Population Health

On Feb. 7, public officials and healthcare IT leaders gathered in Manhattan to celebrate the ongoing success of a New York City IT initiative. Among those speaking were New York City Mayor Michael Bloomberg, National Coordinator for Health IT Farzad Mostashari, M.D., and CDC Director Thomas Frieden, M.D.

Jane Brock, M.D., the chief medical officer of the Colorado Foundation for Medical Care, that state's Medicare quality improvement organization, discusses recent research-driven learnings around what makes for successful forays into improving care transitions-and the IT leveraging that will need to take place in communities nationwide.

Leaders at the American Health Quality Association recently showcased the release of an article published in the Journal of the American Medical Association (JAMA) that documented an impressive decline in avoidable hospitalizations and readmissions among Medicare patients in communities in which Quality Improvement Organizations (QIOs) have coordinated interventions that engaged whole communities in care improvement.

An interdisciplinary team of clinicians, informaticists, and quality experts at NorthShore University HealthSystem, Evanston, Ill., has taken a major step in controlling this disease in its outpatient population, by harnessing its electronic health record (EHR) to screen for and evaluate individuals with previously undetected hypertension in its multi-specialty medical group. The system, which went live in January 2011, has helped the integrated health system make significant progress in eliminating undiagnosed hypertension among its patients receiving care within its primary care network.

Leaders at the Colorado Beacon Consortium are leveraging powerful analytics and health information exchange tools to support region-wide, physician practice-based population health tools, for the benefit of patients scattered across the Rocky Mountain west.