Understanding the Roles, Responsibilities, and Factors for Success of Health Equity Officers in Health Care Settings: A Qualitative Study.

CONTEXT: Recent national guidelines aimed at addressing equity in health care settings have contributed to an increase in equity officer positions, yet little is known about their roles, responsibilities, or strategies for engaging in health equity work. OBJECTIVE: To understand the roles and responsibilities of equity officers, as well as facilitators and barriers to their success. DESIGN: In-depth semi-structured interviews with selected respondents from the Equity Officer National Study. SETTING: Hospitals and health care systems across the United States. PARTICIPANTS: Twenty-six equity officers who had responded to the Equity Officer National Study survey. MAIN OUTCOME MEASURES: The interview guide explored strategies, facilitators, and barriers for engaging in health equity work in hospitals/health systems and communities. RESULTS: The job roles described by participants fell into 4 categories: community benefits/relations, population/community health, workforce, and health equity. Equity officers described key areas to support success at the individual equity officer level: knowledge and expertise, professional skills, and interpersonal skills; at the hospital level: leadership, workforce, infrastructure and resources, and policies and processes; at the community level: leadership and partnerships; and at the system level: requirements and regulations, investment and resources, and sociocultural and political characteristics of the community. These key areas have been organized to create a Framework for Equity Officer Success. CONCLUSIONS: The Framework for Equity Officer Success should be incorporated into hospital board, community stakeholder, and policymaker discussions about how to support health equity work in hospitals and health care systems.

Advancing Virtual at-Home Care for Community Health Center Patients Using Patient Self-Care Tools, Technology, and Education.

Introduction: Health centers are community-based, patient directed primary care providers that offer accessible, high-quality primary care within medically underserved communities. Screening for cancer and managing complex chronic conditions such as diabetes, hypertension, obesity, and depression are vital services for the vulnerable populations seen by community health centers. Delivering care for complex chronic conditions and preventive services using virtual models that integrate self-care tools and technology is an important approach to increasing access for hard-to-reach patients served by health centers. Objective: This study aimed to explore the use of a virtual care model, applied using a systems approach and patient-driven tools and technology, on the performance of clinical and patient experience measures. Methods: A virtual care model, applied using a systems approach offered by the Value Transformation Framework (VTF), was combined with self-care tools and technology in twenty health centers across 17 states to drive improvement efforts. Changes in clinical measures and patient experience were compared. Results: A total of 385 patients were enrolled and 270 (70.1%) completed a baseline visit and at least four virtual visits during the six-month intervention period. Statistically significant improvements were seen in measures for HbA1c, systolic and diastolic blood pressure, and bodyweight. Among the 270 who completed the baseline and at least 4 virtual visits, the percentage up-to-date for colorectal cancer screening increased from 113/270 (41.9%) to 169/270 (62.6%) after six months, p<0.001, a 20.7% increase. Patients completing the baseline visit and at least 4 virtual visits reported a 10.7% decrease in depression and increased satisfaction with virtual care visits compared to in-person visits (p<0.001). Conclusion: Health centers applying the Value Transformation Framework's organizing framework to the use of virtual care models together with patient self-care tools, technology, and education, had improvements in measures for chronic and preventive conditions and patient experience.

Self-Measured Blood Pressure Monitoring During the COVID-19 Pandemic: Perspectives From Community Health Center Clinicians.

ABSTRACT: The early period of the COVID-19 pandemic necessitated a rapid increase in out-of-office care. To capture the impact from COVID-19 on care for patients with hypertension, a questionnaire was disseminated to community health center clinicians. The extent, types, and causes of care delays and disruptions were assessed along with adaptations and innovations used to address them. Clinician attitudinal changes and perspectives on future hypertension care were also assessed. Of the 65 respondents, most (90.8%) reported their patients with hypertension experienced care delays or disruptions, including lack of follow-up, lack of blood pressure assessment, and missed medication refills or orders. To address care delays and disruptions for patients with hypertension, respondents indicated that their health center increased the use of telehealth or other technology, made home blood pressure devices available to patients, expanded outreach and care coordination, provided medication refills for longer periods of time, and used new care delivery options. The use of self-measured blood pressure monitoring (58.5%) and telehealth (43.1%) was identified as the top adaptations that should be sustained to increase access to and patient engagement with hypertension care; however, barriers to both remain. Policy and system level changes are needed to support value-based care models that include self-measured blood pressure and telehealth.

How Hospitals Are Addressing The Effects Of Racism: A Mixed-Methods Study Of Hospital Equity Officers.

Hospital equity officers have become critical leaders in the effort to address the determinants of health care disparities, including structural racism. In this mixed-methods study, we surveyed a national sample of equity officers and interviewed a subset of respondents to provide additional perspective. About one-half of survey respondents reported at least some obstacles to achieving their health equity objectives, including racist beliefs among people working in their hospitals and health care systems, policies that perpetuate racism, and a lack of staff diversity. To address these challenges, some hospitals are collecting information about instances of racism, reviewing clinical algorithms for evidence of bias, or forming community partnerships. However, in interviews, equity officers pointed out that racism is a public health issue that cannot be adequately addressed solely within the health care system. Given the relative newness of most hospital equity officer positions, our research may be viewed as an early glimpse into the challenges and opportunities of this evolving work.

Athletic Trainers' Observations of Social Determinants of Health in the Collegiate Setting: A Card Study.

CONTEXT: Addressing social determinants of health (SDH) in all populations improves patient outcomes, leading to better patient-centered care. Despite known influences of SDH, little is known about the ability of athletic trainers (ATs) to observe SDH in practice. OBJECTIVE: To explore ATs' observations of SDH and describe actions taken at the point-of-care in college/university settings. DESIGN: Descriptive via an observational card study. SETTING: Athletic training facilities. PARTICIPANTS: ATs (23 participants across 20 institutions) employed in the college/university setting. DATA COLLECTION AND ANALYSIS: ATs used a modified observation card to document observations of SDH during patient encounters in the college/university setting. Cards contained instructions for completion and a table with 4 columns: (1) a list of 19 predetermined SDH, (2) checkbox for observed SDH, (3) checkbox for perceived negative influence of observed SDH on patient health, and (4) open box to write in what actions, if any, were taken to address the observed SDH. RESULTS: Overall, 424 cards were collected. Of 725 observed SDH, access to social media (153/725, 21.1%), academic stressors (131/725, 18.1%), and behavioral health issues (71/725, 9.8%) were the most commonly observed. Nearly 39% (281/725) had a perceived negative 16.4%), and transportation issues (32/281, 11.4%) were most common. For the 23.0% (166/725) of SDH acted on, ATs used counseling and education (73/166), provided additional resources (60/166), referred to others (29/166), or communicated with others (4/166). CONCLUSIONS: Because ATs are positioned to accurately assess SDH, they can promote better patient-centered care and improve patient outcomes. Our results suggested many SDH observed by ATs in the college/university setting had a negative influence on patient health. Better support for patients with behavioral health issues and academic stressors is important because these SDH were commonly perceived to negatively influence health and well-being.

Athletic Trainers' Perceptions of and Experience with Social Determinants of Health.

The role that social determinants of health (SDHs) play in athletic healthcare is gaining attention, yet little is known about athletic trainers' (ATs) perceptions of and encounters with the impact of SDHs. The purpose of this study was to evaluate ATs' perceptions of various SDHs and their experience treating patients whose health and well-being were influenced by SDHs. This was a cross-sectional, web-based survey completed by 1694 ATs (completion rate = 92.6%; 61.1% female; age = 36.6 ± 10.8 years). The survey consisted of several multipart questions focusing on specific SDHs. Descriptive statistics were used to report frequencies and percentages. Results indicated widespread agreement that SDHs matter to patient health and are of concern in athletic healthcare. The SDHs that ATs most commonly reported encountering included lifestyle choices (n = 1306/1406; 93.0%), social support (n = 1185/1427; 83.0%), income (n = 1167/1502; 77.7%), and access to quality and timely healthcare (n = 1093/1420, 77.0%). The SDHs that ATs least commonly reported having experience with was governmental policy (n = 684/1411; 48%). The perceived importance of SDHs among ATs and their commonly reported experiences managing patient cases in which SDHs negatively influence patients' health and healthcare suggest that efforts to assess these factors are needed so that strategies to address their influence on athletic healthcare can be identified.

Athletic Trainers' Familiarity, Comfort, Knowledge, and Recognition of Social Determinants of Health.

CONTEXT: Social determinants of health (SDH)-education, transportation, housing, employment, health systems and services, economic status, and physical and social environments-influence patient outcomes; therefore, athletic trainers (ATs) need to be able to understand and address these factors. However, little is known about how ATs perceive SDH or how knowledgeable they are about social factors that contribute to patient health and well-being. OBJECTIVE: To evaluate ATs' familiarity and comfort with SDH and their perceived knowledge and recognition of SDH. DESIGN: Cross-sectional. SETTING: Online survey. PATIENTS OR OTHER PARTICIPANTS: Our survey was distributed to 17 000 ATs; 1829 accessed it (access rate=10.8%), and 1694 completed it (completion rate=92.6%, AT experience=15.2±10.6 years, age=36.6±10.8 years). MAIN OUTCOME MEASURES: The survey included multipart questions that evaluated ATs' perceptions of their familiarity, comfort, and knowledge about SDH. Data were summarized using descriptive statistics. RESULTS: Few respondents (4.1%, 70/1691) reported they were extremely familiar with SDH. Most reported being moderately familiar (45.0%, 761/1691), minimally familiar (34.7%, 587/1691), or not familiar at all (16.1%, 273/1691). For questions about comfort, few reported being extremely comfortable (3.5%, 59/1691) with SDH, and most reported being moderately comfortable (35.4%, 598/1691), minimally comfortable (41.1%, 695/1691), or not comfortable at all (18.6%, 314/1691). For questions about knowledge, few reported being extremely knowledgeable (2.7%, 46/1686) about SDH, and the majority reported being moderately (38.9%, 622/1686), minimally (41.8%, 704/1686) or not knowledgeable at all (18.6%, 314/1686). Over half of ATs accurately categorized 8 of the 9 SDH listed in the survey, and 22% endorsed more correct than incorrect items. CONCLUSIONS: A majority of ATs perceived their familiarity, comfort, and knowledge about SDH to be moderate-to-low, which may reflect the relatively recent emphasis on SDH in athletic healthcare. Because SDH can have a major impact on patient health and well-being, strategies should be developed for educating ATs about SDH. Developing strategies to increase comfort with the SDH in patient care is critical to ensure that those factors that can be addressed at the patient level are identified and managed.

The Primary Care Transformation Executive Fellowship to Develop Community Health Center Leaders.

Introduction: Although many primary care providers from community health centers recognize health disparities and work to transform healthcare, skill gaps and limited support may hinder their ability to be change agents. The Primary Care Transformation Executive (PCTE) Fellowship at A.T. Still University School of Osteopathic Medicine in Arizona (ATSU-SOMA) seeks to address these barriers by providing professional development and support to primary care providers interested in leading change in the nation's health centers. Methods: The PCTE Fellowship is a structured, one-year interprofessional learning experience that emphasizes topics such as healthcare transformation, interprofessional practice, leadership development, and systems thinking. Quantitative and qualitative evaluation of the program was accomplished through surveys and semi-structured interviews throughout the fellowship. Results: Feedback from 18 fellows showed perceived improvements in knowledge and skills related to the various curricular topics, increased engagement in leadership activities, and career advancement. Fellows developed practice and quality improvement projects and successfully implemented the projects within their health systems, addressing observed disparities. Conclusion: Professional development and directed support for primary care providers can enhance their engagement in healthcare transformation and advance health equity.

Using the Practical Robust Implementation and Sustainability Model (PRISM) to Identify and Address Provider-Perceived Barriers to Optimal Statin Prescribing and Use in Community Health Centers.

Statins are an important but underutilized therapy to prevent cardiovascular events, particularly in high-risk patients. To increase use of statin therapy in high-risk patients, the Centers for Disease Control and Prevention funded a project led by the National Association of Community Health Centers to discover reasons for statin underuse in health centers and identify possible leverage points, particularly among vulnerable and underserved patients. The project further sought to develop training and educational materials to improve statin prescribing for and acceptance in eligible high-risk patients. As a first step, investigators implemented a questionnaire to clinical providers (n = 45) at health centers participating in the project to obtain their perspective on barriers to optimal statin use. We used the practical robust implementation and sustainability model (PRISM) domains to frame the overall project and guide the development of our questionnaire. This paper summarizes top perceived barriers to patient and health system/provider statin initiation and sustainment, as well as facilitators to prescribing, using PRISM as an organizing framework. Our questionnaire yielded important suggestions related to public awareness, education materials, health information technology (HIT)/data solutions, and clinical guidelines as key factors in optimizing statin use. It also informed the design of patient education resources and provider training tools. Future directions include using the full application of the PRISM implementation science model to assess how well our educational and training resources help overcome barriers to statin use in high-risk patients, including evaluating how key contextual factors influence successful implementation.

Impact of COVID-19-related care disruptions on blood pressure management and control in community health centers.

BACKGROUND: Uncontrolled hypertension is a leading risk factor for cardiovascular disease. To ensure continuity of care, community health centers (CHCs) nationwide implemented virtual care (telehealth) during the pandemic. CHCs use the Centers for Medicare & Medicaid Services (CMS) 165v8 Controlling High Blood Pressure measure to report blood pressure (BP) control performance. CMS 165v8 specifications state that if no BP is documented during the measurement period, the patient's BP is assumed uncontrolled. METHODS: To examine trends in BP documentation and control rates in CHCs as telehealth use increased during the pandemic compared with pre-pandemic period, we assessed documentation of BP measurement and BP control rates from December 2019 - October 2021 among persons ages 18-85 with a diagnosis of hypertension who had an in-person or telehealth encounter in 11 CHCs. Rates were compared between CHCs that did and did not implement self-measured BP monitoring (SMBP). RESULTS: The percent of patients with hypertension with no documented BP measurement was 0.5% in December 2019 and increased to 15.2% (overall), 25.6% (non-SMBP CHCs), and 11.2% (SMBP CHCs) by October 2021. BP control using CMS 165v8 was 63.5% in December 2019 and decreased to 54.9% (overall), 49.1% (non-SMBP), and 57.2% (SMBP) by October 2021. When assessing BP control only in patients with documented BP measurements, CHCs largely maintained BP control rates (63.8% in December 2019; 64.8% (overall), 66.0% (non-SMBP), and 64.4% (SMBP) by October 2021). CONCLUSIONS: The transition away from in-person to telehealth visits during the pandemic likely increased the number of patients with hypertension lacking a documented BP measurement, subsequently negatively impacting BP control using CMS 165v8. There is an urgent need to enhance the flexibility of virtual care, improve EHR data capture capabilities for patient-generated data, and implement expanded policy and systems-level changes for SMBP, an evidence-based strategy that can build patient trust, increase healthcare engagement, and improve hypertension outcomes.

Patient and Staff Satisfaction and Experience While Transforming Health Center Systems.

Introduction: Patient satisfaction and experience are important measures of overall quality of care. In 2017, the National Association of Community Health Centers (NACHC) launched an initiative to facilitate changes across organizational systems within Federally Qualified Health Centers (FQHCs) with the goal of improving value-driven care. Methods: NACHC worked with eight health centers, four in Georgia and four in Iowa, along with their state Primary Care Associations, to apply the Value Transformation Framework (VTF). This framework distills evidence-based practices into practical knowledge for goal-driven systems change. It provides actionable steps to help health centers reach value-driven goals of improved health outcomes, improved patient and staff experience, reduced costs, and improved equity (referred to as the Quintuple Aim goals). This paper reports on the patient and staff experience when applying VTF systems changes to improve colorectal cancer screening rates. Results: Patient and staff satisfaction and experience remained highly rated even after extensive organizational changes were implemented as part of this project. Implementation of a systems-approach to organizational change, through application of the VTF, did not negatively impact patient or staff experiences. Conclusion: Patient and staff satisfaction and experience were positive despite the application of the VTF and systems-wide organizational changes. These experience results were alongside improved cancer screening rates, as observed from full project results. Investigators are encouraged that the application of systems change using the VTF may result in the achievement of Quintuple Aim goals without disrupting the experience of patients and staff. Investigators recommend continued exploration of this transformation approach.

Applying the Value Transformation Framework in Federally Qualified Health Centers to Increase Clinical Measures Performance.

INTRODUCTION: The transition in health care from a volume-based to value-based model of care, combined with pressures brought about by the COVID-19 pandemic, makes the need for efficiency and coordination of the health center system imperative. The Value Transformation Framework (VTF), developed with health centers in mind, provides an organizing framework to support transformation of infrastructure, care delivery, and people systems. METHODS: NACHC applied the VTF within a cohort of health centers across the country to drive systems change and improve performance on measures of clinical care. RESULTS: A comparison of health centers "participating" in application of the VTF relative to "nonparticipating" health centers nationally showed improvement during 3 years of program implementation. Significant differences ( p < .05) favoring health centers who participated were noted for screening of colorectal cancer ( p < .001), depression ( p < .001), hypertension ( p < .001), obesity ( p = .001), and cervical cancer ( p = .011). Performance for diabetes control also favored participating programs, although the difference did not quite reach significance ( p = .45). CONCLUSIONS: Applying a systems approach, organized by the VTF, with evidence-based interventions and deployed in a learning community, can result in improved performance across multiple measures of clinical care.

The Value Transformation Framework: Applied to Diabetes Control in Federally Qualified Health Centers.

INTRODUCTION: Diabetes and pre-diabetes impact more than 114 million Americans. Federally qualified health centers (FQHCs) provide care to some of the most high-risk and underinsured individuals throughout the US, twenty-one percent of whom report being told they have diabetes, compared to 11% of the general adult population. It is widely agreed our health care system requires a transformation to effectively address diabetes and its complications. OBJECTIVE: By applying the Value Transformation Framework (VTF) in health centers, the National Association of Community Health Centers (NACHC) aims to show improvements in diabetes control. This systematic strategy to transform the way health centers operate can lead to improvements in health outcomes, patient and staff experiences, costs, and equity (Quintuple Aim). Special attention is paid to the health centers' infrastructure, people systems and care delivery systems. METHODS: Evidence-based diabetes interventions, the learning community model, and the VTF were used together to drive system improvements and activate proven diabetes control practices within eight health centers. Multidisciplinary teams at select health centers in Georgia and Iowa, with their partner primary care associations, participated in this NACHC-led quality improvement project. RESULTS: During the one-year intervention (January 2017-December 2017), the mean raw percentage of patients with HbA1c Poor Control decreased from 50.9% (range, 23.7-70.4%) in January to 27.5% (range, 13.6-37.4%) in December. This represents a relative improvement in diabetes control of 46%. The 1-year-intervention data also showed trends in the desired direction with statistically significant improvements related to the following interventions: a formal written clinical policy, standing orders, patient recall/outreach, performance data shared at the provider/team-level, and performance data shared at the site/organization level. CONCLUSION: A conceptual model focused on transforming health center systems, organized by the NACHC Value Transformation Framework and supported by a strong learning community, can lead to better diabetes control outcomes among patients seen at health centers.

Living with an MPN in Ireland: patients' and caregivers' perspectives.

Myeloproliferative neoplasms (MPNs) are associated with a high disease burden, reduced quality of life and shortened survival. The aim of this questionnaire was to gain patients' and caregivers' perspectives on the impact of living with an MPN in the Republic of Ireland. An Irish adaptation of the 'Global MPN Landmark survey' was conducted. Fifty-one patients and 44 caregivers completed the questionnaire. Patients reported a wide variety of symptoms at the time of questionnaire completion; fatigue, bone pain and pruritus being most frequently reported. Approximately one-third of respondents from each of the groups (patients and caregivers) reported a negative impact of MPNs on their emotional wellbeing and daily lives. The study findings revealed that, despite treatment, symptom burden remains high, and several unmet needs exist, including educational, emotional and peer group support. Interventions that focus on reducing symptom burden and addressing these unmet needs, may improve the quality of life for patients with MPNs and their caregivers.

The power of interdependence: Linking health systems, communities, and health professions educational programs to better meet the needs of patients and populations.

Promoting optimal health outcomes for diverse patients and populations requires the acknowledgement and strengthening of interdependent relationships between health professions education programs, health systems, and the communities they serve. Educational programs must recognize their role as integral components of a larger system. Educators must strive to break down silos and synergize efforts to foster a health care workforce positioned for collaborative, equitable, community-oriented practice. Sharing interprofessional and interinstitutional strategies can foster wide propagation of educational innovation while accommodating local contexts. This paper outlines how member schools of the American Medical Association Accelerating Change in Medical Education Consortium leveraged interdependence to accomplish transformative innovations catalyzed by systems thinking and a community of innovation.

Are Community Health Center Patients Interested in Self-Measured Blood Pressure Monitoring (SMBP) - And Can They Do It?

INTRODUCTION: Self-measured blood pressure monitoring (SMBP) helps diagnose and manage hypertension from outside the clinic, which has implications for patient empowerment and outcomes, continuity of care, and resilience in care communities catering to vulnerable populations. METHODS: We instituted a protocol for SMBP among hypertensive patients at 9 community health centers in 3 states and administered questionnaires to patients before and after the protocol was instituted to assess knowledge and engagement with disease management, beliefs and attitudes towards, and experience doing SMBP. Questionnaires included 16 items designed to evaluate patient perceptions and beliefs about SMBP. These included a series of questions using a 5-point Likert scale, binary questions related to their perceived ability to comply with specific SMBP guidelines and open-ended questions to obtain descriptions of experiences with SMBP. RESULTS: The pre-questionnaire was completed by 478 patients and the post-questionnaire was completed by 372. Seventy-seven percent of respondents knew their ideal blood pressure and their engagement with blood pressure management increased significantly (p=0.0024) after completing the protocol. Additionally, 85% of respondents said that they had a positive experience doing SMBP. Open-ended responses revealed insight regarding why patients chose to do SMBP and factors patients appreciated about SMBP. DISCUSSION: When trained properly and supported, community health center patients are capable of and motivated to perform accurate SMBP. Our study provides evidence that health center patients can follow detailed SMBP protocols and monitor their own blood pressure from the safety of their homes, which is critical to their care continuum, particularly in days of a pandemic.

Accelerating Use of Self-measured Blood Pressure Monitoring (SMBP) Through Clinical-Community Care Models.

Self-measured blood pressure monitoring (SMBP), the regular measurement of blood pressure by a patient outside the clinical setting, plus additional support, is a proven, cost-effective but underutilized strategy to improve hypertension outcomes. To accelerate SMBP use, the Centers for Disease Control and Prevention (CDC) funded the National Association of Community Health Centers, the YMCA of the USA, and Association of State and Territorial Health Officials to develop cross-sector care models to offer SMBP to patients with hypertension. The project aimed to increase the use of SMBP through the coordinated action of health department leaders, community organizations and clinical providers. From 1/31/2017 to 6/30/2018, nine health centers in Kentucky, Missouri, and New York partnered with seven local Y associations (local Y) and their local health departments to design and implement care models that adapted existing primary care SMBP practices by leveraging capacities and resources in community and public health organizations. Nine collaborative care models emerged, shaped by available community assets, strategic priorities, and organizational culture. Overall, 1421 patients were recommended for SMBP; of those, 795 completed at least one cycle of SMBP (BP measurements morning and evening for at least three consecutive days). Of those recommended for SMBP, 308 patients were referred to a local Y to receive additional SMBP and healthy lifestyle support. Community and public health organizations can be brought into the health care delivery process and can play valuable roles in supporting patients in SMBP.

Learning to Speak Up for Patient Safety: Interprofessional Scenarios for Training Future Healthcare Professionals.

BACKGROUND: Preventable medical errors represent a leading cause of death in the United States. Effective undergraduate medical education (UME) strategies are needed to train medical students in error prevention, early identification of potential errors, and proactive communication. To address this need, a team of faculty from A.T. Still University's School of Osteopathic Medicine in Arizona developed four digital patient safety case scenarios for second-year medical students. These scenarios were designed to integrate interprofessional collaboration and patient safety principles, increase student ability to identify potential errors, and promote proactive communication skills. METHODS: Faculty used Qualtrics to create four digital case scenarios on patient safety covering the following domains: communicating about potential drug-to-drug interactions; effective handoffs; human factors errors, such as fatigue, illness, and stress; and conflicts with supervising resident. In fall 2018, 97 second-year medical students completed the entire safety module in dyad or triad teams. As they worked through each case study, student teams completed 11 assessment questions with instant feedback, and participated in short case debrief discussions. Next, each individual student took a 12-question post-test to assess learning. Descriptive statistics were reviewed for the assessment questions, and case critical thinking discussion answers were reviewed to evaluate student comprehension. RESULTS: The mean score for the module was 95.5% (SD= 6.36%, range = 75%-100%). Seventy-eight students completed the post-test, which had a mean score of 96.5% (SD = 6.51%, range = 66.7%-100%). Student written responses to the four case critical thinking discussion prompts indicated a high level of comprehension. CONCLUSION: Our results demonstrated that digital case studies can provide an innovative mechanism to introduce key patient safety concepts and experiential practice of interprofessional communication in early UME. Our design and implementation of these engaging interprofessional patient safety training modules provided an opportunity for students to learn key communication and safety concepts in small teams. This training method was cost-effective and could be replicated in other online learning or blended learning environments for a wide range of health professions.

Addressing the Social Determinants of Health in Undergraduate Medical Education Curricula: A Survey Report.

PURPOSE: Social determinants of health (SDH) are recognized as important factors that affect health and well-being. Medical schools are encouraged to incorporate the teaching of SDH. This study investigated the level of commitment to teaching SDH; learning objectives/goals regarding student knowledge, skills, and attitudes; location in the curriculum and teaching strategies; and perceived barriers to teaching SDH. METHODS: A team from the American Medical Association's Accelerating Change in Medical Education Consortium developed a 23-item inventory survey to document consortium school SDH curricula. The 32 consortium schools were invited to participate. RESULTS: Twenty-nine (94%) schools responded. Most respondents indicated the teaching of SDH was low priority (10, 34%) or high priority (12, 41%). Identified learning objectives/goals for student knowledge, skills, and attitudes regarding SDH were related to the importance of students developing the ability to identify and address SDH and recognizing SDH as being within the scope of physician practice. Curricular timing and teaching strategies suggested more SDH education opportunities were offered in the first and second undergraduate medical education years. Barriers to integrating SDH in curricula were identified: addressing SDH is outside the realm of physician responsibility, space in curriculum is limited, faculty lack knowledge and skills to teach material, and concepts are not adequately represented on certifying examinations. CONCLUSION: Despite the influence of SDH on individual and population health, programs do not routinely prioritize SDH education on par with basic or clinical sciences. The multitude of learning objectives and goals related to SDH can be achieved by increasing the priority level of SDH and employing better teaching strategies in all years. The discordance between stated objectives/goals and perceived barriers, as well as identification of the variety of strategies utilized to teach SDH during traditional "preclinical" years, indicates curricular areas in need of attention.