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

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The H&P 360, a 7-domain history and physical, gathers crucial patient information beyond medical conditions. This approach enhances clinical relevance, care planning, and connects medical education to health systems science for improved health equity.

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Area of Science:

  • Medical Education
  • Health Systems Science
  • Patient-Centered Care

Background:

  • Traditional History and Physical (H&P) checklists focus primarily on biomedical conditions.
  • Medical students face challenges integrating biomedical knowledge with health systems science and addressing social determinants of health.
  • There is a need for educational tools that bridge individual patient care with population health and health equity.

Purpose of the Study:

  • To introduce and evaluate the H&P 360, a reconceptualized History and Physical framework.
  • To demonstrate how the 7-domain H&P 360 can enhance clinical relevance, care planning, and patient rapport.
  • To explore the H&P 360's potential as a conceptual bridge between clinical medicine and health systems science curricula.

Main Methods:

  • The H&P 360 expands the traditional H&P by incorporating 6 additional domains: patient values, goals, priorities; mental health; behavioral health; social support; living environment and resources; and function.
  • Clinicians are prompted to gather relevant information from these domains within the context of clinical encounters.
  • Illustrative examples are provided to demonstrate the application of the 7-domain framework.

Main Results:

  • Medical students report the H&P 360 elicits clinically relevant information missed by traditional H&Ps.
  • The H&P 360 informs care planning, promotes interprofessional team care, and enhances patient rapport.
  • The 7-domain framework facilitates understanding of social drivers of health and structural issues like racism.

Conclusions:

  • The 7-domain H&P 360 framework can serve as a conceptual bridge linking individual patient care with health systems science.
  • This approach can promote health equity by addressing social determinants of health and expanding physicians' professional identity.
  • The authors invite discussion and experimentation with the H&P 360 for teaching, assessment, and curriculum development.