By Sarianne Gruber
Twitter: @subtleimpact
Having once been a graduate student in Epidemiology and Public Health, certain books still remain my bookshelf as iconic references for studying disease and our healthcare system. There is the bright orange, soft covered, Foundations of Epidemiology by the father and son team Abraham M. Lilienfeld and David E. Lilienfeld, a relic from the required reading list. Reviewing chapters on retrospective, cross-sectional and prospective studies with classification tables and relative-risk calculations, all has a vague familiarity to reading a Girl Scout handbook before going on an overnight camping trip. The study design you select, the sample size you determine, the conceptual hypothesis for the study plus the rationale for conducting the research, the selection of subjects and the measure of disease status, all demands a well-thought out plan and creates a distinct anatomy of the epidemiological study. Each study type is consistent with specific conditions otherwise the associations between variables could be spurious. There is a lot of value to understanding the basic concepts, principles and methods of population-based epidemiologic research within the framework of managing patient panels, communities of patients and preventing disease.
An Iconic Population Health Study: The Framingham Heart Study
In 1948, the Framingham Heart Study, a cornerstone study of Population Health, was initiated by the National Heart Institute and Boston University. Participants included 5,209 men and women between the ages of 30 and 62 from the town of Framingham, Massachusetts. All the volunteers had baseline physical examinations and lifestyle interviews. A follow-up visit would take place every two years, where detailed medical histories, physical examinations and lab tests were taken. In 1971, a second generation of 5,124 of the original participates’ adult children and their spouses joined the study. Then in 1994, a new study commenced with a more diversified population of participated. It has become a prototype for other epidemiological studies around the world; it is among the most cited references in medical literature. Over the years, the findings have led to the identification of risk factors including high blood pressure, high cholesterol, smoking, obesity, diabetes and physical inactivity.
Starting with the Physician Practice: Taking on Population Health
Dr. Thomas Royle (Roy) Dawber, the legendary founder of the Framingham Heart Study, was head of his time ,a pioneer in the practice of population health management. He was not a traditional epidemiologist; his primary interested was in providing information that could be directly useful to –prevention-minded doctors in practice. He viewed epidemiology clinical investigation on a community level. The citizens of Framingham volunteered in the study for over more than five decades. Hard to imagine, but this study was conducted without the use electronic health records and electronic data warehouses. The success of the Framingham Study was in gathering information on the prevalence, incidence, clinical manifestations and predisposing risk factors that could lead to heart disease and cardiovascular disease. Expanding and beginning programs designed for population health surveillance for CHD, diabetes and other chronic disease risk factors. The Heart of New Ulm Project at the Minneapolis Heart Institute is a large 10-year intervention designed to reduce the incidence of myocardial infarction and improve heart disease. Dr. Dawber passed ten years ago in 2005. Yet, today’s EHRs, longitudinal records, are a documentation tool for individual patient-provider encounters. The potential exists to serve as a tool for managing the health of communities is just starting to be realized with more epidemiological studies in the future.