Shared Language for Shared Work in Population Health.

People working on behalf of population health, community health, or public health often experience confusion or ambiguity in the meaning of these and other common terms-the similarities and differences and how they bear on the tasks and division of labor for care delivery and public health. Shared language must be clear enough to help, not hinder people working together as they ultimately come to mutual understanding of roles, responsibilities, and actions in their joint work. Based on an iterative lexicon development process, the authors developed and propose a definitional framework as an aid to navigating among related population and community health terms. These terms are defined, similarities and differences clarified, and then organized into 3 categories that reflect goals, realities, and ways to get the job done. Goals include (a) health as well-being for persons, (b) population health as that goal expressed in measurable terms for groups, and (c) community health as population health for particular communities of interest, geography, or other defining characteristic-groups with shared identity and particular systemic influences on health. Realities are social determinants as influences, health disparities as effects, and health equity as both a goal and a design principle. Ways to get the job done include health care delivery systems for enrollees and public health in population-based civic activities-with a broad zone of collaboration where streams of effort converge in partnership with served communities. This map of terms can enable people to move forward together in a broad zone of collaboration for health with less confusion, ambiguity, and conflict.

Perceived Influence of Medical Students' Community Health Assessment Projects.

BACKGROUND AND OBJECTIVES: To achieve overall health, physicians must understand how community and population health impacts individual health. Although several US medical schools have incorporated community health assessment project requirements into traditional curricula, examples in longitudinal integrated clerkships are unknown. This study was designed to assess alumni perceptions of the influence of community health assessment projects, a core component of the University of Minnesota Rural and Metropolitan Physician Associate Program's (RPAP/MetroPAP) 9-month longitudinal integrated curriculum. METHODS: This 2018 study consisted of a descriptive cross-sectional survey of 480 RPAP/MetroPAP alumni who completed 457 community health assessment projects between 2004/2005 and 2016/2017. The authors administered a 14-item survey requesting date and location of RPAP/MetroPAP 9-month placement, name of project, source of project idea, and perception of project influence on professional activities. Quantitative data were collected using 4-point Likert scales. We collected qualitative data with open text boxes. RESULTS: The survey response rate was 42.29% (203/480). A key finding was alumni perceived project ideas arising from community partners had greater impact on their acquisition of several community engagement skills. One-half reported projects influenced their professional activities, evidenced by ongoing community engagement, interest and participation in public health and preventive health initiatives, efforts to learn about specific health issues, social determinants of health and patient advocacy. CONCLUSIONS: This exploratory study suggests medical student community health assessment projects enhance community engagement and soliciting project ideas from community partners increases student acquisition of community engagement skills.

How Your Smartphone or Tablet Can Make You a Smarter Doc.

Increasingly, physicians and medical students are integrating apps that run on smartphones and tablets into their clinical work. This article describes a small anecdotal study of app use among third-year University of Minnesota medical students and their faculty preceptors. We describe apps used by the students and physicians we interviewed and offer guidance for choosing apps that are reliable, useful and up to date.

Case series of 148 tongue-tied newborn babies evaluated with the assessment tool for lingual frenulum function.

OBJECTIVE: the Assessment Tool for Lingual Frenulum Function (ATLFF) is the only available tool designed to assess newborn babies for the severity of tongue-tie. The aim of this study was to describe the ATLFF scores obtained on a series of 148 tongue-tied newborn babies. DESIGN: prospective case series. SETTING: a 420-bed community hospital in St. Paul, Minnesota, USA. PARTICIPANTS: newborn babies admitted to the normal newborn nursery from October 1, 2000 to May 1 2002. MEASUREMENTS AND FINDINGS: all babies in the nursery were examined for tongue-tie. One-hundred and forty-eight tongue-tied babies were examined using the ATLFF by at least one of three examiners. The ATLFF could not be completed on five babies. Of the remaining babies, 40 (28%) received 'perfect' scores, five (3.5%) received 'acceptable' scores, and 19 (13.3%) received 'function impaired' scores. The remaining 79 (55.2%) babies received scores that did not fall into any of the three categories of scores. The inter-rater agreement on whether or not the baby had a score of 'function impaired' on the ATLFF was moderate (kappa=0.44). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: few tongue-tied babies had a score of 'function impaired' on the ATLFF. It is a major limitation of the ATLFF that it does not classify most babies. The development and testing of a useful tool to determine which tongue-tied babies will have difficulty with breast feeding remains a research priority.

Newborn tongue-tie: prevalence and effect on breast-feeding.

OBJECTIVE: The purposes of this study were: (1) to determine whether breast-fed infants with tongue-tie have decreased rates of breast-feeding at 1 week and 1 month of age, (2) to determine the prevalence of tongue-tie, and (3) to test the usefulness of the Assessment Tool for Lingual Frenulum Function (ATLFF) in assessing the severity of tongue-tie in breast-feeding newborns. METHODS: A case-control design was used. All infants in the Regions Hospital newborn nursery were examined for tongue-tie. Tongue-tied babies were examined using the ATLFF. Two breast-feeding babies with normal tongues were identified and matched for each case. Mothers were interviewed when the babies were 1 week and 1 month old. RESULTS: The prevalence of tongue-tie was 4.2%. Forty-nine tongue-tied and 98 control infants were enrolled. Tongue-tied babies were 3 times as likely as control babies to be bottle fed only at 1 week [risk ratio (RR), 3.11; 95% confidence interval (CI), 1.21, 8.03) By 1 month, tongue-tied babies were as likely as controls to be bottle fed only. (RR, 1.00; 95% CI, 0.55, 1.82) Twelve of the tongue-tied infants had ATLFF scores of "Perfect," none had scores of "Acceptable," and 6 had scores of "Function Impaired." The remaining 31 infants had scores that fell into none of these categories. CONCLUSIONS: Tongue-tie is a relatively common condition in newborns. Affected infants are significantly more likely to be exclusively bottle-fed by 1 week of age. The ATLFF was not a useful tool to identify which tongue-tied infants are at risk for breast-feeding problems.

Use of clinical indicators to evaluate COPC projects.

BACKGROUND: In 1989, Ramsey Family and Community Medicine Residency adopted a population-based focus for teaching and clinical activities based on the principles of community-oriented primary care (COPC). Evaluation and outcomes measurement proved problematic for each of the five COPC projects we implemented. METHODS: Surrogate measures, or key clinical indicators, were used to monitor the following COPC projects at Ramsey Family Physicians clinic: preschool immunization, family-centered birth, intimate interpersonal violence, teenage pregnancy-sexually transmitted disease prevention, and human immunodeficiency virus (HIV) screening. RESULTS: Between 1995 and 1998, we documented a decline in preschool immunization rates, an increase in preterm births and low-birth-weight infants, improved intimate interpersonal violence screening, a high but stable teenage pregnancy rate, a decrease in teenage chlamydia rate, and improved HIV prenatal screening. Our data collection and analysis were complicated by a lack of relevant indicators related to target goals, a shifting denominator, incomplete data and an unstable numerator, disconnected data sources, and missing comparison data. CONCLUSIONS: COPC project evaluation is an evolving process, and measurement deficiencies become recognized with time. Even so, outcomes measurement legitimizes COPC interventions and provides a value-added component to resident education and clinical activities.