Teresa Cutts and Gary Gunderson have weighed in on a health evaluation controversy. A new National Academy of Medicine’s NAM Perspectives commentary expounds on the difficult, “messy” work of community-level interventions to improve population health, and how these necessarily complex interventions are also challenging to evaluate through traditional means. The authors call for continued investment in and focus on these types of interventions, however, as they impact “human neighborhoods that are alive and worth the trouble.”
The NAM Perspectives provides a venue for leading health, medical, science, and policy experts to reflect on important issues and opportunities.
Evaluating “Hotspotting” and beyond
Authors Teresa Cutts, of Wake Forest School of Medicine, and Gary Gunderson, of Wake Forest School of Medicine and Wake Forest Divinity School, believe nothing is more important than understanding how to value the investments of time, attention, and money that are made in the name of improving the health of communities. And a prime example is the “hotspotting” effort:
Jeffrey Brenner was a young physician who rode with his local police department in 2011 to what police called crime “hot spots” in Camden. Brenner noticed overlap with addresses of patients he knew were incurring high costs of care at the four local hospitals, so he set about trying to understand why this intersection was so clear to him and not many others. Data points in other neighborhoods conveyed the same obvious message—encouraging many hospitals to pay consultants to look at their own data and see if their high-needs patients overlapped with crime hot spots or other patterns.
in January of this year, the New England Journal of Medicine presented a paper that questioned the hot spot efforts in reducing readmission rates to hospitals.
“This is not an intellectual snit,” says Gunderson. “When the New England Journal of Medicine lends its prestige to a very narrowly defined evaluation methodology, we realized that it would dramatically undercut the support for and investment in others similar complex projects.”
“Camden is the ionic flagship of a complex approach to underlying community needs. If you’re going to do complex work you need to do complex evaluation.”
“The menu of possible creative actions represents many things being tried and adapted continuously,” say the authors. They continue:
Some work, some do not, and some work in surprising ways, so every kind of evaluation is valued. Just because community-based approaches do not meet more traditional means of measuring success… does not mean they should be discarded—a complex problem is best solved by a complex approach, which can be difficult to measure accurately and comprehensively.