Operationalizing the Population Health Framework: Clinical Characteristics, Social Context, and the Built Environment

Scott D. Siegel, Madeline Brooks, Frank C. Curriero

Research output: Contribution to journalArticlepeer-review


As a framework, population health emphasizes health outcomes for entire populations, the broad range of determinants of these outcomes, and the comparative effectiveness of medical and public health interventions. In practice, however, many contemporary population health programs instead focus on small subsets of patients who account for a disproportionate share of health care utilization, often with disappointing results. The authors proposed a new approach to operationalize population health in clinical settings, with the example of tobacco use. Electronic health record (EHR) data from a mid-Atlantic health system were used to: (1) define and describe a hospital-based population of current smokers, (2) analyze the demographic characteristics of the population to consider how the social context may impact treatment, and (3) join EHR data with public licensing data on tobacco retail locations to assess the relationship between the built environment and smoking status. Out of a total of 20,310 unique adult admissions to the health system, 3749 (18.5%) were current smokers. Compared to never smokers, current smokers were significantly younger, more likely to be male, more likely to be Black/African American, less likely to be Hispanic/Latino/a, and more likely to be on Medicaid or be self-pay. Current vs. former smokers had significantly higher exposure to tobacco retail locations, even after adjusting for demographic and other covariates. By defining populations around leading modifiable medical determinants of health, and accounting for the larger context of sociodemographic factors and the built environment, health systems can invest in comprehensive programs designed to produce the greatest population health returns.

Original languageEnglish (US)
Pages (from-to)454-462
Number of pages9
JournalPopulation health management
Issue number4
StatePublished - Aug 2021


  • built environment
  • population health
  • smoking
  • social context

ASJC Scopus subject areas

  • Leadership and Management
  • Health Policy
  • Public Health, Environmental and Occupational Health


Dive into the research topics of 'Operationalizing the Population Health Framework: Clinical Characteristics, Social Context, and the Built Environment'. Together they form a unique fingerprint.

Cite this