Implementation of a Biopsychosocial History and Physical Exam Template in the Electronic Health Record: Mixed Methods Study.

Background: Patients' perspectives and social contexts are critical for prevention of hospital readmissions; however, neither is routinely assessed using the traditional history and physical (H&P) examination nor commonly documented in the electronic health record (EHR). The H&P 360 is a revised H&P template that integrates routine assessment of patient perspectives and goals, mental health, and an expanded social history (behavioral health, social support, living environment and resources, function). Although the H&P 360 has shown promise in increasing psychosocial documentation in focused teaching contexts, its uptake and impact in routine clinical settings are unknown.

A 7-Domain Framework That Can Bridge Clinical Care, Health Systems Science, and Health Equity: Lessons From the H&P 360.

The H&P 360 is a reconceptualized history and physical (H&P), which clinical medical students have reported reveals clinically relevant information not elicited by the traditional H&P, informs care planning, promotes interprofessional team care, and enhances patient rapport. In addition to the traditional checklist focused on patients' medical conditions, the H&P 360 includes prompts for gathering limited but critical information in 6 other domains directly relevant to patients' overall health-patient values, goals, and priorities; mental health; behavioral health; social support; living environment and resources; and function. Clinicians are thus reminded to elicit relevant information from each domain appropriate to the context of each clinical encounter.

Quantifying the climate benefits of a virtual versus an in-person format for an international conference.

Background: Academic institutions across the globe routinely sponsor large conferences. During the COVID-19 pandemic, many conferences have used all- or partially virtual formats. The conversion of the 2021 Consortium of Universities for Global Health (CUGH) conference, originally planned in-person for Houston, TX USA to an all-virtual format provided an opportunity to quantify the climate-related impacts of in-person versus virtual conferences.

Tailoring complex care to patients' needs: myths, realities, and best next steps.

The authors of this editorial highlight some of the myths surrounding complex care management, identify areas where research could be most informative, and recommend best next steps in developing effective and efficient complex care management programs.

Expanding the Traditional History and Physical Examination to Address Chronic Diseases and Social Needs: A Multisite Randomized Control Trial of 4 Medical Schools.

Purpose: This study gathers validity evidence of an expanded History and Physical examination (H&P 360) to address chronic diseases through incorporation of biopsychosocial elements that are lacking in traditional H&P assessments via a multisite randomized controlled trial among medical students.

Method: Third- and fourth-year medical students (n = 159) at 4 schools participated in an Objective Structured Clinical Examination designed with 2 cases for chronic disease. Students were randomized into the treatment group, which involved brief written instructions on how to use the H&P 360 followed by a standardized patient (SP) interaction, or the control group, which used the traditional H&P in an SP interaction without additional instructions.

A comparative carbon footprint analysis of disposable and reusable vaginal specula.

Background: Healthcare systems in the United States have increasingly turned toward the use of disposable medical equipment in an attempt to save time, lower costs, and reduce the transmission of infections. However, the use of disposable instruments is associated with increased solid waste production and may have negative impacts on the environment, such as increased greenhouse gas emissions.

Objective: The purpose of this study was to inform this discussion; we applied life cycle assessment methods to evaluate the carbon footprints of 3 vaginal specula: a single-use acrylic model and 2 reusable stainless steel models.

Scaling Up a Global Health and Disparities Path of Excellence Pilot Program at the University of Michigan Medical School.

Problem: Transforming medical school curricula to train physicians to better address society's needs is a complex task, as students must develop expertise in areas other than clinical medicine.

Approach: In 2010, the University of Michigan Medical School (UMMS) launched the Global Health and Disparities (GHD) Path of Excellence as part of a larger curriculum transformation. The GHD Path is a co-curriculum with the goal of ameliorating health disparities in the United States and abroad.

Using a Six-Domain Framework to Include Biopsychosocial Information in the Standard Medical History.

Problem: The traditional approach to physicians' history taking is designed to facilitate diagnosis and treatment of biomedical conditions. However, in the 21st century, health is critically influenced by the interaction of biomedical conditions and nonbiomedical factors such as patient's ability to manage chronic disease and the social determinants of health. Interventions to expand routine history taking to include nonbiomedical factors have not been widely adopted, possibly due to the difficultly of incorporating long checklists into routine care and the inability to achieve consensus on the relevant behavioral or social determinants of health content applicable to all patients.

Improving care transitions: complex high-utilizing patient experiences guide reform.

Objectives: Care management has been adopted by many health systems to improve care and decrease costs through coordination of care across levels. At our academic medical center, several care management programs were developed under separate management units, including an inpatient-based program for all patients and an outpatient-based program for complex, high-utilizing patients. To bridge administrative silos between programs, we examined longitudinal care experiences of hospitalized complex patients to identify process and communication gaps, drive organizational change, and improve care.

Risk Factors and Effects of Care Management on Hospital Readmissions Among High Users at an Academic Medical Center.

Few studies have examined predictors of hospital readmission among high-using patients enrolled in a behaviorally oriented intensive care management program. The purpose of this case control study was to describe risk factors and the effectiveness of a complex care management program for hospital readmission among vulnerable patients at a large academic medical center. One hundred sixty-three patients enrolled in the University of Michigan Complex Care Management Program (UM CCMP) were hospitalized between January 2014 and March 2015.

Implementing the Collaborative Care Model as Part of a Countywide Initiative.

This column describes the planning and implementation of an integrated behavioral health project which was facilitated and endorsed by a developing accountable health community, the Washtenaw Health Initiative (WHI). The WHI is a voluntary countywide coalition of academic, community, health system, and county government agencies dedicated to improving access to high-quality health care for low-income, uninsured, and Medicaid populations. When lack of access to mental health services was identified as a pressing concern, the WHI endorsed pilot testing of collaborative care, an evidence-based treatment model, in county safety-net clinics.

Patient Outcomes in a Medicaid Managed Care Lock-In Program.

Background: Prescription drug abuse is a growing epidemic in the United States, and opioids are among the most commonly abused and misused controlled substances. Managed care organizations can use pharmacy lock-in programs to limit patients' access to opioids by requiring that they receive all scripts from 1 prescriber, potentially reducing inappropriate use.

Objective: To evaluate opioid use patterns among patients in a Medicaid managed care lock-in program limiting opioid coverage to prescriptions written by assigned prescribers.

Reasons Why Individuals Remain Uninsured Under the Affordable Care Act: Experiences of Patients at a Student-Run Free Clinic in Michigan, a Medicaid Expansion State.

Since the enactment of the Affordable Care Act (ACA), many people remain uninsured. While studies have examined this population, few have explored patients' experiences seeking insurance. To elucidate these individuals' perspectives, we surveyed patients (n = 80) at the University of Michigan Student-Run Free Clinic concerning their activity accessing insurance.

Development and implementation of intranasal naloxone opioid overdose response protocol at a homeless health clinic.

Purpose: To describe the development, implementation, and preliminary evaluation of Opioid Overdose Response Protocol using intranasal (IN) naloxone in a homeless shelter.

Data Sources: Opioid Overdose Response Protocol and training curriculum were developed using the Massachusetts Department of Public Health Opioid Overdose Education and Naloxone Distribution (OEND) flow chart, the American Heart Association (AHA) simplified adult basic life support algorithm, and resources through Harms Reduction Coalition.

Conclusions: Intranasal naloxone offers a safe and effective method for opioid reversal.

Developing a professional pathway in health equity to facilitate curricular transformation at the University of Michigan Medical School.

Problem: Medical schools are challenged to realign curricula to address society's needs in a rapidly changing environment, and to support new instruction and assessment methods that require substantial faculty time.

Approach: In 2010, the University of Michigan Medical school began planning the Global Health and Disparities Path of Excellence (GHD Path), an optional co-curriculum for students interested in health disparities, with explicit goals to (1) draw attention to the school's social mission; (2) test new, faculty-intensive methods of learning and assessment for all students; and (3) serve as a template for additional co-curricular paths.

Outcomes: Intended outcomes of the program include enhancing students' competency in leadership related to ameliorating health disparities and the study institution's ability to plan feasible and effective schoolwide reforms in self-directed learning, faculty advising systems, narrative-based feedback for goal setting, Web-based student portfolios, and additional Paths of Excellence.

Centralized care management support for "high utilizers" in primary care practices at an academic medical center.

Although evidence of effectiveness is limited, care management based outside primary care practices or hospitals is receiving increased attention. The University of Michigan (UM) Complex Care Management Program (CCMP) provides care management for uninsured and underinsured, high-utilizing patients in multiple primary care practices. To inform development of optimal care management models, we describe the CCMP model and characteristics and health care utilization patterns of its patients.

Making general internal medicine research relevant to the older patient with multiple chronic comorbidities.

General Internal Medicine research evolves in response to the needs of the patients to whom we provide care. Currently, many studies exclude older adults who deeply affect the clinical care of this population. With the number of older adults increasing, creating research protocols that include older adults with multiple chronic comorbidities is imperative.

Mental health in ACOs: missed opportunities and low-hanging fruit.

Accountable Care Organizations (ACOs) have potential to improve care for chronic conditions through incentives for better performance and bundled payments that promote care coordination. The Chronic Care Model (CCM) is a framework for providing health services for chronic conditions in primary care settings consistent with the organizational and financial goals of ACOs. Integrated mental health care – collaborative care by mental health and primary care providers for selected patients – improves care and is consistent with the Chronic Care Model.

Medicine in the 21st century: recommended essential geriatrics competencies for internal medicine and family medicine residents.

Background: Physician workforce projections by the Institute of Medicine require enhanced training in geriatrics for all primary care and subspecialty physicians. Defining essential geriatrics competencies for internal medicine and family medicine residents would improve training for primary care and subspecialty physicians. The objectives of this study were to (1) define essential geriatrics competencies common to internal medicine and family medicine residents that build on established national geriatrics competencies for medical students, are feasible within current residency programs, are assessable, and address the Accreditation Council for Graduate Medical Education competencies; and (2) involve key stakeholder organizations in their development and implementation.

First-year medical students' perceptions of physicians' responsibilities toward the underserved: an analysis of reflective essays.

Objective: To explore medical students' perceptions of their future role as physicians as it relates to personal and professional responsibilities toward the underserved.

Methods: The authors conducted a qualitative content analysis of 53 first-year medical students' reflective essays focusing on the question: "Access to health care is a societal problem. Do physicians have a professional obligation to help by participating in free clinics, or otherwise doing some service-type activity? What are your personal feelings about how you might balance service to other people with personal issues like income, family, and career choice?"

Results: The student essays revealed students' awareness of the distinct expertise that enables physicians to offset limited access to health care.

Residents' views of plastic surgery in the geriatric population: an objective needs assessment for graduate plastic surgery education.

Background: This study was undertaken to identify educational needs for plastic surgery residents regarding the care of elderly patients.

Methods: A focus group of plastic surgery residents was conducted. Investigators coded the focus group transcript, using a "concept identification" technique and organized the coded concepts within the 6 general competencies of the Accreditation Council for Graduate Medical Education.

Successful implementation of a faculty development program in geriatrics for non-primary care physician educators.

A four-year faculty development program to enhance geriatrics learning among house officers in seven surgical and related disciplines and five medical subspecialties at a large academic institution resulted in changes in attitudes and knowledge of faculty participants, expanded curricula and teaching activities in geriatrics, and enhanced and altered career trajectories of faculty participants. The program centered on problem-oriented longitudinal small group seminars with concurrent application of new skills. Key success factors included securing the active support of institutional leaders, focus on career development, examining presumptions regarding professional scope, protected time for faculty participants, and provision of teaching and evaluation resources for individualized application by faculty.