Why Aren’t There More Population Health Initiatives in Otolaryngology?

A Google Scholar search for “population health diabetes” quickly turns up more than two million articles. “Population health cardiology” points to nearly 1.5 million articles. Search for “population health otolaryngology,” though, and you’ll only receive 640,000 results, including “Independent risk factors for atrial fibrillation in a population-based cohort: the Framingham Heart Study” (the No. 1 result) and “Domestic violence against women: incidence and prevalence in an emergency department population” (result No. 2).

In contrast, the “population health diabetes” articles examine the population health significance of gestational diabetes, health-related quality of life deficits, and the association of health illiteracy with diabetes outcomes. “Population health cardiology” includes articles on hospital readmission of Medicare patients, risk factors for atrial fibrillation, and vitamin intake as a determinant of homocysteinemia in elderly people.

Why are there so few population health articles and initiatives in otolaryngology? According to Kevin Sykes, PhD, MPH, director of clinical research in otolaryngology–head and neck surgery at the University of Kansas Medical Center in Kansas City, “pediatric and family medicine tend to be far ahead of us when it comes to population health because those providers are more interested in a prevention approach rather than a treatment approach.”

As a surgical specialty, otolaryngology has long focused on one-on-one interventions. Patients seek the services of an otolaryngologist when they have a problem they want fixed; otolaryngologists fix it. And although there have been some efforts to improve the otolaryngologic health of particular populations—most notably, the push toward newborn hearing screening—population health research and initiatives are still relatively rare in otolaryngology.

“You don’t see a lot of population health research or initiatives in surgical specialties,” said Elizabeth Calhoun, PhD, MEd, executive director of the Center for Population Health at the University of Arizona Health Sciences in Tucson. “They aren’t preventionists; they’re interventionists.”

But as healthcare moves away from the fee-for-service model of care toward models of care that reward providers for maintaining patient health rather than treating patient illness, there’s an economic incentive to prioritize prevention and population health. Providers and the public are also realizing that social determinants, such as income and access to care, drastically affect health. This realization points to an obligation to adapt treatment to the needs of particular populations.

Population Health Defined

Generally speaking, population health considers the health outcomes of a group of individuals, including the distribution of those outcomes within the group. “You can define a population according to geography, demographic, genetics, or anything else,” Dr. Sykes said.

Population health and public health are closely linked. “Public health involves taking large amounts of data, looking specifically at the health of the population, analyzing contributors to health, and understanding how to prevent disease,” said Steven S. Chang, MD, an otolaryngologist and co-lead of the Cancer Epidemiology, Prevention and Control Research Program at the Henry Ford Health System in Detroit. Vaccination and hearing screenings are two healthcare initiatives that grew out of the public health sciences.

Population health “is a newer buzz-word,” Dr. Chang said. It drills down into the whys that influence health outcomes within a population. “Population health looks at the social determinants that lead to whether a person gets vaccinated or not,” he added. “Is it health literacy? Their understanding of why vaccination is important? Is it transportation?” The answers to those questions are imperative because an intervention that aims to increase vaccination rates by emphasizing the potential harm of infection will never succeed if lack of transportation is the primary cause of sub-par vaccination rates.