The Emergence of Population Health in US Academic Medicine

Marc N Gourevitch,William M Tierney,Maureen S Durkin,Annetine C Gelijns,Richard Platt,Judith Wylie-Rosett,Lesley H Curtis,Katherine Jones,Angela Fagerlin,Belinda M Reininger

doi:10.1001/jamanetworkopen.2019.2200

Abstract

In response to rapidly growing interest in population health, academic medical centers are launching department-level initiatives that focus on this evolving discipline. This trend, with its potential to extend the scope of academic medicine, has not been well characterized. To describe the emergence of departments of population health at academic medical centers in the United States, including shared areas of focus, opportunities, and challenges. This qualitative study was based on a structured in-person convening of a working group of chairs of population health-oriented departments on November 13 and 14, 2017, complemented by a survey of core characteristics of these and additional departments identified through web-based review of US academic medical centers. United States medical school departments with the word population in their name were included. Centers, institutes, and schools were not included. Departments were characterized by year of origin, areas of focus, organizational structure, faculty size, teaching programs, and service engagement. Opportunities and challenges faced by these emerging departments were grouped thematically and described. Eight of 9 population health-oriented departments in the working group were launched in the last 6 years. The 9 departments had 5 to 97 full-time faculty. Despite varied organizational structures, all addressed essential areas of focus spanning the missions of research, education, and service. Departments varied significantly in their relationships with the delivery of clinical care, but all engaged in practice-based and/or community collaboration. Common attributes include core attention to population health-oriented research methods across disciplines, emphasis on applied research in frontline settings, strong commitment to partnership, interest in engaging other sectors, and focus on improving health equity. Tensions included defining boundaries with other academic units with overlapping areas of focus, identifying sources of sustainable extramural funding, and facilitating the interface between research and health system operations. Departments addressing population health are emerging rapidly in academic medical centers. In supporting this new framing, academic medicine affirms and strengthens its commitment to advancing population health and health equity, to improving the quality and effectiveness of care, and to upholding the social mission of medicine.

Highlights

Much attention has been focused in recent years on improving population health
While much of this work historically has been accomplished with only minimal contributions from health care and academic medicine, these sectors command an enormous concentration of health-related resources
An emerging group of population health–oriented initiatives within academic medicine is seeking to transcend the traditional gulf between medicine and public health—engaging all sectors, including health care and public health—in understanding and improving the health of populations

Summary

Introduction

Much attention has been focused in recent years on improving population health This emphasis marks an acknowledgment that the poor performance of the United States on many indicators of health has persisted despite US leadership in many aspects of health care delivery and that other factors, like social determinants of health, must receive greater attention if national health goals and health care cost-savings goals are to be achieved.[1] Further, improving population health aligns with language introduced through the triple-aim framework[2] and the accompanying shift toward a valuebased health care paradigm, in which accountable care and accountable health communities figure prominently. Rising attention to pervasive health disparities and their fundamental causes has further elevated the conversation about societal drivers of health and the value of shifting deliberately to a more upstream focus.[5,6] An emerging group of population health–oriented initiatives within academic medicine is seeking to transcend the traditional gulf between medicine and public health—engaging all sectors, including health care and public health—in understanding and improving the health of populations

Methods

Results

Discussion

Conclusion