Susan M. Swider, PhD, APHN-BC, FAAN

AACN Baccalaureate Conference

November 18, 2016

Anaheim, CA

Health Care Challenges in the U.S.

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Areas of US Health Disadvantage

Infant Mortality & Low Birth Weight

Injuries & Homicides

Adolescent Pregnancy & STIs

HIV and AIDS

Drug related deaths

Obesity and Diabetes

Cardiovascular disease

Chronic lung disease

Disability21

Cancer mortality

Stroke mortality

Control of blood pressure and cholesterol

levels

Suicide

Elderly survival

Self-rated health

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Social determinants of healthThe World Health Organization (WHO) defines social determinants of health as “the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life” (WHO, 2015a).

• Income• Race/ethnicity• Civil unrest• Education• Environment• Housing

Public/Population health focus necessary to

improve outcomes & reduce costs

• Social & environmental determinants of health

• Primary prevention

• Health care costs, ACA provides opportunities for

change

• PCMH/ ACO population management

The First Era(Yesterday) The Second Era

(Today) The Third Era(Tomorrow)

Focused on acute and infectious disease

Germ Theory

Short time frames

Medical Care

Insurance-based financing

Industrial Model

Reducing Deaths

Increasing focus on chronic disease

Multiple Risk Factors

Longer time frames

Chronic Disease Mgmt & Prevention

Pre-paid benefits

Corporate Model

Prolonging Disability free Life

Increasing focus onachieving optimal health

Complex Systems - Life Course Pathways

Lifespan/ generational

Investing in population-based prevention

Network Model

Producing Optimal Health for All

Health System 1.0

Health System 2.0

Health System 3.0

Population health

• Population health

– “the health outcomes of a group of individuals, including the distribution of such outcomes within the group.” NACNEP, 2016; Kindig and Stoddart, 2003

Public health:

Population health

Nursing and Population Health

• Nursing’s role in improving the health of the public

– ACA

• NPS• Value based payment

– Addressing the SDOH

– Care coordination

• Clinical prevention

National Prevention Strategy

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National Prevention Strategy (2011)

Nursing and Population Health

• Nursing’s role in improving the health of the public

– ACA

• NPS

• Value based payment– Addressing the SDOH

– Care coordination

• Clinical prevention

Nursing and Population Health

– National Academy of Science (NAS)

• Population health

• Teaching SDOH

– Nursing leadership

• Health policy

• Health professions education

• Health promotion research

NAS Conceptual model for strengthening health

professional education in the social

determinants of health

NAS Conceptual model for strengthening health

professional education in the social determinants of

health

Experiential learning• Applied learning

• Community engagement

• Performance assessment

Collaborative learning• Problem/project-based learning

• Student engagement

• Critical thinking

Integrated curriculum• Interprofessional

• Cross-sectoral

• Longitudinally organized

Continuing professional development• Faculty development

Interprofessional workplace learning

Reciprocal commitment• Community assets

• Willingness to engage

• Networks

• Resources

Community priorities• Evaluation of health impacts toward equity and well- being

Community engagement• Workforce diversity

• Recruitment, retention

Vision for and commitment to education in the social determinants of health• Policies/strategies/program reviews

• Resources

• Infrastructure

• Promotion/career pathways

Supportive organizational environment• Transformative learning

• Dissemination of pedagogical research

• Faculty development/continuing professional development

Recommendation 1: Health professional

educators should use the framework presented

in this report as a guide for creating lifelong

learners who appreciate the value of

relationships and collaborations for

understanding and addressing community-

identified needs and for strengthening

community assets.

Recommendation 2: To prepare health professionals to take action on the social determinants of health in, with, and across communities, health professional and educational associations and organizations at the global, regional, and national levels should apply the concepts embodied in the framework in partnering with communities to increase the inclusivity and diversity of the health professional student body and faculty.

Recommendation 3: Governments and

individual ministries (e.g., signatories of the

Rio Declaration), health professional and

educational associations and organizations, and

community groups should foster an enabling

environment that supports and values the

integration of the framework’s principles into

their mission, culture, and work.

Recommendation 4: Governments, health professional and educational associations and organizations, and community organizations should use the committee’s framework and model to guide and support evaluation research aimed at identifying and illustrating effective approaches for learning about the social determinants of health in and with communities while improving health outcomes, thereby building the evidence base.

Nursing and Population Health

– National Academy of Science (NAS)

• Population health

• Teaching SDOH

– Nursing leadership

• Health policy

• Health professions education

• Health promotion research

Nursing and Population Health

– DHHS National Advisory Council on Nurse Education and Practice (NACNEP) report– Public Health Nursing: Key to Our Nation’s Health (2014)

– Preparing Nurses for New Roles in Population Health Management (2016)

– Nursing workforce

• Acute care

• Community/ambulatory care

• Public health

Public Health Nursing: Key to

Our Nation’s Health (2014)

RECOMMENDATIONS :

○ 1. Provide an increase in the resources and opportunities

solely aimed at the education, training, and workforce

development of public health nurses.

○ 2. Convene a summit of key public health organizations,

foundations, and schools of nursing to delineate the required

leadership, training, and professional development required to

advance the field of public health nursing.

○ 3. Identify and remedy the gaps in the cost effectiveness of

public health nursing.

○ 4. Provide opportunities to advance public health practice and

research.

Preparing Nurses for New Roles in

Population Health Management (2016)

Recommendations:

1: agencies serving rural or frontier areas, such as HRSA, the Veterans

Health Administration, and the Indian Health Service, better coordinate

their undergraduate nursing student training programs to reduce

administrative burdens on schools and clinical sites, and expand access to

a wider variety of clinical opportunities.

2: Congress provide funding to develop a more comprehensive public

health infrastructure in rural, frontier, inner city, and other underserved

areas, including improving access to clear and accurate health

information, remote health monitoring, and telehealth and other virtual

access services. further recommends changes to healthcare legislation to

promote the involvement of registered nurses and advanced practice

nurses in primary care to the full extent of their education, and to ease the

provision of care across state boundaries through telehealth and related

services.

3: HRSA’s Title VIII funding opportunity announcements for registered nurse education and training include language that encourages grantees to:

○ a) Establish and/or expand population health clinical learning opportunities for nursing students in community health organizations.

○ b) Develop curricular innovations that integrate population health competencies across the nursing educational pipeline from undergraduate to post-doctoral studies.

○ c) Promote training to better prepare nursing faculty to teach both incoming and practicing nurses the skills needed to address population health management.

• 4: In accordance with recommendations from NACNEP’s 11th report, the Council recommends that Congress place renewed emphasis on providing access to educational grants through Title VIII funding opportunity announcements for nursing students from underrepresented or minority backgrounds and/or for minority-serving schools of nursing, to promote a nursing workforce better prepared to practice in underserved communities and address the complex health needs of an increasingly diverse U.S. population.

• 5: NACNEP recommends that Congress and the HHS Secretary work with the National Institute of Nursing Research, the National Center for Advancing Translational Science, and other relevant federal research agencies to expand investment in population health science, including infrastructure and training, and increase funding support for research studies on population health management initiatives and data collection on population health measures and metrics.

• 6: NACNEP recommends that HHS establish and convene a

federal working group to address population health. This

working group would consist of representatives from

agencies across HHS and related agencies of the federal

government involved in the areas of public health,

population health, health research, and the healthcare

workforce, as well as housing, education, and justice.

Nursing and Population Health

– DHHS National Advisory Council on Nurse Education and Practice (NACNEP) report– Public Health Nursing: Key to Our Nation’s Health (2014)

– Preparing Nurses for New Roles in Population Health

Management (2016)

– Nursing workforce

• Acute care

• Community/ambulatory care

• Public health

Population health

– Knowledge and skills needed• Client/community engagement

• Epidemiology

• SDOH and impact on client/community health

• Cultural competence– Health literacy

• Care coordination across the continuum

• Ethics and Social justice

• Health Promotion and disease prevention

• Client assessment-physical and SDOH

Population health

Resources

• General

• Build Healthy Places Network http://buildhealthyplaces.org/

• Community Commons http://www.communitycommons.org/

• Community Health Improvement Navigator http://www.cdc.gov/chinav

• Community Toolbox http://ctb.ku.edu/en

• County Health Ranking and Roadmaps Action Center

http://www.countyhealthrankings.org/

• Practical Playbook http://practicalplaybook.org

Population health

Resources Public Health Nursing

○ ACHNE www.achne.org

AACN○ Population Health Supplement to the Baccalaureate Essentials

http://www.aacn.nche.edu/education-resources/BSN-Curriculum-Guide.pdf

○ CDC Fellowships http://www.aacn.nche.edu/public-health-nursing/fellowships

○ DNP project support http://www.aacn.nche.edu/public-health-nursing/dnp-projects

○ Resources and Reportshttp://www.aacn.nche.edu/public-health-nursing/resources-opportunities

○ PEHSU modules for nursing (forthcoming)

○ Small grant projects evaluating population health initiatives http://www.aacn.nche.edu/public-health-nursing/small-grant-projects

○ Workforce Improvement Projects http://www.aacn.nche.edu/public-health-nursing/wips

○ Webinars

○ Curriculum exemplars http://www.aacn.nche.edu/public-health-nursing/curriculum-improvement

Curriculum innovation in

population health

• Curriculum innovation in population health: innovations; outcomes; challenges

– Case Western Reserve University

– Amy Bieda, PhD, APRN, PNP-BC, NNP-BC

– University of Maryland

– Marik Moen, MPH, MSN, RN

Questions: susan_m_swider@rush.edu

“Of all the forms of inequality,

injustice in health care is the most

shocking and inhumane.”

― Martin Luther King Jr.