Populations II Unit Exam

Population-Level Data in Health Care Management

• Informatics is gathering, manipulating, storing, retrieving, and classifying recorded information.
  • Public Health Informatics (PHI) focuses on using information science and technology to promote population health rather than individual health.
  • PHI's goal is disease prevention to avoid disease spread rather than treatment.
• PHI operates at the governmental level, such as WHO, CDC, or Maricopa County.
• Large datasets are analyzed to improve patient outcomes, optimize resource allocation, and support evidence-based decision-making.
• Public health informatics (PHI) uses information, computer science, and technology in public health areas like surveillance, prevention, preparedness, and health promotion.
  • Its main applications are promoting health of the whole population to promote individual health and preventing injuries/diseases by changing population risk factors.
  • PHI uses informatics in public health data collection, analysis, and actions.
  • Disease prevention focus, interventions variety, and governmental settings differentiate PHI from other informatics fields.

Disease Surveillance & Public Health Monitoring

• Tracking flu outbreaks using electronic health records (EHRs) and syndromic surveillance systems.
• Monitoring chronic disease prevalence via national health databases.
• Using real-time data to detect and respond to emerging infections, like COVID-19 dashboards.

Social Determinants of Health (SDOH) Analysis

• Analyzing food insecurity and transportation barriers that impact patient access to care.
• Higher rates of preventable hospitalizations are pinpointed that are due to socioeconomic factors.
• Mapping disparities in vaccination rates relative to income and education levels.

Healthcare Utilization & Cost Analysis

• Examination of trends in emergency department (ED) visits for non-urgent conditions.
• Weighing effects of telehealth expansion on reducing in-person visit burdens.
• Medication adherence and its cost implications are assessed using claims data.

Health Information Technology

• Health information technology (HIT) uses electronic systems to store, share, and analyze health information.
  • HIT includes hardware, software, and other systems.
• Benefits of :
  • Improved care: Improves the quality of care, prevents errors, and reduces costs.
  • More efficient administration: Reduces paperwork and increases administrative efficiency.
  • Better access to care: Expands access to affordable care (ex - telehealth for rural communities)
• Examples of :
  • Electronic health records (EHRs): Allows doctors to keep track of patients' health information and share it with specialists.
  • Knowledge management systems: reduces administrative burden.

Community Assessment Process

• A community is a group of people, often living in a defined geographical area, whom share common culture, values, and norms.
• Purpose of Community Assessment:
  • Data about a community is collected.
  • Community health is described.
  • Basis for program planning & development
  • Core public health function
• Three assessment components:
  • People
  • Place
  • Social systems

Data Collection Sources & Methods

• Data collection methods for assessment:
  • Self – use your senses, sensitizer observers
  • Existing data – national, state, and local sources; levels of population data-specific to broad comparison between levels of data
  • Surveys – may be large or small scale can assist to obtain data that cannot be located
• Direct data collection:
  • Informant interviews
  • Participant observation
  • Windshield surveys
  • This is primary data collection which Gives the community "pulse"
• Reported Data Collection:
  • Focus groups
• Surveys
• Public forums
• Compiling data from various sources
• Assessment data can be Quantitative or Qualitative
  • Quantitative
    • Census figures
    • Local agencies
    • Community surveys
    • Observations
  • Qualitative
    • Community surveys
    • Key informant interviews
    • Resident interviews
    • Observation

Program Planning

• Health program planning helps communities understand how to move from their current location to where they want to be.
• Health program planning is one of the 10 essential public health services
  • Should occur in every community
• Program Planning:
  • Multistep process with 5 steps
    • Define the problem
    • Assess strengths/needs
    • Create a plan
    • Feedback
    • Evaluation
  • Planning occurs at all levels:
    • Local
    • State
    • Federal
    • Global
• Goals should be determined by the COMMUNITY and their needs
• Program planning generally follows this format:
  • Describe the problem
  • Formulate the plan
  • Conceptualize the problem
  • Detail the plan
  • Evaluate the plan
  • Implement the program plan
  • Many of the community change models follow this general formal
• Other program planning considerations:
  • Cultural considerations:
    • Consider language, ethnicity, cultural beliefs, etc
  • Evidence-based practice:
    • Literature reviews are key
    • Population-based approaches
    • Evaluate if they were successful or not
  • Implementation considerations Resources (what resources will we use?)
• Mechanism for delivery (how will changes be made) Five stages:
• Community acceptance is key!
• Specifying tasks & needed resources
• Developing specific plans
• Establishing mechanism for program management
• Putting plan into action Evaluation considerations Analysis provides useful feedback!
• Are activities implemented as designed?
• Is the program cost-effective?
• Are the intervention & program theories correct?
• Is the time-line appropriate?
• Is the program expanded or duplicated?

Community Change Models & Frameworks

• Community change models aim to improve aggregate health.
  • "Aggregate health" refers to the collective health status of a population, calculated by combining health data from multiple individuals within that group, providing a broader picture of health trends and patterns rather than focusing on individual patient details
• Applies the nursing process (ADPIE) to the community
• 3 popular community change models include:
  • PATCH (Planning Approach to Community Health)
    1. Mobilize the community to act
    2. Collect data
    3. Choose health priorities (consider the community's priorities)
    4. Develop comprehensive intervention plan
    5. Implement plan
    • note: this model does not have evaluation which is a key part of the nursing process (ADPIE)
  • APEXPH (Assessment Protocol for Excellence in Public Health)
    1. Assess internal organizational capacity
    2. Assess priorities for health problems – ask the community
    3. Set priorities for health problems
    4. Implement plan
    • note: this model does not have evaluation which is a key part of the nursing process (ADPIE)
  • MAPP (Mobilizing for Action Through Planning and Partnership)
    1. Mobilize communities members and organizations
    2. Generate shared visions and common values
    3. Develop a framework for long-range planning
    4. Conduct needs assessment in four areas – community strengths, local public health system, community health status, forces of change
    5. Evaluate the process (All steps of ADPIE covered)
• PROCEED-PRECEDE is a program planning model.
  • It's a community-oriented, participatory model for creating successful community health promotion interventions.
  • PRECEDE: 5 phases
    1. Social diagnosis
    2. Epidemiological diagnosis
    3. Behavioral & environmental diagnosis
    4. Educational & organizational diagnosis
    5. Administrative & policy diagnosis
  • PROCEED: 4 phases 6. Implementation 7. Process evaluation 8. Impact evaluation 9. Outcome evaluation
  • Benefits: multi-faceted diagnoses emphasizing evaluating and making changes.

SDoH and Health Status of Community

• Social determinants of health (SDOH) are non-medical factors that impact health outcomes
• SDOH can indicate community health and influence aggregate health.
• SDOH is a priority for Healthy People 2030 with health equity and literacy.
  • Addressing SDOH can enhance health and lead to better outcomes
• Examples of social determinants of health include: income level, education attainment, employment status, healthcare access, neighborhood quality, food security, housing stability, transportation options, social support networks, exposure to discrimination, and community safety.
  • Affect a person's overall health and well-being.

Communicable Disease - Disease Occurrence & Patterns:

• Number of disease cases in a population at a specific time.
• Incidence – Rate of new disease cases in a population over time.
• Epidemic – Unexpected increase in disease spread within a community or area.
• Pandemic – Disease outbreak with wide geographical spread across several countries.
• Endemic – Amount of disease typically present in a community.

Disease Transmission & Causation:

• Reservoir – Where the agent resides.
• Environmental factors – Conditions external to the host and agent linked to the transmission of the agent.
• Communicable – Transferred from one individual to another.

Host & Immunity Factors:

• Capacity of agent to cause disease in a human.
• Herd immunity – Population immunity to an agent.
• Active immunity – Acquired through exposure to the agent.
• Innate immunity – Ability of host to resist disease independent of antibodies.

Communicable disease:

• A disease spread through direct or indirect contact.
• Chain of Infection is described as the following:
  • Pathogenic agent: viruses, bacteria, or fungi cause disease
  • Reservoirs: Where pathogen resides (dirt for Valley Fever or water for E. coli)
  • Portal of Exit: How the pathogen leaves a host
  • Mode of Transmission: How the pathogen spreads
  • Portal of Entry: Pathogens enter a new host
  • Host Susceptibility/ Host Resistance: The host's susceptibility to disease is determined by factors such as age or immunocompromised status, while resistance is influenced by factors such as vaccination.

Epi Triangle

• The epidemiological triangle, also called the epidemiological triad, is scientists' model to understand disease spread.
  • Can be applied to communicable or non-communicable disease
  • Three components include:
    • Agent: Biological, chemical, nutritive, or physical/psychological factors.
    • Host: Susceptible human or animal.
    • Environment: External risk factors affecting the host like:
      • Physical factors such as geology & climate
        • Haboobs in Phoenix spread Valley Fever
      • Biological factors such as insects that transmit the agent
        • Mosquitos in Florida can transmit Zika or Malaria
      • Socioeconomic factors (crowding, sanitation, availability of health services)
        • Overcrowding increases risk of TB
      • Cultural factors
        • Not believing in vaccines

Transmission/Characteristics

• Spread from parent to offspring.
  • Examples like HIV, hepatitis B, or syphilis spread at birth through breastfeeding.
• Spread between individuals in the population.
  • Examples include Covid-19, flu, or malaria.
• Direct transmission involves contact of the organism spread from the infected person.
  • An example is C. difficile.
• Indirect transmission through contact of a fomite.
  • A fomite is a contaminated surface.
• Airborne routes include TB.
• Droplet include the flu.
• Vector-borne diseases include malaria.
• STD's include syphilis, gonorrhea, or chlamydia.
• Common vehicle transmission describes how it's commonly spread.

Surveillance/Reporting

• What information to include for disease surveillance
• Geographic area
• Age
• Race
• Location
• Birthplace (foreign or U.S. citizen)
• Agent known

Immunity

• Active Immunity
  • Natural-Antibodies made after exposure to infection
  • Artificial-Antibodies made after getting a vaccination
• Passive Immunity
  • Natural_ Antibodes transmitted from mother to baby
  • Artificial- Antibodies acquired from an immune serum medicine

Herd immunity

• When enough people in a group are immunized which stops the infection from spreading easily.
• The more people with immunity, the harder it is for the infection to spread.
  • More virulent strains requires the majority to be immunized.
    • Polio was eradicated from the US once it had widespread vaccination campaigns.

Family Assessment & Caregiver Role Strain

• Caregivers can be parents, grandparents, grown kids, spouses, etc.
• High-strain caregivers are more prone to depression and health issues.
• Caregiver strain, known as caregiver burden or burnout, has physical, emotional, and mental stress due to a caregivers time spent looking after someone.
  • Lack of attention leads to the caregivers own significant health concerns of their own.
• Preventative measures for caregiver role strain:
  • Healthy self-care routines
  • Social time
  • Support groups
  • Therapy or counseling
  • Respite or home care
  • External support: meals on wheels, church support, etc

Family Assessment and Delivery of Family-Centered Care

• Family Nursing Assessment: comprehensive family data collection used to ID major family problems.
  • It also ensures that individual family members and the family are assessed as a whole. WHY assess the family?
• They are major decision-makers in healthcare.
• Nurses and families adapt the family to health and illness.
• Risk on one member impacts the ENTIRE family
• Working with the entire family means:
  • Reduce the factors that damage health
  • Enhance well-being
  • Strengthen self-coping skills
  • Implement mutual goal setting

3 Major Family Health Risks

• (1) Biological and Age-related Risk- This includes Genetics or Lifestyle risk patterns with Transitions as times of potential risk

  • genograms are visual representations family relationships between members and medical and mental histories

• (2) Environmental Risks:

• Focus is based on social risks such as;

• High-crime neighborhoods, inadequate recreational or health resources, noise or chemical pollution or cultural that may contribute to PTSD

• Discrimination Financial resources to purchase necessary goods and services. housing, clothing, food, education, health care.

  • Availability of illness care but not preventive care
  • Affordable nutrition that is nutritious vs what is actually available at reach.

• ecomap: shows the people as they are and the

  • "Begin with the people as they are and the situation as it is"

• Connecting families to community resources is critical

Behavioral (Lifestyle) Risk

• Personal health habits Family is the basic unit
• What food is purchased and prepared
• Sleep patterns
• Family activities
• Carry out treatments and any substance abuse. Strength-Based Approach to the Family Assessment _ Always assess the family's strengths and use them! Strengths of familes consist of: Commitment Appreciation & affection Positive communication Time together Spiritual well-being Ability to cope with stress and crisis

Health Behavior Change Process & Motivational Interviewing

• All health behavior models integrate client values, beliefs, perceptions and motivations
• Health behavior change model frameworks INCREASE people's control over their health
• Ex Health Belief Model:
  • Widely used in explaining behavior change
  • Can help promote medical compliance!
  • Addresses the individual's perceptions of threats posed by a health problem
  • susceptibility, severity
  • The benefits of avoiding the threat AND
    • factors influencing the decision to act:
      • Barriers
      • Cues to action
      • Self-efficacy
  • Can be use at an individual level, family, or community level
  • For general preventative health issues across clinical settings
• Health-related behavior depends on
  • Severity of potential illness or physical change
  • Level of conceivable susceptibility
  • The benefits of taking preventative action
  • Obstacles that prevent taking action toward goal of health promotion
• Considerations:
  • The severity of potential illness
  • Level of conceivable susceptibility
  • The benefits of taking preventative action
  • Challenges that may be faced in acting word the goal Modifying factors: culture, age, gender, literacy, SES, values There is cultural sensitivity by understanding:
• How might age affects people's perception of risk?
• What levels one understands and appreciates others viewpoints?
• There are different values one follows and how that would influence choices

Transtheoretical Model/Stages of Change

• Developed by Prochaska and DiClemente

• Research findings on smoking cessation

• Proposes that health-related behavior change takes time and progresses through 5 stages

• • Sequential approach to behavior changes that involves the READINESS of the learner. -5 Stages of Change

• Pre-Contemplation: No intention to taking action within next 6 months Increase awareness for need change and information about risks/benefits

• Contemplation: Intends to take action in the next 6 months Motivate; encourage to make specific plans

• Preparation: Intends to take action within next 30 days & has taken some behavioral steps in this direction Assist with developing implementing concrete action plans; help set gradual goals

• Action: Has changed behavior for than 6 months

• Assistance providing:

• Assist with feedback

• Solving social problems

• social support

• reinforcement Maintenance: has changed behavior for more than 6 months assist coping, reminders, alternatives, avoiding slips/relapses (as applicable)

• *Relevance to public health interventions & application- Can be used to help patients change behaviors!

• Is Especially applied to critical cases where health factor is taking toll on one's life (ex: substance abuse)

• Treatment/rehab facilities tend to use this model

Motivational Interviewing (MI)

• Is a collaborative conversation style for strengthening a person's own motivation & commitment to change with key steps: assists clients with developing motivation to resolve insecurities and ambivalent feelings toward change
• MI helps identify person's thoughts and feelings
  • The goal is to develop NEW thought patterns to help in behavior change as well assisting to;

State of readiness

• The ability to take charge of personal health and control lifestyle factors
• Motivational Interviewing Skill OARS:
• Open Questions
• Affirmations
• Reflective listening statements
• Summarizing

Public Health

• Addresses health & wellness for the entire population.
• A look at and tracks any health trends that may be relevant.
• Maintains a safe and clean environment for access to air, food and drinking water.
• Implements health policies that maintain the public interest.
• Educates individuals about public health.

The Health Care System

• The focus is to provide assistance to individuals as may need.
• Assesses individuals to dx different types of conditions and ailments.
• Offers specialty services for:
• • primary care
• physical therapy
• Mental health

There are many organizations that collaborate together to pay assist with payments for;

• • Healthcare workers
• Healthcare services
• Government assistance.

Rural Health Systems

• Classification of which is a rural area is based on the population size, population density or proximity to a major metropolitan area.
• • Urban areas are defined first then rural areas are classified. -Rural areas are defined at;
• Department Agriculture 86% of the land area in the USA is considered rural
• 61 million people Issues Rural Health May Face:
  • Lack of Health Care providers in area leading to -* Only 35% of Hospitals
• Less bed -* Rural hospitals closed between 2010-2021
  • Aging population needs
• Larger % of un and under-insured
• Farmers are considered self employed.

The Govermnetal Responsibilities

• Federal Government/the State/the Local Health Dept.
• Role of the Federal Government;
  • Government sets policies, standards, and even laws. An exmaple is:Affordable Care Act (2010) The government supports and assists by investing into biomedical & health services research. This may lead to finance/deliver personal health services
• *Ex: Medicare, medicaid Government also must respond to international threats that have the ability to harm. Federal unit is: United States Public Health Service in the Department of Health and Human Services which leads into:
• • Responsibility
• State Mandates for healthcare and coverage plans.

Local Health Responsibilities

• • To follow state mandates. The health Departments set health policies and state regulations/mandates! Each has to follow for:
• • Public health & responsibilities.

• Analyze data -* set policies/standards

• Oversees educational, environment -* Access to those underserved in community.

• Governmental responsibilities include passing the Affordable care act and funding through the Department of Human and Health Services (DHHS. Medicare is managed through government systems by passing laws/regulations.

• • The goal; protect from international threats.

Local level has front line responders such as police which provides the following;

• • The distribution of trash collection to the testing for water qualities.

• Governments regulate & and own health facilities like Hospitals and care centers!

• The state is in control and in power given Maricopa County, of Arizona.

Governemnet responsibilities lead assistance with governmental programs sucha s medicaid and medicare. Medicare functions under The U.S. Department of Health & Social Services (DHHS). It is administered by CMS.

• Has social Insurance set in 1965

• The funding is set by the federal level.

• There is also services like Medicaid that are similar to Medicare.

• The major difference is that it works with both federal and state governments.

• Rural Areas must be noted by

• • Higher chance of death
• • Higher rates of smoking/activity.

• There is a trend within; Unintentional harm, chronic and undiagnosed disease that can be linked to exposures. There is a; higher drug/suicide rate

• There is;opioid & alcoholism that goes without much treatment.

• • Pregnancy in rural settings often has much mental distress with much fewer access to prenatal care and services.

TELEHEALTH

• Access through technology,
• Education of family and professional members.
• Delivery of technology enhanced
• To;broad range of medical care
• focus on exchanging medical information and providing diagnosis and treatment -It requires; * audio/visual tools

Mobile health services can include; Record to patient data through electronic devices, or any type of medical device.

• • Assist with; Access points with rural communities. Is can be a barrier with;
• • Spotting coverage
• Lack of housing for consults
• The public plays a role;
• Promote healthcare access.
  • • Conduct routine screening for illness.