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Population Health

Mailing Address
Evans Army Community Hospital
Attn: Population Health, DQS Office: Bldg. 7500, Rm. 5854, 5th Floor Tower
1650 Cochrane Circle
Ft. Carson, CO 80913


Monday – Friday 0730 – 1630
Not open on Federal Holidays

To balance awareness, education, prevention, and intervention activities required to improve the health of a specified population. Population Health Improvement is the foundation of optimization efforts. This model unites self-care, Health Readiness Platform, worksite and community-based wellness and prevention activities and medical interventions into a comprehensive paradigm centered on primary, secondary, and tertiary prevention to reduce morbidity, premature morality and improve health.


To work in tandem with the patient, the provider/PCM and Provider Group Support Team while interfacing with all beneficiaries - patients and their families, ultimately to improve your access to care and to optimize your healthcare through interactive outreach efforts.

What We DO for YOU
We actively message our beneficiaries through audio-care calls, letters, reminder notice mailers, and secure messaging. We conduct several community events coordinated through EACH, ACS and MWR - outreach health and wellness fairs striving provide patient education and improve Access to Care by offering appointment booking and educational materials.

We are striving to ensure our population receives appropriate care as related to the National Standards for HEDIS measures:

• Cancer prevention – Have we provided cancer prevention tracking and screening?
   o Breast cancer screening (Females: age 40 to 65 yo or older as needed.)
   o Cervical cancer screening (Females: age 21 to 29 every 3 years; age 30 to 65 every 5 yrs with HPV testing)
   o Colorectal cancer screening (Both genders: Age 50 until age 74, annually FOBT, Colonoscopy – minimum every 10yrs unless otherwise indicated)
• Appropriate Care Testing - Did we meet the Standard of Care/CPG?
   o Children with pharyngitis – Tracking Antibiotic Appropriate Usage
   o Children with Upper Respiratory Infections – Tracking Antibiotic Appropriate Usage
   o Imaging with initial low back pain diagnosis – Tracking Imaging Usage
• Prevalence of disease occurrences - Adhering to Clinical Practice Guidelines (CPG)?
   o Asthma - Medication Use/Med Renewals and Asthma Action Plans
   o Diabetes Management - Annual and Quarterly A1C monitoring – CPG
   o Chlamydia screening – Annual lab testing- tracking
   o COPD, CHF, HTN, and dyslipidemia.- tracking Labs and Standard of Care
   o Overweight/Obesity tracking for Adult/Children – diagnosis/intervention/patient education and resources – Standard of Care
• Well Child screening visits- First 6 visits/15months of life – Standard of Care
• Behavioral Health Management tracking – Adhering to Standards of Care
   o Antidepressant medication management for acute and chronic usage
   o Post-mental health hospitalization follow-up care standards
   o Depression management
• Body Mass Index – Standard of Care/Clinical Practice Guidelines (CPG)
   o Adult overweight/obese population – tracking and intervention/education
   o Child overweight/obese population – tracking and intervention/education
   o ADSM BMI – tracking, Medical Readiness, intervention/education

We generate notices based on your health data within the electronic health record (EHR) indicating you are past due or due for preventive health screenings. If our data is not correct or updated please contact us via secure voice-mail, and you may also fax the data or mail the data to us. We will ensure that it is added to your EHR and given to your provider. If you receive a phone call or letter from Patient Access Services or the Population Health Nurse, please contact us at 719-524-5665 (secure voice-mail) – we are attempting to book your preventative healthcare visits. Please leave your Name/DOB/Return Call Phone number – we check the secure voice-mail daily!

Thank you – Evans Army Community Hospital & Your Population Health Nurse!

Call us (719) 524-5665/0547-- We would love to book your appointments for your preventative healthcare!



This Web site provides an introduction to the U.S. Army Medical Department's headquarters organizations, which are the Office of the Army Surgeon General and
U.S. Army Medical Command headquarters. It is intended for interested members of the public, news media and Army Medical Department beneficiaries.
Last Modified 15 March, 2016