DeVoe Jennifer E, Likumahuwa-Ackman Sonja, Shannon Jackilen, Steiner Hayward Elizabeth
J.E. DeVoe is professor and chair, Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, and senior research advisor, OCHIN, Inc., Portland, Oregon. S. Likumahuwa-Ackman is research program manager, Department of Family Medicine, Oregon Health & Science University, Portland, Oregon. J. Shannon is associate professor, School of Public Health, director, Knight Community Engaged Research Program, Knight Cancer Institute, and associate director, Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland, Oregon. E. Steiner Hayward is adjunct associate professor, Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, and senator, Oregon State Legislature, Salem, Oregon.
Acad Med. 2017 Apr;92(4):475-482. doi: 10.1097/ACM.0000000000001385.
Academic medical centers (AMCs) in the United States built world-class infrastructure to successfully combat disease in the 20th century, which is inadequate for the complexity of sustaining and improving population health. AMCs must now build first-rate 21st-century infrastructure to connect combating disease and promoting health. This infrastructure must acknowledge the bio-psycho-social-environmental factors impacting health and will need to reach far beyond the AMC walls to foster community "laboratories" that support the "science of health," complementary to those supporting the "science of medicine"; cultivate community "classrooms" to stimulate learning and discovery in the places where people live, work, and play; and strengthen bridges between academic centers and these community laboratories and classrooms to facilitate bidirectional teaching, learning, innovation, and discovery.Private and public entities made deep financial investments that contributed to the AMC disease-centered approach to clinical care, education, and research in the 20th century. Many of these same funders now recognize the need to transform U.S. health care into a system that is accountable for population health and the need for a medical workforce equipped with the skills to measure and improve health. Innovative ideas about communities as centers of learning, the importance of social factors as major determinants of health, and the need for multidisciplinary perspectives to solve complex problems are not new; many are 20th-century ideas still waiting to be fully implemented. The window of opportunity is now. The authors articulate how AMCs must take bigger and bolder steps to become leaders in population health.
美国的学术医疗中心（AMCs）在20世纪构建了世界级的基础设施，以成功抗击疾病，但这对于维持和改善人群健康的复杂性而言已显不足。AMCs现在必须打造一流的21世纪基础设施，将抗击疾病与促进健康联系起来。这种基础设施必须认识到影响健康的生物-心理-社会-环境因素，并且需要远远超越AMCs的围墙，去培育支持“健康科学”的社区“实验室”，以补充支持“医学科学”的实验室；培育社区“教室”，在人们生活、工作和娱乐的地方激发学习与发现；加强学术中心与这些社区实验室和教室之间的桥梁，以促进双向教学、学习、创新和发现。私人和公共实体在20世纪进行了大量资金投入，促成了AMCs以疾病为中心的临床护理、教育和研究方法。现在，许多这些同样的资助者认识到有必要将美国医疗保健转变为一个对人群健康负责的系统，以及有必要培养一支具备衡量和改善健康技能的医疗 workforce。关于将社区作为学习中心的创新理念、社会因素作为健康主要决定因素的重要性以及解决复杂问题所需的多学科视角，并非新鲜事物；许多都是20世纪的理念，仍有待全面实施。现在正是机会之窗。作者阐述了AMCs必须如何采取更大胆的举措，成为人群健康领域的领导者。
