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POPULATION HEALTH: Kaiser Permanente innovative model

Kaiser Permanente Oakland Medical Center is collaborating with the UC Berkeley School of Public Health in offering a population-health focused residency program.  The program is small – there are two degrees being offered and only two residents matched into each of the programs each year.  Two residents are in an Internal Medicine-Masters in Public Health (MPH) track and the other two are in a Pediatrics MPH track.  There have been a total of 16 program graduates so far.

Source: Lo, J.C., and others. (2017). Innovative partnerships to advance public health training in community-based academic residency programs. Advances in Medical Education and Practice. 8, 703-706. Click here for full text: https://www.dovepress.com/innovative-partnerships-to-advance-public-health-training-in-community-peer-reviewed-article-AMEP  Posted by AHA Resource Center, (312) 422-2003 rc@aha.org

POPULATION HEALTH: How many complex patients?

Data on complex patients are provided based on an analysis done by PricewaterhouseCoopers of data collected in the federal government’s 2013 Medical Expenditure Panel Survey.  The following are some national counts of patients, “visits” are not defined in the text:

  • 24.7 million people are complex chronic patients (average of 13 visits each year)
    • 4.9 million of these are complex chronic patients who are top spenders (average of 29 visits each year)
      • 2.9 million of these have asthma or chronic obstructive pulmonary disease (average of 30 visits each year)

Source: PricewaterhouseCoopers. (2016, May). Population health: Scaling up. Health Research Institute Spotlight. Click here: http://www.pwc.com/us/en/health-industries/health-research-institute/publications/pdf/pwc-hri-population-health.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

POPULATION HEALTH: 678,383 ESRD patients in US (2014)

Each year, there are about 120,000 patients newly diagnosed with end stage renal disease (ESRD) and this number has been rising steadily.  Here are the exact counts of incidence – that is, new cases treated in the U.S.:

  •   77,018 new ESRD cases in 1996
  •   94,662 new cases in 2000
  • 106,662 new cases in 2005
  • 115,920 new cases in 2010
  • 120,688 new cases in 2014

The prevalence of end stage renal disease – the total number of patients who are living with the disease at any given point in time – has more than doubled during the 1996 to 2014 time period.  Here are the exact prevalence counts:

  • 303,311 total ESRD cases in 1996
  • 390,158 total cases in 2000
  • 484,935 total cases in 2005
  • 591,776 total cases in 2010
  • 678,383 total cases in 2014

What kind of treatment do ESRD patients receive?

Looking at the entire population of patients with end stage renal disease, about two-thirds are on hemodialysis – usually received in a dialysis center.   Another seven percent are on peritoneal dialysis.  The balance (30 percent) have received a kidney transplant.  These percentages are based on 2014 data.

Geographic differences

There are substantial differences in the incidence of kidney failure in different parts of the country.  Areas with the highest rates of new end stage renal disease patients include Texas and Southern California, while New England states have the lowest rates.

Source: United States Renal Data System. (2016). Incidence, prevalence, patient characteristics, and treatment modalities. In Annual data report 2016: Epidemiology of kidney disease in the United States. (Vol. 2, Chapt. 1). Ann Arbor, Michigan: USRDS Coordinating Center. Click here for free full text https://www.usrds.org/adr.aspx  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

 

CANCER: 5-year survival rate improves in recent decades

Survival improved substantially over this time period for both whites and blacks overall (all sites) and for almost all cancer types…”

The overall five-year survival rate for cancer patients has improved in the past 40 years, according to national data in this fact-packed, scholarly article.

Looking at the more treatable cancers, here are the top five with the highest survival rates, based on recent data:

  • Prostate (99.3 percent five-year survival rate)
  • Thyroid (98.3 percent)
  • Skin (93.2 percent)
  • Breast (90.8 percent)
  • Uterine (83.4 percent)

Source: Jemal, A., and others. (2017). Annual report to the nation on the status of cancer, 1975-2014, featuring survival. Journal of the National Cancer Institute, 109(9).  Click here for free full text: https://academic.oup.com/jnci/article-lookup/doi/10.1093/jnci/djx030  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

POPULATION HEALTH: How many diabetics in 2030?

The team finds that in spite of medical advances and prevention efforts, diabetes presents a major health crisis in terms of prevalence, morbidity, and costs, and that this crisis will worsen significantly over the next 15 years.

An estimated 54.9 million people will have diabetes in the U.S. in the year 2030, compared to 35.6 million in 2015, according this study from the Institute for Alternative Futures.  This represents a 54 percent increase.  The prevalence of diabetes will represent a cost to the nation of over $622 billion in 2030 (calculated in 2015 dollars), up from roughly $408 billion in 2015.  Maps included in the article show some clustering projected for 2030 – states with higher proportions of diabetics are in the southeast, southwest, and Rust Belt regions.

Source: Rowley, W.R., and others. (2017, February). Diabetes 2030: Insights from yesterday, today, and future trends. Population Health, 20(1), 6-12.  Click here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5278808/pdf/pop.2015.0181.pdf.  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

POPULATION HEALTH: Trends in heart disease and cancer death rates by county shows geographic clusters in U.S.

Thirty years ago researchers first noted an ‘enigma of the Southeast’ with high mortality rates in that region, often due to stroke, and a range of possible causes including environmental exposures related to coal and metal mining, housing and population density, and access to health care.”

Death rates from different types of cardiovascular disease and 29 types of cancer were studied at the county level for the entire U.S. in these related articles out of the University of Washington’s Institute for Health Metrics and Evaluation.  Extensive variation was found in death rates between counties and some degree of clustering was found.  For example, there is a cluster of counties with high death rates from ischemic heart disease on a line between central Oklahoma and eastern Kentucky and also along the Mississippi River valley – although there were also counties with high mortality in other parts of the country.  Death rates from stroke and hypertension were found to be concentrated in the South.  Counties with higher rates of breast cancer death were found to be along the Mississippi River and in the South.  High death rates from lung and related cancers were found to be clustered in Kentucky and West Virginia.  Again, in each of these categories, there are also counties with high mortality rates in other parts of the country.

NOTE: There is also information in these articles about areas of the country where the mortality rates were found to be unusually low.

Sources:

Roth, G.A., and others. (2017, May 16). Trends and patterns of geographic variation in cardiovascular mortality among US counties, 1980-2014. JAMA, 317(19), 1976-1992. Click here: http://jamanetwork.com/journals/jama/fullarticle/2626571?resultClick=3

Mokdad, A.H., and others. (2017, January 24). Trends and patterns of disparities in cancer mortality among US counties, 1980-2014. JAMA, 317(4), 388-406.  Click here: http://jamanetwork.com/journals/jama/fullarticle/2598772  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

POPULATION HEALTH: Are these battles winnable?

An estimated 400,000 people quit smoking between 2012 and 2016 – one of the successful initiatives of the “Winnable Battles” campaign begun by the Centers for Disease Control and Prevention in 2010.  The outcomes of this program five years later are reviewed in this report and summarized in the JAMA article.  The idea was to target a carefully-chosen set of public health issues and then devote federal, state and local resources to improving them.

Here is a summary of what happened five years on:

  1. Clear success in decreasing adult and teen smoking
  2. Likewise, exceeded the target in decreasing teen pregnancies
  3. Making good progress on most measures of reducing healthcare-associated infections – except catheter-associated urinary tract infections
  4. Slow progress on measures related to nutrition, exercise, obesity
  5. Slow progress on reducing foodborne illness
  6. Slow progress on reducing motor vehicle deaths
  7. Mixed results on measures related to HIV

Sources:

Winnable battles: Final report. (2016, November). Atlanta: U.S. Centers for Disease Control and Prevention. Click here: https://www.cdc.gov/winnablebattles/report/docs/winnable-battles-final-report.pdf; and, Frieden, T.R., Ethier, K., ad Schuchat, A. (2017, February 2). Improving the health of the United States with a “winnable battles’ initiative. JAMA. Click here: http://jamanetwork.com/journals/jama/fullarticle/2601246  Posted by AHA Resource Center (312) 422-2050, rc@aha.org