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The American College of Physicians (ACP), Society of Hospital Medicine (SHM), Society of General Internal Medicine (SGIM), American Geriatric Society (AGS), American College of Emergency Physicians (ACEP) and the Society for Academic Emergency Medicine (SAEM) developed consensus standards to address the quality gaps in the transitions between inpatient and outpatient settings. The following summarized principles were established: 1.) Accountability; 2) Communication; 3.) Timely interchange of information; 4.) Involvement of the patient and family member; 5.) Respect the hub of coordination of care; 6.) All patients and their family/caregivers should have a medical home or coordinating clinician; 7.) At every point of transitions the patient and/or their family/caregivers need to know who is responsible for their care at that point; 9.) National standards; and 10.) Standardized metrics related to these standards in order to lead to quality improvement and accountability. Based on these principles, standards describing necessary components for implementation were developed: coordinating clinicians, care plans/transition record, communication infrastructure, standard communication formats, transition responsibility, timeliness, community standards, and measurement.

The majority of pharmacogenomic (PGx) studies have been conducted on European ancestry populations, thereby excluding minority populations and impeding the discovery and translation of African American–specific genetic variation into precision medicine. Without accounting for variants found in African Americans, clinical recommendations based solely on genetic biomarkers found in European populations could result in misclassification of drug response in African American patients. To address these challenges, we formed the Transdisciplinary Collaborative Center (TCC), African American Cardiovascular Pharmacogenetic Consortium (ACCOuNT), to discover novel genetic variants in African Americans related to clinically actionable cardiovascular phenotypes and to incorporate African American–specific sequence variations into clinical recommendations at the point of care. The TCC consists of two research projects focused on discovery and translation of genetic findings and four cores that support the projects. In addition, the largest repository of PGx information on African Americans is being established as well as lasting infrastructure that can be utilized to spur continued research in this understudied population.

A primary barrier to translation of clinical research discoveries into care delivery and population health is the lack of sustainable infrastructure bringing researchers, policymakers, practitioners, and communities together to reduce silos in knowledge and action. As National Institutes of Healthʼs (NIH) mechanism to advance translational research, Clinical and Translational Science Award (CTSA) awardees are uniquely positioned to bridge this gap. Delivering on this promise requires sustained collaboration and alignment between research institutions and public health and healthcare programs and services. We describe the collaboration of seven CTSA hubs with city, county, and state healthcare and public health organizations striving to realize this vision together. Partnership representatives convened monthly to identify key components, common and unique themes, and barriers in academic–public collaborations. All partnerships aligned the activities of the CTSA programs with the needs of the city/county/state partners, by sharing resources, responding to real-time policy questions and training needs, promoting best practices, and advancing community-engaged research, and dissemination and implementation science to narrow the knowledge-to-practice gap. Barriers included competing priorities, differing timelines, bureaucratic hurdles, and unstable funding. Academic–public health/health system partnerships represent a unique and underutilized model with potential to enhance community and population health.

The CommunityRx system, a population health innovation, combined an e-prescribing model and community engagement to strengthen links between clinics and community resources for basic, wellness, and disease self-management needs in Chicago. The components of CommunityRx were a youth workforce, whose members identified 19,589 public-serving entities in the 106-square-mile implementation region between 2012 and 2014; community health information specialists, who used the workforce's findings to generate an inventory of 14,914 health-promoting resources; and a health information technology (IT) platform that was integrated with three electronic health record systems at thirty-three clinical sites. By mapping thirty-seven prevalent social and medical conditions to community resources, CommunityRx generated 253,479 personalized HealtheRx prescriptions for more than 113,000 participants. Eighty-three percent of the recipients found the HealtheRx very useful, and 19 percent went to a place they learned about from the HealtheRx. All but one organization continued using the CommunityRx system after the study period ended. This study demonstrates the feasibility of using health IT and workforce innovation to bridge the gap between clinical and other health-promoting sectors.

A difficult challenge in health equity training is conducting honest and safe discussions about differences in lived experience based on social identity, and how racism and other systems of oppression impact health care. To evaluate a Theatre of the Oppressed workshop for medical students that examines systems of oppression as related to lived health care experiences. Mixed-methods cross-sectional survey and interviews. Forty randomly assigned early first-year medical students. A 90-min virtual workshop with three clinical scenes created by students where a character is being discriminated against or oppressed. During performance, students can stop scene, replace oppressed character, and role play how they would address harm, marginalization, and power imbalance. Participants discuss what they have witnessed and experienced. Likert-scale questions assessing workshop's impact. Open-ended survey questions and interviews about workshop. Thirty-one (78%) of 40 participants completed the survey. Fifty-three percent were female. Thirty-seven percent were White, 33% Asian American, 15% Black, 11% Latinx, and 4% multiracial. Ninety percent thought this training could help them take better care of patients with lived experiences different from their own. Most agreed or strongly agreed the workshop helped them develop listening (23, 77%) and observation (26, 84%) skills. Twelve (39%) students felt stressed, while 29 (94%) felt safe. Twenty-five (81%) students agreed or strongly agreed there were meaningful discussions about systemic inequities. Students reported the workshop helped them step into others' shoes, understand intersectional experiences of multiple identities, and discuss navigating and addressing bias, discrimination, social drivers of health, hierarchy, power structures, and systems of oppression. Some thought it was difficult to have open discussions because of fear of being poorly perceived by peers. Theatre of the Oppressed enabled medical students to engage in meaningful discussions about racism and other systems of oppression.

Effective community-engaged research is critical for designing and testing solutions to decrease the 10-year life expectancy gap between Black and non-Black residents of Chicago, Illinois. In community listening sessions, the Chicago Chronic Conditions Engagement Network found that community members’ highest priority health issues were social determinants of health and that there is a strong mistrust of research. Conversations with leaders of community organizations addressing social determinants of health suggest strategies to help researchers overcome mistrust and build effective community–research partnerships. ( Am J Public Health. 2025;115(S2):S130–S133. https://doi.org/10.2105/AJPH.2025.308082 )

The ‘5As’ model of behavior change provides a sequence of evidence-based clinician and office practice behaviors (Assess, Advise, Agree, Assist, Arrange) that can be applied in primary care settings to address a broad range of behaviors and health conditions. Although the 5As approach is becoming more widely adopted as a strategy for health behavior change counseling, practical and standardized assessments of 5As delivery are not widely available. This article provides clinicians and researchers with alternatives for assessment of 5As implementation for both quality improvement, and for research and evaluation purposes, and presents several practical tools they may wish to use. Sample instruments for tracking delivery of the 5As and related tools that are in the public domain are provided to facilitate integration of self-management support into clinical care. We discuss the strengths and limitations of the various assessment approaches. Promising and practical measures to assess the 5As exist for both quality improvement and research purposes. Additional validation is needed on almost all current procedures, and both clinicians and researchers are encouraged to use these instruments and share the resulting data.

The majority of pharmacogenomic (PGx) studies have been conducted on European ancestry populations, thereby excluding minority populations and impeding the discovery and translation of African American–specific genetic variation into precision medicine. Without accounting for variants found in African Americans, clinical recommendations based solely on genetic biomarkers found in European populations could result in misclassification of drug response in African American patients. To address these challenges, we formed the Transdisciplinary Collaborative Center ( TCC ), African American Cardiovascular Pharmacogenetic Consortium ( ACCO u NT ), to discover novel genetic variants in African Americans related to clinically actionable cardiovascular phenotypes and to incorporate African American–specific sequence variations into clinical recommendations at the point of care. The TCC consists of two research projects focused on discovery and translation of genetic findings and four cores that support the projects. In addition, the largest repository of PGx information on African Americans is being established as well as lasting infrastructure that can be utilized to spur continued research in this understudied population.

Background A difficult challenge in health equity training is conducting honest and safe discussions about differences in lived experience based on social identity, and how racism and other systems of oppression impact health care. Objective To evaluate a Theatre of the Oppressed workshop for medical students that examines systems of oppression as related to lived health care experiences. Design Mixed-methods cross-sectional survey and interviews. Participants Forty randomly assigned early first-year medical students. Interventions A 90-min virtual workshop with three clinical scenes created by students where a character is being discriminated against or oppressed. During performance, students can stop scene, replace oppressed character, and role play how they would address harm, marginalization, and power imbalance. Participants discuss what they have witnessed and experienced. Main Measures/Approach Likert-scale questions assessing workshop’s impact. Open-ended survey questions and interviews about workshop. Key Results Thirty-one (78%) of 40 participants completed the survey. Fifty-three percent were female. Thirty-seven percent were White, 33% Asian American, 15% Black, 11% Latinx, and 4% multiracial. Ninety percent thought this training could help them take better care of patients with lived experiences different from their own. Most agreed or strongly agreed the workshop helped them develop listening (23, 77%) and observation (26, 84%) skills. Twelve (39%) students felt stressed, while 29 (94%) felt safe. Twenty-five (81%) students agreed or strongly agreed there were meaningful discussions about systemic inequities. Students reported the workshop helped them step into others’ shoes, understand intersectional experiences of multiple identities, and discuss navigating and addressing bias, discrimination, social drivers of health, hierarchy, power structures, and systems of oppression. Some thought it was difficult to have open discussions because of fear of being poorly perceived by peers. Conclusions Theatre of the Oppressed enabled medical students to engage in meaningful discussions about racism and other systems of oppression.