Defining Value in Population Health: Evaluating Program Impact and Outcomes; Investigating the Forces Behind Food Insecurity: A Comparative Analysis of the United States and Finland

My technical report details my capstone team’s efforts to create a framework for defining the value of Interactive Home Monitoring (IHM), a program housed within the Population Health Department at University of Virginia (UVA) Health. The purpose of IHM is to provide post-discharge care for UVA Hospital patients, with remote vital signs monitoring and/or phone call check-ins being the core activities of the program. The objective of IHM at the health system level is to reduce readmissions and non-critical emergency department (ED) visits. However, currently, there is no defined methodology for proving that IHM accomplishes its purposes.
Our team sought to make progress towards solving this problem by conducting value analysis using available data and by recommending new data to be collected. To define the value of IHM, we used existing quantitative data collected by the program. Rates of readmission, length of stay (LOS), and ED visits were compared between IHM-enrolled patients and comparable non-enrolled IHM-eligible patients using Python and R, with a Mann-Whitney test as the method of statistical analysis. It was found that the differences in readmissions, ED visits, and LOS were statistically significant between the two populations. These improved metrics prove the value of IHM. Additionally, Social Determinants of Health (SDOH) screening data was used to determine which flagged SDOH domains had the highest risk of having worsened rates of readmission, LOS, or ED visits, and it was found that these domains were housing risk, food risk, interpersonal safety risk, depression risk, and utilities risk. Therefore, we recommended that health professionals connect patients to more resources that target these domains.
To define the value of IHM, we also conducted qualitative interviews with key stakeholders, including the program director, enrolled patients, and involved health professionals. Conventional content analysis was performed on the interview data using Dedoose, with no predetermined theories. During these interviews, the top three recurring themes were that IHM provides continuous monitoring, IHM connects patients to resources, and IHM reduces readmissions. These findings added more detail to our findings of value.
To improve the definition of value of IHM, we recommend that data collection be expanded to include new metrics such as patient emotional support, continuous monitoring of patients, and patient health literacy. Collecting more data will assist the IHM team in evaluating all aspects of the program. Additionally, this research can be used to inform the development of evaluation frameworks for other population health programs, with adjustments made as appropriate to the activities of the specific program.
My STS research paper is related to the topic of population health, since its objective is to analyze the reasons behind the nutritional well-being of the population of the United States and that of Finland, a nation that is ranked highly in terms of food security. By analyzing the situation of Finland, recommendations can be made on how to increase food security in the United States. In my STS research, I found that those who are a member of a disadvantaged group in society, such as the economically disadvantaged, the chronically ill, and/or historically discriminated against racial groups, are at higher risk of becoming food insecure while struggling financially, both in the United States and in Finland. However, Finland has unique aspects of its dietary culture that promote nutritional well-being. For example, although the Finns consume considerably more coffee than Americans, the coffee that they drink is largely free of additives such as sugar and milk. To improve the nutritional situation of the United States, I conclude that the culture around food in the United States must change as well. Improving nutrition is important because it is a part of achieving holistic health and well-being, which is a central theme of my technical research as well.

School of Engineering and Applied Science

Bachelor of Science in Systems Engineering

Technical Advisor: Rupa S. Valdez and Jose A. Valdez

STS Advisor: Karina Rider

Technical Team Members: Zeena H. El-Mufti, Grace M. Fry, Allison J. Gregory, and Rachel J. Huh