Throughout the course, you’ll use the map below to engage important population health concepts. Click on each hot spot to learn more about the population in that area.

This week, you discovered that the focus of healthcare has a growing emphasis on population health. Emphasis on quality improvement and tracking outcomes has led to exploring “why?” Why do some patients have trouble controlling their diabetes? Why do so some pediatric diabetic patients show up in the emergency department with an uncontrolled episode? These questions have led the DNP scholar and other healthcare providers to consider the social determinants of health. This query also requires that consideration be given to “how?” How do healthcare providers improve outcomes for a given population? Explore these questions as they relate to the populations represented on the interactive map below. Select one of the populations on the map and address the following:

• Create a culturagram for your selected population. Refer to Week 1, Explore page 2, for guidance in creating a culturagram. You may use the attached template, if you desire. (New York)
• Conduct a search for evidence. Identify one evidence-based intervention to reduce health disparities in the selected population.
• Consider how the selected intervention addresses at least one of the CLAS standards.
• Share your professional experience related to the topic.

Reflection on Learning

Reflective inquiry allows for expansion in self-awareness, identification of knowledge gaps, and assessment of learning goals. Each week, you will reflect upon what you have learned and complete a reflective journal assignment: Reflection on Learning. Each weekly reflection is placed in one document, which will be submitted for grading at the end of Week 7. There is no weekly reflection in Week 8 because a reflection is incorporated into the discussion question. Please review the Reflection Guidelines and Rubric for complete assignment requirements. Create a document where you will keep your weekly reflection.

In your document, reflect upon your Week 1 learning journey in NR704 and consider the following in one or two paragraphs.

• As you assess your learning, provide one specific example of how you achieved the weekly objective(s):
• What strategies will you use to lead culturally and linguistically appropriate healthcare?
• What do you value most about your learning this week?

Welcome to NR704: Concepts in Population Health Outcomes! In this course, you’ll explore how the DNP scholar uses population health outcomes to improve the health of diverse and often-underserved populations. You’ll start the week by exploring the foundations and evolution of population health. From there, you’ll examine the determinants of health and how these factors influence the care of populations. You’ll also investigate culturally and linguistically appropriate healthcare, including your organization’s provision of these important services. What’s more, you’ll create a culturagram and begin analyzing various populations and their healthcare needs. There’s so much to learn! It’s time to get started on your journey in population health!

Week 1: Student Lesson Plan for Learning Success

Table of Contents

Outcomes, Objectives, and Concepts

Foundations for Learning

Start your learning for the week by reviewing Healthy People goals.

Healthy People 2020

Since 1979, the U.S. Department of Health and Human Services (HHS) has analyzed data from past decades, integrated new knowledge, current data, trends, and research to determine the nation’s healthcare priorities for the next 10 years. Our nation’s health priorities are associated with many areas such as national health, national preparedness, and disease prevention, as well as identification of risks to health and wellness and changing public health priorities. Planning is underway for the development of Healthy People 2030. For additional information, go to http://www.healthypeople.gov (Links to an external site.)

Student Learning Activities

Learning Success Strategies

• Review key terms in the chapters to ensure you understand the definitions and relate them to population health.
• As you review weekly content, consider how each concept and discussion can be translated into practice at your unique setting.
• Be ready to share your thoughts through the interactive discussion. Review the discussion guidelines and rubric to optimize your performance.
• You have access to a variety of resources to support your success. Click resources on the home page to access program and project resources.
• Your course faculty are here to support your learning journey. Reach out for guidance with study strategies, time management, and course-related questions.
• Be certain to complete your student attestation, due by Sunday 11:59 PM MT. You can locate this by going to Modules and selecting Student Attestation.

Bemker, M. A. & Ralyea, C. (2018). Population health and its integration into advanced nursing practice. DEStech Publications, Inc.

• Chapter 1: Population Health Introduction
• Chapter 2: Integration of Population Health to Advanced Nursing Care

Ibrahim, M., Savitz, L., Carey, T., & Wagner, E. (2001). Population-based health principles in medical and public health practice. Journal of Public Health Management & Practice, (3), 75-81.  https://chamberlainuniversity.idm.oclc.org/login?url=http://ovidsp.ovid.com.chamberlainuniversity.idm.oclc.org/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=ovft&AN=00124784-200107030-00012&PDF=y (Links to an external site.)

Jayshree, J. & Okundaye, J. (2014). The Culturagram: An educational tool to enhance practice competence with diverse populations. Journal of Baccalaureate Social Work, 19(1), 53-63. https://chamberlainuniversity.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=sih&AN=109924424&site=ehost-live&scope=site

Week 1: Population Health Concepts

Table of Contents

The Health of Populations

The DNP scholar holds the key to improved healthcare outcomes through an understanding of the determinants of health and by intervening to translate evidence into effective strategies and solutions. Population healthcare rises from the premise that individuals will benefit from a focus on improving the health of aggregates. The practice scholar understands the highly specific, often economic and cultural, influences on individuals and populations in diverse communities. This awareness of the impact of social dynamics on health allows for more effective interventions and superior outcomes.

View the following video about population health by industry expert and award-winning textbook author, Patrick LaRose, DNP, MSN/Ed, RN.

The CDC (2019) defines population health as an “interdisciplinary, customizable approach that allows health departments to connect practice to policy for change to happen locally.” Another recognized definition of population health is provided by Healthcare Information and Management Systems Society (HIMSS). According to HIMSS (2019), population health “addresses the health status and health issues of the aggregate population. It brings significant health concerns into focus and addresses ways in which communities, healthcare providers, and public health organizations can allocate resources to overcome the problems that drive poor health conditions in the population, e.g. diabetes, obesity, autism, heart disease, etc”. Both definitions emphasize that population health strives toward advancing the health of all people.

Five fundamental principles underpin the care of populations (Ibrahim, Savitz, Carey, & Wahner, 2001). These guiding principles serve as a basis for the assessment, development, implementation, and evaluation of population-focused interventions.

Population Health

View the following activity to explore the guiding principles underpinning the care of populations.

Population Health  (Links to an external site.)

Transcript

Hello! I’m back to guide your investigation into life expectancy rates and the measure of premature mortality.

Life expectancy at birth is one of the most common ways to calculate life expectancy; it can also be calculated as the remaining life expectancy for any given age.

However, if the average life expectancy at birth for one individual is 79 years, the remaining average life expectancy of that same individual at 72 years old is 7 years. 

In population health, the years of potential life lost is often calculated in references to mortality. This is useful in measuring the outcomes of population health interventions.

Let’s consider the years of potential life lost (YPLL) for diabetes. Consider an intervention aimed at stabilizing AIC levels in a population of 10 patients.

The patients in the study range in age from 22 to 67.  

If diabetes has the potential to reduce life expectancy by 9 years, the total life expectancy for the group of 10 patients is 233 years. 

The long-term goal of the intervention is to increase the life expectancy of diabetic patients through the maintenance of stable A1C level for 5 years for individuals under the age of 50, and 3 years for those over the age of 50.

If this occurs, the years of potential life lost decreases by 42 years.

The outcome associated with this long-term intervention decreases the years of potential life lost due to diabetes by 42 years for the 10 patients.

Populations and Communities

Populations and communities are foundational to population health. A population refers to a group of people who have at least one attribute in common. Populations can be defined by geographical, cultural, or other characteristics that link people together. A community is a collection of populations. Communities may be geographic such as nations, but can also be groups such as employees, ethnic populations, prisoners, the elderly, the military, the chronically ill, or any other defined group. The health outcomes of these groups are of relevance to the DNP practice scholar, healthcare providers, policymakers, and others committed to greater possibilities in health.

View the following activity to examine the foundations of population health.

Evolution of Population Health and Epidemiology

Population health in the United States has a relatively short history as the initial focus of healthcare was on the individual rather than on a specific community or population. This shift in emphasis began in the 19^th century and is now gaining momentum as the population ages and chronic illnesses have become a central concern of health economics and policy (Chokshi & Stine, 2016). Epidemiology, with its emphasis on the analysis of the determinants of health and disease conditions in populations, is the cornerstone of population health.

Evolution of Population Health and Epidemiology

View the following activity to investigate the evolution of population health and epidemiology.

Evolution of Population Health and Epidemiology (Links to an external site.)

Transcript

Evolution of Population Health and Epidemiology

Click on each date below to examine milestones in the field of population health.

• 1945 – The United Nations Conference in San Francisco unanimously approves the establishment of a new, autonomous international health organization: World Health Organization (WHO).
• 1948 – CDC is established for communicable diseases.
• 1948 – The International Classification of Disease—the global standard to report and categorize diseases, health-related conditions, and external causes of disease and injury—is published.
• 1951 – The Epidemic Intelligence Service (EIS) is established, recognizing the need for an adequate corps of trained epidemiologists who can be deployed immediately for any contingency, including chemical or biological warfare.
• 1953 – The Communicable Disease Center National Surveillance Program is developed to maintain constant vigilance over communicable diseases and to respond immediately when an outbreak occurs.
• 1961 – CDC takes over publication of Morbidity and Mortality Weekly Report (MMWR) from the National Office of Vital Statistics. MMWR is a weekly publication containing a few short narrative reports and the weekly morbidity and mortality tables. It also publishes the annual Summary of Notifiable Diseases.
• 1974 – Through the Study of the Efficacy of Nosocomial Infection Control (SENIC), CDC begins to monitor trends in hospital-acquired infection rates.
• 1988 – Disabilities Prevention Program is developed to provide a national focus for the prevention of disabilities.
• 1995 – Emerging Infections Program (EIP) is established in response to the Centers for Disease Control and Prevention’s (CDC) 1994 strategy, Addressing Emerging Infectious Disease Threats: A Prevention Strategy for the United States.
• 2000 – The Global Outbreak Alert and Response Network is established to detect and combat the international spread of outbreaks.
• 2001 – The Children’s Health Act (Public Law 106-310) establishes the National Center on Birth Defects and Developmental Disabilities (NCBDDD) at CDC. The Act expands research and services for a variety of childhood health problems and authorizes the establishment of Centers of Excellence at both CDC and NIH to promote research and monitoring efforts related to autism.
• 2010 – Healthy People 2020 is published by DHHS.
• 2010 – The Patient Protection and Affordable Care Act is enacted.
• 2011 – The CDC launches the groundbreaking “Tips from Former Smokers” national ad campaign to increase awareness about the suffering caused by smoking and to encourage smokers to quit.
• 2014 – The Global Health Security Agenda is initiated.

Adapted from CDC Timeline https://www.cdc.gov/museum/timeline/index.html (Links to an external site.) and WHO at 70 http://www.who.int/about/history/en/ (Links to an external site.)

Determinants of Health on the Care of Populations

An array of determinants impact health outcomes. Determinants of health are defined as “the range of personal, social, economic, and environmental factors that influence health status” (Office of Disease Prevention and Health Promotion, 2018, para. 3). The environment we live in, the cleanliness of the air, our access to food and water, our social networks, as well as our education and employment opportunities all impact our ability to maintain and sustain health. Another key determinant of health is access to quality, affordable healthcare.

Failure to address the role of socioeconomic, environmental, cultural, and other population-level determinants of health can contribute to the disproportionate burden of disease within specific populations. Consider the Pima Indian population of Arizona and Mexico, who have one of the highest prevalence rates of Diabetes in the world (Schultz & Chaudhari, 2015). Although the Pima population may be genetically prone to Diabetes and obesity, environmental determinants have been major contributors to their burden of disease. Consider, for example, that the average energy expenditure from farming has been reduced with the advent of grocery stores, and that climate change has led to the decline of family gardens and farming as lower rainfall has reduced harvests. Moreover, the low socioeconomic status of this population has resulted in the inability to afford quality, healthy food.

Healthcare providers, including DNP practice scholars, must be aware of the determinants of health for populations such as the Pima Indians in order to improve outcomes. Individuals also can contribute to the overall health of a population by enacting laws. For example, motor vehicle safety laws reduced the injury rate due to car accidents from 1,130 to 722 during the time period of 2000 to 2009 (Morbidity and Mortality Weekly Report, 2011).

Week 1: Culturally Appropriate Healthcare

Table of Contents

Culturally and Linguistically Appropriate Healthcare

The population of the United States is rapidly diversifying, making culturally and linguistically appropriate healthcare a top priority for the DNP scholar. The practice scholar must be culturally competent to provide high-quality care to diverse populations. According to Henderson, Horne, Hills, and Kendall (2018), culturally competent care is associated with improved healthcare outcomes, including increased satisfaction with care, increased perceptions of quality healthcare, and better communication and adherence to treatments. However, to be effective, culturally competent care requires the practice scholar to be aware of assumptions and biases, both implicit and explicit.

In nursing, the wants and needs of those receiving care must be considered. Population health is no different. Just as cultural practices and beliefs may impact the types of care consumed by an individual, communities or populations may also have cultural practices which impact the types of services used. For example, if the community does not eat processed foods, a service such as Women, Infants, and Children (WIC) that offers these food items may not be sought out. Similarly, an immunization program offered to children through local health departments and providers may not be utilized if a population or community does not believe in the need to vaccinate.

Population Culturagrams

A strong foundation in techniques that foster better care delivery pave the way for the DNP scholar to champion culturally competent care. A culturagram enables the practice scholar to assess the impact of culture on health, become more empathic with regard to cultural differences, and empower culturally diverse populations to achieve better health.

View essential components of the culturagram below. Refer to this diagram when creating a culturagram to address a selected population in this week’s discussion.

Image Description

National Standards for Culturally and Linguistically Appropriate Services

The Health and Human Services Office of Minority Health established the National Standards for Culturally and Linguistically Appropriate Services (CLAS) (Links to an external site.) to guide healthcare institutions in providing culturally competent healthcare. These standards provide a blueprint for advancing health quality and equity.

Consider your organization’s standards. Do they support a culturally varied workforce and patient population? How do the values of the organization’s leaders help shape the workplace culture? What strategies will you use as a DNP practice scholar to create a culturally competent organization?

Now, apply culturally and linguistically appropriate services to the case study below.

An Example of Culturally and Linguistically Appropriate Services

An Example of Culturally and Linguistically Appropriate Services (Links to an external site.)

Transcript

An Example of Culturally and Linguistically Appropriate Services

A middle-aged Chinese male was admitted for cataract surgery. Following the procedure, he refused pain medication. The nurse assessed that he was restless and appeared uncomfortable and again, offered pain medication. The patient still refused, stating that he could bear the pain and that her responsibilities were many and he didn’t want to impose. The nurse then reassured him that his comfort was one of her top responsibilities. 

What role, if any, does culture play in this scenario?

Click here to find out. 

Chinese people are taught self-restraint. The needs of the group are often considered more important than those of the individual.  

Another factor that may be involved in the patient’s refusal of pain medication is courtesy. Asians generally consider it impolite to accept something the first time it is offered.  

What is the best course of action? Click here to learn more.

The safest approach for the nurse is to anticipate the needs of an Asian patient for pain medication without waiting for requests. Nurses must be aware of Asian rules of etiquette when offering pain medication, food, or other services. If the patient continues to refuse medication, his wish should be respected.

Continue.

Now, let’s consider culturally appropriate services at the population level. Population-based surveys have identified cataracts as the leading cause of blindness and visual impairment in China, which has the largest number of people in the world with these afflictions (Zhang et al., 2017).

Given that Chinese people are more at risk to develop cataracts and less likely to receive treatment than other populations, what is one evidence-based intervention you might consider to address the population as a whole?

Click here to explore a possible intervention.

Zhang et al. (2017) report that although cataract surgery is an effective means to reverse cataract blindness, the cataract surgical rate in China is low due to a lack of experienced surgeons in rural areas and costs of surgery in urban centers. These barriers have resulted in a large number of patients who have little or no access to affordable surgical services. To overcome this disparity, Project Vision was established to create a sustainable model to reduce cataract blindness in rural China. The top priority of this nongovernmental organization is to develop rural charity eye centers for training local doctors to provide high-quality and low-cost cataract surgery (Zhang et al., 2017). 

Reference

Zhang, X., Li, E. Y., Leung, C. K. S., Musch, D. C., Tang, X., Zheng, C., … & Lam, D. S. C. (2017). Prevalence of visual impairment and outcomes of cataract surgery in Chaonan, South China. PloS one, 12(8), e0180769. 

Hello! You’re off to a strong start in NR704! Let’s recap what you learned this week. You began the week by exploring the foundations of population health and how change is dominating population health management. You considered how the changing healthcare landscape is placing more emphasis on population health, and you examined the work that is underway to align efforts and resources to enhance the impact on outcomes. You also investigated culturally and linguistically appropriate healthcare and appraised your organization for the provision of these services. What’s more, you utilized an interactive population map to develop a culturagram for a selected population, an intervention to reduce health disparities in this population, and relevant CLAS standards. You’ll use this interactive map throughout the course, so look for it in the coming weeks. Let’s move on to Week 2 and begin our investigation into epidemiology. There’s so much to learn!

References

Centers for Disease Control and Prevention. (2019). What is population health. https://www.cdc.gov/pophealthtraining/whatis.html

Centers for Disease Control and Prevention. (2016). CDC timeline. https://www.cdc.gov/museum/timeline/index.html

Chokshi, D. A. & Stine, N. (2016). Milestones on the path to population health.  Health Affairs. https://www.healthaffairs.org/do/10.1377/hblog20160411.054376/full/

GerriShaftel Constant. (2015, April). Longevity secrets of the Loma Linda blue zone. [Video]. https://www.youtube.com/watch?v=zhJl-T_AB6A

Healthcare Information and Management Systems Society. (2019). Population health. https://www.himss.org/population-health

Henderson, S., Horne, M., Hills, R., & Kendall, E. (2018). Cultural competence in healthcare in the community: A concept analysis. Health & social care in the community.

Ibrahim, M., Savitz, L., Carey, T., & Wagner, E. (2001) Population-based health principles in medical and public health practice. Journal of Public Health Management & Practice, (3), 75-81.

Jayshree J. & Okundaye, J. (2014) The Culturagram: An educational tool to enhance practice competence with diverse populations. Journal of Baccalaureate Social Work, 19(1), 53-63.

Office of Disease Prevention and Health Promotions. (2019).  Determinants of health. https://www.healthypeople.gov/2020/about/foundation-health-measures/Determinants-of-Health

Schultz, L. O. & Chaudhari, L. S. (2015). High-risk populations, The Pimas of Arizona and Mexico. Current Obesity Reports, 4(1). 92-98. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4418458/pdf/nihms657043.pdf

Seibert, P. Stridh-Igo, P. & Zimmerman, C. (2002). A checklist to facilitate cultural awareness and sensitivity. Journal of Medical Ethics, 28(3), 143-146.

Statis Health. (n.d.). Culture care connection-Quick quiz: Implicit bias in healthcare. https://www.cvent.com/surveys/Welcome.aspx?s=5f4bb751-dc19-421c-90a0-376c7d598913

Stone, J. & Moskowitz, G. B. (2011). Non-conscious bias in medical decision making: What can be done to reduce it, 45(8), 768-776.

Think Cultural Health. (n.d.). What is culturally competent nursing care: A cornerstone of caring? U.S. Department of Health and & Human Services. https://ccnm.thinkculturalhealth.hhs.gov/

U.S. Department of Health and Human Services. (2018). Healthy People 2020. www.healthypeople.gov

World Health Organization. (2019). WHO at 70. https://www.who.int/news-room/detail/05-04-2018-who-at-70—working-for-better-health-for-everyone-everywhere

Zhang, X., Li, E. Y., Leung, C. K. S., Musch, D. C., Tang, X., Zheng, C., & Lam, D. S. C. (2017).   Prevalence of visual impairment and outcomes of cataract surgery in Chaonan, South China. PloS one, 12(8), e0180769.

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