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Bridging the Gap Between Primary Care, Public Health

March 5, 2014
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‘Practical Playbook’ offers resources, concrete examples of collaboration

In 2012 the Institute of Medicine issued a report focusing on the need to better integrate primary care and public health efforts to improve population health. That report spurred several organizations to come together to create a web-based resource called the Practical Playbook, which was officially launched in Washington, D.C., this week.

Leading the charge are the Centers for Disease Control and Prevention (CDC), Duke Community and Family Medicine in North Carolina, and the de Beaumont Foundation, a grant-making organization focused on building public health capacity, especially through the use of technology. The Practical Playbook was designed as a Web-based resource to provide clinicians and public health officials with tools and strategies to support a variety of integrated models for improving population health.

I had the chance Tuesday to speak briefly with Denise Koo, M.D., M.P.H., senior advisor for health systems in the Office of Public Health Scientific Services at the CDC, and Brian Castrucci, chief program and strategy officer at the de Beaumont Foundation.

Dr. Koo has held several leadership positions at CDC, including chief of the National Notifiable Diseases Surveillance System, director of the Division of Public Health Surveillance and Informatics, and director of the Division of Applied Public Health Training. “The IOM report was valuable at describing the high-level issues," she said, "but there was a need for more practical examples and some regional success stories to showcase,” such as the close working relationship between Duke Community and Family Medicine and Durham County, N.C., as well as the State of North Carolina on issues such as pediatric asthma and hypertension.

Castrucci talked about the importance of leveraging public health data in a timely way to help clinicians address chronic illnesses. There is a need to use the electronic health records in physicians’ offices and to have the benefit be bi-directional. “We know that barriers exist, but we have to start pushing health forward by using the data we have,” he said. For instance, pediatricians are entering height and weight data every time children come in for a visit, he said. Public health officials would find that data valuable in combating childhood obesity.

“Or let’s say there are four primary care providers in one neighborhood, each with four children experiencing breathing problems as patients,” he explained. Today, those four doctors and 16 patients are likely on four different networks and there is no way to see that 16-person cluster. “If public health officials could see all 16, they might find that the students all go to the same school and ride the same bus. After an investigation, they might find they are breathing a toxin and realize there is a crack in the tailpipe of that bus.” That could be fixed very inexpensively as opposed to the hundreds of thousands of dollars spent on treating those patients, Castrucci said. “But to do that, we need access to that information.”

Public health officials often can add value by “triangulating” provider data with other data sets such as environmental data that they have access to, Dr. Koo noted.

The web site is full of success stories involving partnerships between primary care and public health. For instance, the Healthy Futures program in Traverse City, Mich., provides expectant mothers with everything they need to offer their children a healthy beginning. The program involves collaboration between Munson Medical Center, local health departments, and health care providers. Thanks to Healthy Futures, 99 percent of participating newborns and children have a primary care provider, according to Practical Playbook.

In New Mexico, the Health Extension Rural Offices (HEROs) program links community priority health needs with resources from the University of New Mexico's Health Sciences Center to achieve measurable improvement in health status. The initiative, modeled after the Agriculture’s Cooperative Extension Service, is co-led by the New Mexico State University and the Department of Health. Currently 10 HEROs serve 33 counties, and the state of New Mexico is interested in rapidly expanding this capacity.

Dr. Koo said the Office of the National Coordinator for Health IT should be applauded for including public health standards involving cancer registries, electronic lab reporting, immunizations and syndromic surveillance. She added that public health has to be at the table when all the quality metrics are discussed for an array of quality reporting programs, including those for accountable care organizations.

“ONC and meaningful use are useful in terms of standards and requirements, and we need those,” Castrucci said. But communities need to think in terms of health outcomes they want to achieve. “Then they can work on deciding how to get there, and part of that is sharing data. They may ask hospitals to show every inpatient diabetic last night or every pediatric asthma ER visit. But you need both the technology and a holistic view of what you want to achieve.”