Medical Journal of Islamic World

Running head: PATIENT CENTERED POPULATION HEALTH IMPROVEMENT PLAN
PATIENT CENTERED POPULATION HEALTH IMPROVEMENT PLAN
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1PATIENT CENTERED POPULATION HEALTH IMPROVEMENT PLAN
Introduction
Implementation of a Public Health Improvement Initiative (PHII) is an effective way with
which the specific healthcare needs and concerns of a population can be identified, assessed,
prevented, treated and managed (Kobernick et al., 2018). The following report will thus,
extensively explore and discuss on the outcome achievements and potential strategies for a
concerned PHII, with respect to a patient, Mr. Nowak, who has presented with symptoms of
hypertension, loss of balance and possible history of traumatic brain injury.
Discussion
Public Health Improvement Plan Outcomes
The PHII whose effectiveness will be evaluated is the one which was implemented by the
non-profit organization, Safe Headspace, as evidenced in the case study by the director, Alicia
Balewa. The concerned PHII targeted combat veterans with either a diagnosed or undiagnosed
history of Post-Traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI), and thus,
demonstrates potential for assisting Mr. Nowak in achieving positive health outcome with
respect to this present complaints.
Outcome Achievement
From the given case study, it can be observed that the key outcomes targeted by the
PTSD and TBI based PHII, are: mood, short term memory and muscle control, across male
combat veterans within the age group of 45 of 80 years of age.
It has been evidenced that, TBI occurs as a result of a unpredictable and excessive
damage to the head resulting in a range of cognitive and psychological symptoms such as, loss of
memory, decreased ability to concentrate or be attentive, sleeplessness, loss of balance,

2PATIENT CENTERED POPULATION HEALTH IMPROVEMENT PLAN
depression or low moods, disoriented or confused states as well as a disturbances in emotional
wellbeing and frequent feelings of irritability (Carney et al., 2017). Likewise, PTSD is associated
with debilitating psychological symptoms which are triggered due to encountering a traumatic or
adverse experience, such as nightmares, sleeplessness, emotional distress, low self-esteem and
depressed moods (Shalev, Liberzon & Marmar, 2017). It is also worthwhile to note that elderly
individuals, due to the physiological process of ageing, encounter a range of musculoskeletal
issues like loss of balance, strength and flexibility which in turn impair muscle movement and
control (Teixeira et al., 2019). Thus, considering the above symptoms associated with the range
of healthcare concerns targeted by the concerned PHII, it can be observed that the outcomes
targeted by Headspace are of relevance.
For the purpose of achieving these targets, the concerned PHII adopted a range of
interventions, namely aerobic exercise, strength training, meditation, psychotherapy, medications
and memory activities like crossword games and Sudoku. Out of the key outcomes targeted by
the given PTSD-TBI PHII, it can be observed that each intervention demonstrated varied rates in
the improvement of mood, memory and muscle control. A key outcome which demonstrated
consistent achievement across all interventions was improved muscle control, in variations like
32% in mediation, 15% in exercise and 4% in resistance training. Likewise, improvements in
mood were observed as 70% during meditation, 22% during exercise and 26% during
psychotherapy and medications. Improvements in short term memory outcomes across
participants were observed in the form of 70% during meditation, 61% in exercise and 6% during
participation in psychotherapy and medication based treatments.

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Contributing Factors
From the above results, it can be observed that for each intervention implemented by the
given PHII for PTSD and TBI, variations were reported in terms outcome achievements. While
the success of a PHII is largely dependent on the quality and frequency of interventions, there is
also a need to address social determinants of health such as an individual’s literacy levels, culture
and personal behaviors for the purpose of ensuring optimum patient compliance and participation
(Hill et al., 2017).
Prior to in any form PHII intervention, program, there is a need to educate participants on
the nature and consequences of their health concerns and the range of best practice interventions
which can be used to manage the same. Often participants demonstrate low compliance to PHII
programs due to inadequate health literacy and lack of awareness concerning the benefits
associated with participation (Barton et al., 2018). Indeed, it can be observed that Headspace, did
not attempt to educate participants on the outcomes associated with each intervention, which
may be a reason why participants were not aware of the advantages in meditations and thus
demonstrated low rates of engagement. Additionally, as per the trans-theoretical model,
individuals are most likely to demonstrate resistance to health behavior change. To address the
same, program formulates must not only educate participants but must also obtain feedback from
them in order to understand any grievances (Hashemzadeh et al., 2019). Lack of the same is
likely to pave the way for participant dissatisfaction and attrition – as evidenced in the high rates
of exercise program dropouts, possibly due to age-associated inability to engage strenuous
activities (Tseng et al., 2017). Lastly, it can be observed that despite incorporating psychological
assessments, Headspace did not seem to prioritize comprehensive health assessments and
structure their interventions based on results of the same. Comprehensive health assessments

4PATIENT CENTERED POPULATION HEALTH IMPROVEMENT PLAN
have been evidenced to assist in correct symptom severity and associated diagnosis, following
which, participants can be encouraged to engage in health interventions customized to their
disease severity and diagnosis (Shah et al., 2019). For this reason, not only were participants not
segregated on the absence or severity of their PTSD diagnosis, there was also no standardization
on the type of interventions they must participate in resulting in high variations in outcomes
achievement in Headspace’s PHII.
Relation to Mr. Nowak’s Case
Taking insights from the PTSD and TBI related interventions and associated outcomes
reported in Headspace’s PHII program, it can be observed that the same can be related to the
healthcare needs and concerns presented by Mr. Nowak. In addition to his hypertension and
cardiovascular symptoms, symptoms pertaining to loss of balance coupled with a history of
encountering a fall demonstrate the possibility that Mr. Nowak may have experienced
undiagnosed TBI. This is because one of the causative factors of TBI includes encountering any
severe accident which yields an adverse and sudden injury to the head – as observed from the
falls incident in Mr. Nowak (Taylor et al., 2017).
TBI is largely associated with loss of orientation and a prevalence of confusion across
individuals resulting in irritability, emotional distress, loss of balance and control across
individuals - as evidenced in Mr. Nowak after he experienced a fall. Engagement in aerobic or
strength training exercises have been evidenced to be useful in correcting these deficits – which
in turn, a part of the key interventions provided by Headspace’s PHII targeting combat veterans
with PTSD and TBI (Uyar et a., 2017). However, in criticism, it must be noted that that elderly
individuals, like Mr. Nowak, may in turn may in turn, find it difficult to sustain in strenuous
activities due to age-associated neuromuscular changes such as loss of muscle density and bone

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strength. With this respect, engagement in mild physical and cognitive activities such as
meditation, may yield improved outcomes in mood, memory and muscle control and thus overall
balance coupled with enhanced compliance and participation. Since in addition to exercise,
meditation based interventions are also provided by Headspace, the same can thus be related to
the case of Mr. Nowak (Donnelly et al., 2019).
Additionally, it can also be observed that while Mr. Nowak has not yet presented with a
confirmed diagnosis of PTSD yet, he still demonstrates considerable distress concerning his
declining health condition. Indeed, it has been evidenced that with gradual old age, elderly
individuals encounter considerable decline in terms of neurological, cognitive and sensory
functions resulting in loss of memory and critical thinking or decision making skills, coupled
with increased risk of mental health issues like depression, anxiety and stress (Blakey et al.,
2018). Engaging a patient in comprehensive physical and medical health assessments along with
encouraging participation in associated interventions like psychotherapy or behavioral strategies
can yield two fold positive outcomes, both in terms of correct identification and diagnosis of
health issues as well as timely management of the same (Bryant, 2018). Since the PHII provides
multiple options of psychotherapy, assessments as well as medication, such interventions can
thus be well related to Mr. Nowak’s present complaints of stress. Additionally, engagement in
such assessment based activities provided by Headspace can be useful in detecting the presence
of any mental health issues like PTSD, as well as any progression or deterioration in his
cardiovascular symptoms as evidenced by his presentation of hypertension and
hypercholesterolemia (Kronstadt et al., 2018).

6PATIENT CENTERED POPULATION HEALTH IMPROVEMENT PLAN
Improvement-based Corrective Measures and Personalized Plan
Despite the relation observed between Headspace’s PHII and Mr. Nowak’s healthcare
concerns, there is still a need to correct and improve upon the concerned public health
interventions for the purpose of providing a personalized, patient centered plan. Based on the
identified contributing factors, one of the first corrective measure which Headspace must
implement to improve their PHII is to educate and enhance Mr. Nowak’s health literacy. This
can be done by teaching him on the symptom and consequences associated with PTSD and TBI,
associated management strategies as well as best practice interventions (Littlecott et al., 2018).
To further ensure better understanding, Headspace must teach the same considering Mr.
Nowak’s cultural background, as well as via usage of simple, person-centered language.
Engaging participants in culturally competent, patient centered education will enhance health
literacy, motivation to change as well as increased program compliance (Inderstrodt et al., 2019).
Additionally, comprehensive health assessments pave the way for implementation of
patient centered interventions. With this respect, Headspace must first assess for the presence of
PTSD and TBI in Mr. Nowak, diagnose the same accurately and provide exercise or meditation
interventions based on diagnostic severity as well as Mr. Nowak’s preferences and consent (Kite,
2018). This allow ethical practice of patient autonomy and greater motivation to participate by
Mr. Nowak. Likewise, Headspace must prioritize procurement of continuous feedback from Mr.
Nowak, on his opinions regarding the PHII and modify the same based on his needs and
preferences. Such follow up not only enable timely detection of changing health needs but also
instill positive perceptions of motivation and positive satisfaction across participation
(Greenhalgh et al., 2017).

7PATIENT CENTERED POPULATION HEALTH IMPROVEMENT PLAN
Conclusion
From the case study, it can be observed that interventions pertaining to exercise and
meditation, coupled with psychotherapy, can be useful in assisting Mr. Nowak to overcome his
loss of strength, balance and positive mental wellbeing. In conclusion, to further reduce the high
degree of variance as well as attrition, it is recommended that the given PHII incorporate
improvements in the form patient education, patient feedback, standardized interventions and
health behavior change model.

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