Traditionally, physicians have focused on one-on-one care, addressing the needs of the individual patient in the exam room. But thanks to technology and healthcare delivery system changes, that focus is shifting to population health—a method that aims to improve the medical outcomes of groups of individuals in a certain population.
An education module offered via the AMA Ed Hub™ helps medical students, residents and physicians who may not have received training during their medical school years understand this shift toward population health and learn how they can take part in moving it ahead.
The AMA Ed Hub is an online platform that consolidates all the high-quality CME, maintenance of certification, and educational content you need—in one place—with activities relevant to you, automated credit tracking and reporting for some states and specialty boards.
The free online module, “Understanding and Improving Population Health,” is enduring material and designated by the AMA for a maximum of 0.5 AMA PRA Category 1 Credit™. It is one of 13 modules released as part of the Health Systems Science Learning Series.
Learn more about AMA CME accreditation.
Public versus population health
The idea of public health involves actions to ensure a community is healthy, such as educating the public and enforcing health-related laws.
Population health, however, involves actions to improve medical outcomes for specific groups of individuals. For example, a physician practice can target improving outcomes for patients who have high blood pressure, diabetes, or another ailment.
Population health allows physicians to address some of the shortcomings in the U.S. healthcare system, which spends a higher percentage of its gross domestic product on healthcare than other nations, yet lags when it comes to life expectancy and prevention of chronic diseases. It helps by:
- Focusing on wellness instead of sick care.
- Using data more effectively to improve care.
- Engaging patients in their care.
- Coordinating care that was previously siloed and fragmented, something that is easier to do as accountable care organizations and patient-centered medical homes have evolved.
Implementing population health
Population health can involve harvesting data from electronic health records to assess what is going on in a certain part of the patient population. For example, a physician practice could use data to look at which patients had hypertension in the past two years, their blood pressure values, emergency department visits, hospitalizations and more, and put individuals into risk categories. From there, physician practices can:
- Develop a process to follow up with high- and medium-risk patients.
- Create a patient portal.
- Provide patient education brochures and materials in the waiting room.
- Support patients in finding resources to help them make lifestyle changes, such as local exercise programs at the YMCA or senior center.
- Improve continuity of care by assigning patients a nurse care manager or by setting up a community nurse visit.
More help to study health systems science
The AMA has released several books about health systems science including Health Systems Science Review book and Health Systems Science Education: Development and Implementation, both published by Elsevier.
Both books complement the AMA’s 2020 Health Systems Science textbook, which outlines a formal method to teach students how to deliver care that meets patients’ needs in modern health systems. More than 13,000 copies of the first and second editions have been sold worldwide, and it is being used in many medical and health professions schools. A third edition will be published in 2027.
