My work in population health
I spent the first 20 years of my career as an emergency room nurse. After that, I worked for several years in outpatient clinics serving vulnerable and disenfranchised youth and homeless adults.
Sitting in a room with a patient, I used to be thrilled by small wins, like us speaking the same language (or them understanding my poor Spanish!). I’d wonder if they would be able to follow up on the recommendations I gave, and wished I had better access to evidence-based resources in the community that would help. I was happy when everything went smoothly, but would be really frustrated when it didn’t. I have long-known what I wanted the one-on-one patient encounter to look like, but I didn’t know all the pieces that were needed for things to work on a larger scale.
Now, as a public health nursing advisor for the Diabetes Prevention and Control Program (DPCP) within the Massachusetts Department of Public Health (MDPH) (www.mass.gov/dph/), I have the unique opportunity to help bring those pieces together.
MDPH focuses on population health by tapping into the expertise of various disciplines across the department, the same way consulting physicians provide input on challenging cases. We have surveillance teams who collect and analyze data to identify the problem. We use formative research to help determine the best approach to address the problem. We work with internal and external clinical content experts to identify and use the best evidence surrounding the problem. Working across programs and disciplines to address the different social and economic determinants that affect health, we have a larger and longer lasting impact on population health at the community level. MDPH puts this approach to use with Mass in Motion (http://www.mass.gov/massinmotion/ ) a statewide obesity prevention initiative that stresses the importance of creating opportunities for healthy eating and physical activity by changing policies, systems and environments.
Another way we use the population health approach with at-risk populations is with the DPCP’s multi-faceted initiative around women with a history of gestational diabetes (GDM). Studies show that fewer than 40% of women with a history of GDM receive the recommended post-partum screening for diabetes. This demonstrated a need for increased provider and consumer awareness of the screening recommendations. Using public health surveillance (http://www.mass.gov/dph/datatranslation ) to identify populations at greatest risk for GDM and qualitative research on women’s knowledge and perceptions about GDM, the DPCP developed a media campaign targeted toward Latina women with a history of GDM. The messages of the campaign included future risk for type 2 diabetes, the importance of follow-up screening, and speaking with a health care provider about healthy lifestyle. To support these messages, we are collaborating with clinical experts from across the Commonwealth to draft recommendations for diagnosis, management and follow-up of women with GDM. We will also work with Mass in Motion communities to ensure women with GDM have access to resources and community support for lifestyle interventions.
This population health approach is in stark contrast to my former life. What has been most challenging, and at the same time most rewarding, is learning how to develop systems to link all those pieces together, with the ultimate goal of helping people live healthy lives.
Public Health Nurse Advisor
Massachusetts Department of Public Health