What Is Population-Based Care?

Healthcare has its share of buzzwords. Population health, while not new, is getting a lot of attention today. A Google search returned about 775,000,000 results for "population health." At 446,000,000 results, "population-based care" was not far behind.

The Triple Aim is one reason these terms are everywhere. One goal of the Triple Aim is to improve the health of populations. Nurses spend the most time with patients, and they are being called on to help achieve the nation's population health goals.

Earning a Bachelor of Science in Nursing (BSN) can help RNs develop the skills for population-based care. For example, the online RN to BSN program at the University of New Mexico (UNM) includes several courses that emphasize population health competencies.

What Is Population Health All About?

Nurses work with patients of every age. They might focus on geriatric or pediatric care, for example. In pediatrics, they might further specialize with newborns, neonates and adolescents. Age groups are one aspect of population health.

Population health is about improving the health outcomes of particular groups. The Health Resources and Services Administration (HRSA) report "Preparing Nurses for New Roles in Population Health Management" uses the following definition of population health: "The health outcomes of a group of individuals, including the distribution of such outcomes within the group."

Population-based care involves identifying risk factors for certain patient populations. Looking at the risk of flu complications across age groups is one example.

Adults 65 and over are at a higher risk for serious complications from flu than young, healthy adults, according to the Centers for Disease Control and Prevention (CDC). Benefits of increasing the flu vaccine rate for this age group mirror the Triple Aim.

  • Improved patient outcomes: Flu patients 65 and older are likely to have a shorter ICU stay than unvaccinated adults in this age group. They are also less likely to die.
  • Improved population health: Influenza is a leading cause of death in the U.S. Reducing vaccine-preventable diseases is a public health goal.
  • Reduced healthcare costs: According to MarketWatch, flu costs for hospitalization and other medical expenses reach an average of $10.4 billion a year. Prioritizing vaccination can result in cost savings.

How Does Population Health Relate to Health Disparities?

The CDC describes health disparities as "differences in health outcomes and their causes among groups of people." Health equity, according to the Robert Wood Johnson Foundation, is when everyone has a "fair and just opportunity to be as healthy as possible."

Health disparities are often linked to social, economic and environmental differences. Examples include:

  • Country of birth
  • Disability status
  • Family income
  • Education level
  • Race and ethnicity
  • Veteran status
  • Geographic location

Geographic location impacts the health of populations for various reasons. People in rural areas tend to skew older and have lower socio-economic status. Rural areas may have more limited employment opportunities than urban areas. Access to primary care is another issue.

The National Rural Health Association reports that the patient-to-primary care physician ratio in rural areas is only 39.8 physicians per 100,000 people. In urban areas, this jumps to 53.3 physicians per 100,000. Getting to the nearest healthcare provider may mean more travel time and higher costs. As a result, people living in rural areas may not get the healthcare they need at the right time.

For pregnant women, the challenge may be even greater. The Centers for Medicaid and Medicare Services report that nearly 50% of all rural counties in the U.S. do not have a hospital that provides obstetric care. For 10% of women in rural areas, access to maternal healthcare may be 100 or more miles away.

According to the CDC, people living in rural areas are:

  • More likely to die from heart disease, cancer, unintentional injury, chronic lower respiratory disease and stroke than urban residents
  • About 50% more likely to die from unintentional injuries than residents in urban areas, including from motor vehicle accidents and opioid overdoses

A population health approach can reduce health inequities to improve outcomes for vulnerable populations.

How Can a BSN Program Prepare RNs for Population-Based Care?

The benefits of earning a BSN are well-established. According to the American Association of Colleges of Nursing, research shows that associate- and diploma-level nurses strengthen professional-level skills by earning their BSN.

RNs who go on to earn their BSN take coursework that prepares them for new roles in nursing, including those in population health. Examples of courses from UNM's RN to BSN program are:

  • Nursing in the Community: Students explore community-oriented population nursing practice with a focus on health promotion, risk reduction and disease management.
  • Care of Vulnerable Populations: This course focuses on nursing roles that address the health needs of population groups at risk for health disparities.
  • Health Policy, Economics, and Systems: Students examine how policies influence organizational responses to issues of healthcare equity, access and affordability.

Because of their prominent role in healthcare, RNs are well-positioned to help the nation eliminate disparities to improve the health outcomes of all groups. As the Robert Wood Johnson Foundation puts it, "Our nation has never had a greater need for investment in public and population health, and nurses are uniquely suited to play a major role."

Learn more about UNM's online RN to BSN program.


Institute for Healthcare Improvement: Initiatives

National Advisory Council on Nurse Education and Practice: Preparing Nurses for New Roles in Population Health Management

CDC: People at High Risk for Flu Complications

CDC: New CDC Study Shows Flu Vaccine Reduces Severe Outcomes in Hospitalized Patients

Health IT Analytics: Adult Vaccine Project Produces Population Health Best Practices

MarketWatch: This Year's Flu Season Could Be the Deadliest in Years — and the Most Expensive

CDC: Strategies for Reducing Health Disparities

Robert Wood Johnson Foundation: What Is Health Equity?

National Rural Health Association: About Rural Health Care

Centers for Medicare and Medicaid Services: Improving Access to Maternal Health Care in Rural Communities

CDC: About Rural Health

American Association of Colleges of Nursing: The Impact of Education on Nursing Practice

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