chronic
disease
ď‚— Health Insurance
ď‚— Readmission Rates
15. INSURANCE PROVIDER TRENDS
Insurance Provider 25 Year Trend
60
50
Percentage of Population
40
30
20
10
0
CY-25 Cy-20 CY-15 CY-10 CY-5 CY
No Insurance Medicare Medicaid Blue Cross/Blue Shield Commercial Other- VA, etc
16. READMISSION RATES
Readmissions
20
15
Percentage of Discharges
10
5
0
Within 7 Days Within 15 Days Within 30 Days
Hillsboro Capital City
17. INFANT MORTALITY
Infant Mortality
8
6
Rate Per 1,000
4
2
0
Hillsboro County Capital City United States
18. SUSA HEALTH INDICATORS FRAMEWORK
Social and Physical
Environment
Health-Related
Health Related Health
Behaviors
Behaviors Outcomes
Health Systems
20. CARDIOVASCULAR HEALTH
Comparative Mortality
Internal Death Rate
Heart Related Mortality Heart Related
35
Death Rates Heart
30 Related
35%
25
Rate per 10,000
20
15
Other
10
Causes
65%
5
0
Hillsboro County Capital City USA
21. CHOLESTEROL AWARENESS
Cholesterol Awareness
80
70
60
Percent of Adult Population
50
40
30
20
10
0
Cholesterol Checked (Within Last 5 Years) High Cholesterol (Ever)
Hillsboro County Capital City State Wide
22. HYPERTENSION AWARENESS
Hypertension Prevalence
40
30
Percentage of Adult Population
20
10
0
Hillsboro County Capital City State Wide
23. BMI DEMOGRAPHICS
BMI Demographics
60
Percentage of Adult Population
40
20
0
Neither Overweight or Obese Overweight (BMI 25.0-29.9) Obese (BMI 30.0-99.8)
(BMI < 24.8)
Hillsboro County Capital City State Wide
24. MALIGNANT NEOPLASMS
Comparative Mortality
Internal Death Rate
Malignant Neoplasms Proportion of
Mortality Rate Malignant Neoplasms
20 Deaths
Malignant
Neoplasms
15 20%
Rate Per 10,000
10
Other
Causes
80%
5
0
Hillsboro County Capital City USA
25. SUBSTANCE ABUSE - TOBACCO
Smoking Status
30
Percent of Adult Population
25
20
15
10
5
0
Everyday Some Days Former Smoker
Hillsboro County Capital City State
26. EMPLOYMENT RELATED FACTORS
Middleboro Employment Sectors
Manufacturing Agriculture Other Industries
30%
51%
19%
27. POSITIVE HEALTH FACTORS
 Hillsboro appears to be succeeding in some areas as
related to chronic diseases:
ď‚— Exercise
ď‚— Fruits and vegetables
ď‚— Managed care penetration
28. EXERCISE
Exercise
80
Percentage of Adult Population
60
40
20
0
Any Physical Activity (Within Last Month) Cardiovascular Exercise
Hillsboro County Capital City State Wide
29. FRUITS AND VEGETABLES
Fruit and Vegetable Consumption
40
30
Percentage of Adult Population
20
10
0
Consume 5+ Servings per Day
Hillsboro County Capital City State Wide
30. MANAGED CARE PENETRATION
25-Year Trend Insurance Types
100
90
80
Percentage of Insured Population
70
60
50
40
30
20
10
0
CY-25 CY-20 CY-15 CY-10 CY-5 CY
FFS Managed Care
31. CONCLUSION
 Overall, similar health outcomes as other
communities
 But, chronic disease is an issue
ď‚— Cholesterol, Hypertension, Tobacco usage
ď‚— Access to care: declining health insurance coverage
 Moving forward,
ď‚— Continue positive trends: exercise, healthy
foods, managed care penetration
ď‚— Implement prevention & health promotion
programs, improved coordination of care, expand
insurance coverage
Hinweis der Redaktion
Defining population health: concerns the health outcomes of a group of individuals, including the distribution of such outcomes within the groupObjectives of population health studies: describe, explain, predict, control.Describe the state of health of the population and identify prevalent health problemsExplain why the state of health is the way it is and why certain health problems occurPredict health effects and strategies for risk avoidancePrevent disease and promote healthWhen we can describe, explain, predict, and control the health of a population, we can answer why why some people are healthier than others
Conceptual framework to think about why some people are healthier than others
For HC, comparable to other places (Capital City and the US).
Comparatively across HC, CC, USA (HC is healthy)Objective: show that HC is relatively the same- no major outliers, Overall HC is comparatively healthy compared to Capital City and the USA, mortality rates are similarBut within population when comparing mortality rates in total, more people are dying from chronic diseases such as heart disease, followed by cancer and then stroke
HC internally (HC is doing poorly in chronic diseases)Within HC internally, clear distinction that chronic diseases are a major problem. The 3 leading causes of death (other than other) are related to chronic disease. as you can see heart disease, and MN (eg cancer), and stroke are the primary causes of death. In this community health profile we are going to be discussing heart disease and cancer in further detail.If you want to talk about “other causes” just mention that while they do make up a significant portion of the death rate as we don’t know what they specifically are we can’t make any community health related conclusions regarding them.The health indicator framework will be applied as applicable to chronic diseases to describe, explain, predict, control
Conceptual framework to think about why some people are healthier than others
Relatively speaking, HC has a similar mortality rate to nearby CC . This suggests that the overall health of the population is comparable to other populations. Age does not appear to be a contributing factor to the chronic disease issue.
As you can see the populations of the towns in Hillsboro County are relatively stagnant. The exception is Jasper which has had a population which is steadily growing.Population is not increasing in HC, so is not significant factor contributing to chronic disease issuePopulation trend doesn’t relate to chronic diseaseThis is a point to keep in mind for when we discuss health systems
While there are relatively the same amount of people employed in HC as CC/State
Conceptual framework to think about why some people are healthier than others
-no insurance coverage is high (spiked 5 years ago) in the community (as seen in the red line) -no health insurance – no access to needed health coverage, which has negative impact on chronic disease in the community
-for those with health insurance, the health system appears to be serving them relatively well (people not coming back as much – hospitals achieving the right outcomes)-also, the observed slightly higher readmission rate within 30 days may suggest that the population is experiencing problems with chronic disease
-for those with health insurance, the health system appears to be serving them relatively well-health insurance coverage is low, but for those with, the health delivery system seem to be fine
Conceptual framework to think about why some people are healthier than others
Compared to Capital City and the US, HC has the worst mortality rates in cardiovascular health and cancer (leading causes of death for HC)
HC has higher heart disease mortality rate than both Capital City and the U.S.Currently within HC, 35% of population is dying from diseases of the heart
First behavior under cardiovascular health – cholesterol awarenessMeasured people who’ve had their cholesterol checked within the last five years (not so many people), cholesterol checked, and those who do have high cholesterol (we have most ppl who have cholesterol compared to CC and state wise)
Hypertension can lead to cardiovascular diseaseHC has the highest hypertension prevalence compared to CC and StateGraph: people who know they have high blood pressure (prevelance)
-so, obesity may not be significant contributing factor to chronic diseases… but further research needed (for example age-adjusted)-for those that have high BMI, may be factor in prevalence/incidence of chronic disease
HC has comparatively similar mortality rates to CC and USA. However, internally shows that cancer is the second leading cause of death20% of population with HC has died from cancer
- HCis the worst in smoking compared to CC and the State, higher proportion of smokers everyday in HC = correlates to less former smokers in HC-smoking contributes to high rate of chronic disease, specifically cancer
-because sizable percentage of population is employed in blue-collar sectors (agriculture and manufacturing) there may be a higher chance of exposure to factors that contribute to chronic disease conditions such as poor cardiovascular health and cancer. In manufacturing this might be: in agriculture this might be: pollutants – factors in cancer, according to a Johns Hopkins study from 1994 published by the American Journal of Epidemiology. http://aje.oxfordjournals.org/cgi/content/abstract/139/11/1055
Positive parts of health
-indicates type of health insurance has changed – fee for service to managed care-this is a positive trend because managed care seeks to better manage chronic disease-as trend continues, we expect improved outcomes with respect to chronic disease