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      Academic Medicine’s Fourth Mission: Building on Community-Oriented Primary Care to Achieve Community-Engaged Health Care

      , MBE 1 , , MD 2 , , MD 3 , , MD, MSPH 4 ,
      Academic Medicine
      Lippincott Williams & Wilkins

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          A 2021 article, “Now is our time to act: Why academic medicine must embrace community collaboration as its fourth mission,” by Association of American Medical Colleges (AAMC) authors, including AAMC president and CEO Dr. David J. Skorton, offers 2 aims that are highly related: community collaboration and health equity. The AAMC’s call to prioritize community collaboration and health equity as pillars of the academic medicine mission echo earlier work on community-oriented primary care (COPC) and an even more robust model that builds on COPC, community-engaged health care (CEHC). COPC is a tested, systematic approach to health care by which a health clinic or system collaborates with a community to reshape priorities and services based on assessed health needs and determinants of health. COPC affirms health inequities’ socioeconomic and political roots, emphasizing health care as a relationship, not a transaction or commodity. Communities where COPC is implemented often see reductions in health inequities, especially those related to socioeconomic, structural, and environmental factors. COPC was the foundation on which community health centers were built, and early models had demonstrable effects on community health and engagement. Several academic health centers build on COPC to achieve CEHC. In CEHC, primary care remains critical, but more of the academic health center’s functions are pulled into community engagement and trust building. Thus, the AAMC has described and embraced a care and training model for which there are good, longitudinal examples among medical schools and teaching hospitals. Spreading CEHC and aligning the Community Health Needs Assessment requirements of academic health centers with the fourth mission could go a long way to improving equity, building trust, and repairing the social contract for health care.

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          Most cited references35

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          Community-based participatory research contributions to intervention research: the intersection of science and practice to improve health equity.

          Community-based participatory research (CBPR) has emerged in the last decades as a transformative research paradigm that bridges the gap between science and practice through community engagement and social action to increase health equity. CBPR expands the potential for the translational sciences to develop, implement, and disseminate effective interventions across diverse communities through strategies to redress power imbalances; facilitate mutual benefit among community and academic partners; and promote reciprocal knowledge translation, incorporating community theories into the research. We identify the barriers and challenges within the intervention and implementation sciences, discuss how CBPR can address these challenges, provide an illustrative research example, and discuss next steps to advance the translational science of CBPR.
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            Making Neighborhood-Disadvantage Metrics Accessible — The Neighborhood Atlas

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              Aligning the goals of community-engaged research: why and how academic health centers can successfully engage with communities to improve health.

              Community engagement (CE) and community-engaged research (CEnR) are increasingly viewed as the keystone to translational medicine and improving the health of the nation. In this article, the authors seek to assist academic health centers (AHCs) in learning how to better engage with their communities and build a CEnR agenda by suggesting five steps: defining community and identifying partners, learning the etiquette of CE, building a sustainable network of CEnR researchers, recognizing that CEnR will require the development of new methodologies, and improving translation and dissemination plans. Health disparities that lead to uneven access to and quality of care as well as high costs will persist without a CEnR agenda that finds answers to both medical and public health questions. One of the biggest barriers toward a national CEnR agenda, however, are the historical structures and processes of an AHC-including the complexities of how institutional review boards operate, accounting practices and indirect funding policies, and tenure and promotion paths. Changing institutional culture starts with the leadership and commitment of top decision makers in an institution. By aligning the motivations and goals of their researchers, clinicians, and community members into a vision of a healthier population, AHC leadership will not just improve their own institutions but also improve the health of the nation-starting with improving the health of their local communities, one community at a time.

                Author and article information

                Acad Med
                Acad Med
                Academic Medicine
                Lippincott Williams & Wilkins (Hagerstown, MD )
                20 January 2023
                February 2023
                : 98
                : 2
                : 175-179
                [1 ] C.L. Savage Hoggard is a medical student, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois.
                [2 ] A. Kaufman is vice president for community health, University of New Mexico Health Sciences, Albuquerque, New Mexico.
                [3 ] J.L. Michener is professor emeritus, Department of Family Medicine and Community Health, Duke School of Medicine, Durham, North Carolina.
                [4 ] R.L. Phillips Jr is founding executive director, Center for Professionalism and Value in Health Care, Washington, DC.
                Author notes
                Correspondence should be addressed to Robert L. Phillips Jr, Center for Professionalism and Value in Health Care, 1016 16th St. NW, Ste 700, Washington, DC 20036; telephone: (202) 527-9993; email: bphillips@ 123456theabfm.org .
                Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Association of American Medical Colleges.

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

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