Author Archives: Nicholas Stine

Primary Care and Population Health: Last in a Five-Part Series

Feb 8, 2013, 12:00 PM, Posted by Dave Chokshi, Nicholas Stine

Nicholas Stine, MD, and Dave Chokshi, MD, MSc, writing on behalf of the New York Academy of Medicine Primary Care and Population Health Working Group.

The New York Academy of Medicine is the National Program Office for the Robert Wood Johnson Foundation Health & Society Scholars program, which works to reduce population health disparities and improve the health of all Americans. The New York Academy recently conducted a survey of 17 thought leaders in primary care and population health. In the final of five blog posts, we share a synthesis of what those leaders had to say. All quotes are printed with permission.

Addressing Social Determinants of Health: Given the current state of the clinical delivery system, it may seem unrealistically burdensome to ask health care institutions to address the social determinants of health (SDH). “In this country it’s an accomplishment if you can reward value for delivery,” noted Arnold Milstein, MD, MPH, “and social determinants approaches are a step or two beyond that.”

Examples of clinical engagement in social determinants, however, can be quite impactful:

  • Lloyd Michener, MD, and Bob Lawrence, MD, described how Duke and Johns Hopkins both invested in SDH initially in order to repair or promote their public image. For example, Duke invested in some SDH programs and community partnerships in part to help repair their image in the setting of poor relationships with a minority, low-income community in Durham—though these investments have grown into more lasting partnerships. 
  • David Stevens, MD, pointed out the example of the 16th St Community Health Center in Milwaukee, where an environmental wing of the health center was created to combat lead poisoning—and then expanded over years into broader projects, such as combatting brownfields and creating green spaces for exercise.

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What is Population Health? Definitions from the Field

Jan 23, 2013, 9:00 AM, Posted by Dave Chokshi, Nicholas Stine

The New York Academy of Medicine (NYAM) conducted a survey of 17 thought leaders* across America's primary care and public health sectors on the definition of population health. In this post, Nicholas Stine, MD, and Dave Chokshi, MD, MSc, on behalf of the NYAM Primary Care and Population Health Working Group, share a synthesis of what those leaders had to say. All quotes are printed with permission. In a follow-up post on the NYAM website, the authors discuss challenges and opportunities in an urban context for achieving population health.

The New York Academy of Medicine was the National Program Office for the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program, a signature RWJF initative which ended in 2017. In a corresponding video, the program interviewed additional leaders who discuss the role of public policy and cross-sector collaboration in achieving population health. Watch the video.

What is Population Health?

In a survey conducted by the New York Academy of Medicine on the definition of public health, many discussants cited the definition developed by David Kindig, MD, PhD, as a reference point: “health outcomes of a group of individuals, including the distribution of such outcomes within the group.” Regardless of specific vantage point, there was a generally shared sentiment that population health should be thought of broadly and in common terms by a range of clinical and non-clinical stakeholders.

More discussants described a baseline framework of a clinical delivery system oriented around patients in a practice, in contrast with a public health system oriented around geographic communities. A more clinical, or “population medicine,” perspective often centered around evidence-based interventions and disease management categories so as to triage and allocate health care resources in a cost-effective manner.

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