Population health management and its relevance to community nurses

Population health management (PHM) is a data-based approach to identify the current and future health and care risks of the local population. The Social Care Institute for Excellence (2018) describes PHM as a methodology to put together a comprehensive understanding of population health needs by joining up data about:

These four areas combine to provide comprehensive baseline information about the locality in terms of health and other challenges faced by residents. This is then analysed to gain further understanding about current and future needs by segmenting the data broadly along the following lines:

Factors associated with success are high-quality local data and effective information management systems. The statistical analysis used to model future projections must be robust and supported by credible algorithms that incorporate tacit knowledge from service users and professional staff involved in care delivery. When modelling future demand, allowance must be made for levels of uncertainty, and scenario plans should model the possible interactions of various parameters with audit trails of the assumptions made.