Three-Step Approach To Selecting Population Health Interventions

In this article series, part one covered reasons why population health management (PHM) adoption is accelerating and ways healthcare organizations can mature their data PHM data models. Part two addresses robust data analytics to deliver new levels of population health value. We wrap up this three-part series by exploring ways to research, strategize, and choose evidence-based interventions for a population health initiative.

Choosing PHM intervention framework

There are a number of PHM intervention frameworks. Some, like one shared at the American College of Healthcare Executives' Congress on Health Leadership, focus on several types of interventions. These include disease management, catastrophic care management, demand management, disability management, lifestyle management, and integrated care management. Other frameworks, like the Public Health Intervention Wheel created by the Minnesota Department of Health (MDH), divide health activities by whether they are systems-focused, community-focused, or individual-focused.

Yet, no matter what PHM intervention framework you work with, choosing the best interventions for your program, population, and goals takes a thoughtful approach. We suggest a three-step approach that guides you through strategy, research, and selection.

Three-step approach to selecting the highest impact PHM intervention

The goal of any intervention is to enable action and create positive change for the least amount of resources in cost and time.

Intervention strategy

Program or cohort goals is the foundation of an intervention strategy. What types of overarching and quantifiable goals do you want to achieve -- health outcomes, population metrics, quality scores, utilization or cost? What is the nature of the type of impact do you want to see from interventions, individually and collectively?

These goals and priorities provide performance targets for interventions. They anchor the initiative and drive the next step.

Intervention research

The search for the right intervention takes concerted effort, considering that the National Institute of Health (NIH) clinicaltrials.gov have nearly 10,000 studies for public health and nearly 65,000 studies for population health as related topics. Of these, over 6,000 specifically call out population health management intervention.

While the NIH site is a robust source for evidence-based intervention research, there are many resources, including this sampling:

The Community Guide - The Guide to Community Preventive Services (aka The Community Guide) is a collection of evidence-based findings of the Community Preventive Services Task Force (CPSTF), which is made up of 32 liaison organizations. With more than 25 years of evidence-based findings for population health, The Community Guide provides efficacy information for interventions in over 20 conditions and topics. For example, they provide What Works fact sheets for 14 health issue with coded findings like this one on what they have found that works for mental health.

Health People 2030 – Published by the Office of Disease Prevention and Health Promotion (ODPHP), these evidence-based resources include reviews of studies and interventions. They are organized into health conditions, health behaviors, populations, systems and settings, as well as SDoH. An example includes screening guidelines for gestational diabetes.

National Association of County and City Health Officials (NACCHO) Toolbox - Members of the public health community share tools and toolkits that they have used and assessed for a host of issues and conditions. Registered users can also use and review interventions and provide feedback.

Programs That Work is an archived document from the Proven Program Network (PPN), which was operated by the RAND Corporation from 2014-2019. The summary highlights programs and practices proven through evaluation or have shown promise to improve outcomes for children and families.

Effective Health Care Program – The Agency for Healthcare Research and Quality (AHRQ) has evidence-based practice centers that publish systematic review of studies, collections within healthcare themes, research protocols, and key questions.

Database of Interventions: The Centers for Disease Control and Prevention (CDC) offers an online collection of interventions grouped by four action areas – socioeconomic, physical environment, health behaviors, and clinical care.

Depending on the amount of time dedicated to research, availability of internal evidence around interventions, or other professional associations and journals that offer interventions to consider, these sources offer many options for conducting intervention research.

Intervention selection

Evidence-based interventions have demonstrated the kind of outcomes you want to achieve. But, how do you make decisions about which level of evidence is required for the interventions you're considering?

The Minnesota Department of Public Health offers a five-level model for assessing the level of research involved in an intervention:

• Level 1 - Experimental studies, which are randomized controlled trials (RCT) or systematic reviews of RCTs.
• Level 2 - Studies with quasi-experimental designs, which could include systematic reviews of mixed RCTs and quasi-experimental studies or solely quasi-experimental studies.
• Level 3 - Studies with non-experimental designs that include qualitative studies and surveys or systematic reviews of non-experimental studies that may include RCTs and quasi-experimental studies.
• Level 4 - Clinical practice guidelines, consensus panels or position statements.
• Level 5 - Literature reviews, quality improvement evaluations, program evaluations, case reports or expert opinion in published or programmatic documents.

When researching and assessing possible interventions, consider the type and level of scientific rigor involved. Another category of intervention merits discussion as well.

Best practices approach

In an article in the Journal of Public Health Research, scientists from Oxford and the World Health Organization (SWHO) suggested that a best practice approach can be a reasonable and appropriate for PHM interventions. “Similar to clinical medicine, evidence-based public health emphasises proof of efficacy, so that scarce resources are efficiently utilised on interventions which have been shown to bring about desired outcomes, and that benefits outweigh harm for both individuals and society." However, the authors posit that many sources of evidence may be considered in choosing the right intervention.

Because the quality of evidence is often judged solely by the internal validity of study designs as RCTs, there is “growing awareness of the importance of demonstrating effectiveness in actual programme settings, on top of efficacy."

Interventions can be viable based on real-world considerations like interactions between contextual factors and the intervention to ensure feasibility, or external validity, as well as assessments beyond simple individual-based interventions. Factors that can support effectiveness and impact include social determinants of health (SDoH), the ease with which professionals can deliver the interventions, and how accessible resources are.

The researchers consolidated any previous best practice selection criteria that they found into a model of eight factors within three categories as shown below:

Ng E, de Colombani P. Framework for Selecting Best Practices in Public Health: A Systematic Literature Review. J Public Health Res. 2015 Nov 17;4(3):577. doi: 10.4081/jphr.2015.577. PMID: 26753159; PMCID: PMC4693338.

Aligning goals with research and intervention fit

This three-step approach breaks down the process of choosing the best intervention for your needs based on your goals, the availability of intervention options, and the level of evidence required. When brought together, population health management interventions can utilize multiple sources of valuable PHM data, analyze the population health data for maximum insight, and launch the highest-potential intervention for the desired impact.

RTI Health Advance brings together the power of data analytics, digital health, and patient experience to help provider and payer organizations build population health management programs that are mature and aligned with organizational objectives.