Association of Academic Health Centers

IntroductionAcademic health centers (AHCs) play critical roles in population health by providing health care, conducting population health research, and providing population health training and education. This publication describes an interactive, multipart, case-based session targeted at AHC executives, faculty, and administrators about population health initiatives at AHCs and how the AHC structure can be leveraged to promote population health.MethodsThis 90-minute virtual session was conducted during the Association of Academic Health Centers’ 2020 annual meeting. The session opened with 5-minute, Ignite-style presentations showcasing population health innovations. Next, in small groups, participants discussed a case introducing a fictional AHC charged with assisting its local government's population health efforts. Participants self-selected into one of four small groups (analytics, education and training, community engagement, and implementation) and were provided additional case content and tailored prompts. In the large group, participants debriefed their discussions. Participants completed a postsession survey.ResultsForty-six individuals from 31 AHCs participated. Eighteen participants completed the survey. Sixteen respondents (89%) agreed the session was valuable and provided ideas for implementation at their AHC. Fifteen participants (83%) indicated that they planned to follow up with their colleagues regarding how to leverage the AHC structure to improve population health.DiscussionThis session provides an interactive forum to discuss population health in the context of an AHC and examine how its structure can facilitate population health. While offered at a conference, the session can also be implemented at a single AHC to foster local understanding of population health and inform future initiatives.

Biomedical science is usually framed for the public in terms of its "promise." When a breakthrough results from scientific inquiry, that promise is translated into a hope for a cure. The "promise" of such advances in biomedical research can have a paradoxical effect. In the case of pediatric neuromuscular disease, rather than reducing suffering, the expectation of cure can be a burden-both physically and emotionally-for affected children and their families. If a family expects a cure, it is likely to do everything possible to help the child live as long as possible, in the hope that the child will eventually receive it. I am not arguing that the appropriate response to the paradox of promise is to impede scientific progress. What is needed, however, is a broader conception of hope-one that values hope for a good day, a good quality of life, good relationships, or even a good death-alongside the hope for a cure.

From Hippocrates to Osler, the sacrosanct physician-patient relationship has been paramount. Hippocrates is best remembered for the Oath that bears his name(1), often recited at medical school graduations, which places the patient first and foremost in the physician encounter. More than two thousand years later, William Osler, the renowned professor of medicine at Johns Hopkins Hospital and Oxford, wrote that the premier quality of a good physician is “aequanimitas”, meaning calmness and patience(2). The foundational idea of the personal, caring relationship between physicians and patients has clearly withstood the test of time. Perhaps it can serve as a guidepost for the enormous changes coming in medical care in the 21st century. Indeed, across the ages of advances in scientific discovery, the special nature of the physician-patient relationship, exemplified by compassion, has been the mainstay of medicine.[...]

Despite concern that patients in the intensive care unit (ICU) may not be treated with respect and dignity, there is not conceptual clarity regarding what constitutes such treatment. In addition, measures specific to treatment with respect and dignity in the ICU are unavailable. Accordingly, a multidisciplinary group developed a conceptual model for treatment with respect and dignity in the ICU and used mixed methods to gather data on this issue. This effort included interviews with patients and families, focus groups with health care professionals, and direct observations. These data were then compared and contrasted to synthesize what was learned. Finally, pilot quantitative patient and family survey data were collected and analyzed. Each of these approaches, which comprise the papers in this supplement to Narrative Inquiry in Bioethics, is briefly described in this article.

Editor’s Note: This month, the journal features a group of articles that tell important stories of change at 10 academic health centers in the United States. Dr. Steven A. Wartman served as guest editor for those articles and wrote this month’s column discussing them. I thank him for that and also for his extensive efforts and those of his assistant, Alcenia McIntoshPeters, in working with the authors and Al Bradford and his colleagues at the journal to develop and organize the articles so that they share valuable lessons and document pivotal events in an important part of the history of academic medicine.

To assess and compare parent and adolescent views on the importance of risk behavior research and the need for parental consent and to identify predictors of views. Confidential survey. Adolescent, general pediatrics clinics. Adolescents aged 14 to 17 years presenting alone (solo) or with a parent or guardian (paired) and parents or guardians. Of 265 eligible pairs (199 solo adolescents), 134 (93) had useable surveys. The proportion of females in the parent or guardian, paired adolescent, and solo adolescent groups was 92%, 59%, and 75%, respectively; and the proportion of African Americans in these groups was 67%, 69%, and 91%, respectively. Views on the importance of and requirement of parental consent for confidential risk behavior research. Most parents (98%), paired adolescents (99%), and solo adolescents (100%) believed confidential risk behavior research surveys with teenagers were important; greater than 90% of all groups believed surveys should be conducted. The proportion of parents, paired adolescents, and solo adolescents that endorsed requiring parental permission was 84%, 53%, and 19%, respectively. Parents were less likely to endorse requiring permission if they had confidential health concerns as teenagers and were more likely to endorse requiring permission if their child was younger or female, if they believed their child had sex, and if they were a parent vs a guardian. Adolescents were more likely to endorse requiring permission if they were younger, not African American, and had more educated parents. Adolescents presenting with parents were more likely to endorse requiring permission. Parents and adolescents believed risk behavior research with adolescents was important. Most parents believed parental permission is needed for participation. Compared with parents, fewer adolescents believed parental consent was necessary. It is not clear what effect requirement of parental permission would have on participation or validity. Further research is needed to elucidate views on adolescent risk behavior research.

ing rooms of medical oncology, radiation oncology, and cardiology outpatient clinics at 16 institutions across the country were interviewed about their attitudes toward medical research; whether they had experience as a participant in medical research; and, if applicable, the reasons for enrolling and the nature of their experience as a participant in research. Sample. Five geographic areas were selected for this project: Ann Arbor, Michigan; Baltimore/Washington; Dallas/San Antonio, Texas; Durham/Raleigh, North Carolina; and Seattle/Tacoma. Each area included at least one institution that