Expert Perspective on ‘Precision Population Health’
It is a well-established fact that multiple factors (eg, family history / genetics, clinical care, socioeconomics, lifestyle) contribute to the prevalence and outcomes of cardiovascular disease. Today, a growing body of evidence suggests that there is also a strong relationship between economic indicators (eg, Wealth, prosperity, employment) and cardiovascular disease.
Large-scale demographic studies indicate that improvements in local economic prosperity are associated with relative decreases in cardiovascular mortality rates, ischemic heart disease death rates, and all-cause death rates, regardless of race, ethnicity or gender. Additionally, evidence suggests that living in more prosperous areas is associated with generally higher quality of health care (including better reception of recommended services), lower hospitalization and death rates. and lower per capita health expenditure (including end-of-life care). fresh).
For vulnerable populations living in less prosperous areas, the data shows conditions that are the opposite – and the economic hardship created by COVID-19 has exacerbated the problems. Now could not be a better time for researchers to step up their efforts to better understand the importance of socio-economic variables (e.g., income supplements, local economic opportunities, housing availability, nutrition) and other social determinants of health for defined demographic areas.
It reminded me of an editorial that caught my attention a few months ago. After discussing the above issues in more detail, the authors hypothesized that in the future, “population health precision” strategies and tactics will “exploit the data” to reduce inefficiencies and wasteful delivery of social and support services, better meet the needs of the population. and improve the health of the population by identifying which interventions work for which subgroups of the population in which areas. “
Curious to learn more about precision population health, I contacted one of the authors, James Weinstein, DO, MS. Weinstein considers his clinical specialty (spine surgery) to be one of the main motivators for his involvement in the health of the population. “When 30% of people in the world suffer from back pain, we have a population health problem! Back pain has an interesting impact on health and quality of life. The symptoms are painful and debilitating, and the disease occurs in all demographic segments – every race, gender, economic stratum and level of education. “
In addition to conducting research for the National Institutes of Health (the basic science of pain / function, and fundamental clinical trials on how to advance the health of the people), Weinstein served as President and CEO of Dartmouth- Hitchcock and Director of the Dartmouth Institute for Health Policy and Clinical Practice (home of the Dartmouth Atlas of Health Care, the go-to resource for understanding the continuing variations in the quality and cost of health care delivery in the United States)
How does he view precision health care in the context of population health? Precision medicine has made great strides in the treatment of individual patients; however, as medicine progresses, Weinstein believes that the N = 1 approach can become reality. The ability to aggregate metadata in the cloud and apply sophisticated artificial intelligence (AI) models will lead to more patient-specific treatments with better outcomes within and between populations. Using a precision approach to population health will allow us to design and organize cohorts of “people like me” to focus on subpopulations for improved population studies and N = outcomes 1 more predictable, within and between populations.
As senior vice president of equity and innovation at Microsoft Healthcare, Weinstein now leads the Precision Population Health team. With an explicit focus on equity, the team seeks to improve population health and healthcare delivery by leveraging the potential of big data, advanced machine learning, and inference techniques. causal. The main areas of concentration are:
- Health equity: Use information and tools to assess whether health care is being provided equitably. Support treatment decision tools based on fair trial design. Recognize that the social determinants of health contribute about 60% of an individual’s health. Aim to understand if, when and for whom diagnostic and treatment interventions would be helpful.
- Quality of care: Use methods to adjust patient demographics, geography, and socio-economic factors to avoid suboptimal outcomes associated with over or under treatment. Work with providers, payers, pharmacies, policy makers and patients to assess quality of care and identify areas where improvements can be made.
- Consumer-centric decision tools: Create and transform AI models into easy-to-understand visuals to help patients and providers better understand patient preferences and the most appropriate diagnostic and treatment options. Decision aids fully inform patients of the risks versus benefits of options based on the best available evidence, while fully integrating the patient’s own values / utilities for selecting one treatment over another.
Weinstein quickly recognized Microsoft’s central role and its focus on healthcare. Its platform has enormous potential for surveillance, artificial intelligence, machine learning, diagnostics, and education with a primary interest in finding community-based solutions to promote health equity. Microsoft Teams technology has already demonstrated its value in delivering healthcare (particularly since the emergence of the COVID-19 pandemic), and the company’s ongoing acquisition of Nuance Communications (with critical expertise in voice AI) will be useful for medical applications with Microsoft cloud capabilities. “I hope that with a better understanding of technology, we as a society will continue to develop tools that create better equity opportunities,” he said.
As cities around the world come together around broadband and healthcare platforms, maybe we can turn the curve around. With a quarter of its citizens living in poverty, the challenges of providing accurate population health in a city like Philadelphia will be enormous. But despite that, I share Weinstein’s true optimism about the future.