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How U.S. children's hospitals define population health: a qualitative, interview-based study
Daniel Skinner1, Berkeley Franz2, Matthew Taylor3
1Heritage College of Osteopathic Medicine, Department of Social Medicine, Ohio University, 6775 Bobcat Way, MEB1-452, Dublin, OH, 43016, USA.
Insights
Children's hospitals define population health broadly, encompassing both public health and population health management. Ongoing debates highlight the need for clearer definitions to effectively address social determinants of health.
Area of Science:
- Healthcare Management
- Public Health Initiatives
- Pediatric Health Services
Background:
- Adult hospitals are implementing population health programs, yet definitions remain ambiguous, distinguishing between social determinants of health and patient population management.
- U.S. children's hospitals also engage in population health initiatives, but their specific definitions and approaches are less understood.
- Existing literature indicates a lack of consensus on the scope and objectives of population health programs within healthcare institutions.
Purpose of the Study:
- To investigate how U.S. children's hospitals define population health.
- To understand how these institutions are adapting to emerging preventive healthcare models.
- To explore the definitional nuances and strategic focus of population health efforts in pediatric settings.
Main Methods:
- Conducted semi-structured interviews with key stakeholders at ten leading children's hospitals.
- Utilized a semi-structured interview guide to gather in-depth insights.
- Analyzed verbatim interview notes using Dedoose software with a modified constructivist grounded theory approach.
Main Results:
- Children's hospitals employ diverse strategies that integrate population health management and public health principles.
- Evidence indicates active deliberation within children's hospitals regarding the definition and primary focus of population health.
- Innovators in population health demonstrate varied approaches, reflecting the dynamic nature of the field.
Conclusions:
- Definitional ambiguity persists even among children's hospitals heavily invested in population health.
- Clarifying the conceptual distinctions between population health and population health management is crucial for distinct long-term healthcare visions.
- Agreement on population health definitions is essential for evaluating the impact of social determinants of health interventions on population well-being.
Background:
The literature suggests that although adult hospitals are establishing population health programs around the country, there is considerable definitional ambiguity regarding whether interventions are aimed at the social determinants of health or the management of existing patient populations. U.S. children's hospitals also undertake population health programs, but less is known about how they define population health. The purpose of this study is to understand how U.S. children's hospitals define population health, and how institutions are adjusting to new preventive health care models.
Methods:
We conducted semi-structured interviews with key stakeholders at ten hospitals with the highest amount of staff time dedicated to population health activities as reported in the 2016 Children's Hospital Association's population health survey. Using a semi-structured interview guide, we interviewed representatives from each hospital. Verbatim interview notes were coded and analyzed using the data analysis software Dedoose. Data analysis followed a modified constructivist grounded theory approach.
Results:
Our results suggest that even population health innovators employ a variety of approaches that span both population health management and public health. We present further evidence that U.S. children's hospitals are actively debating the definition and focus of population health.
Conclusions:
Definitional debates are ongoing even within children's hospitals that are dedicating significant resources to population health. Increased clarity on the conceptual boundaries between population health and population health management could help preserve the theoretical differences between the two concepts, especially insofar as they mark two quite different long-term visions for health care. Without agreement about the meaning of population health within and among institutions, hospitals will not be able to know whether projects aimed at addressing the social determinants of health are likely to improve the health of populations.