A 7-Domain Framework That Can Bridge Clinical Care, Health Systems Science, and Health Equity: Lessons From the H&P 360

Abstract

The H&P 360 is a reconceptualized history and physical (H&P), which clinical medical students have reported reveals clinically relevant information not elicited by the traditional H&P, informs care planning, promotes interprofessional team care, and enhances patient rapport. In addition to the traditional checklist focused on patients’ medical conditions, the H&P 360 includes prompts for gathering limited but critical information in 6 other domains directly relevant to patients’ overall health—patient values, goals, and priorities; mental health; behavioral health; social support; living environment and resources; and function. Clinicians are thus reminded to elicit relevant information from each domain appropriate to the context of each clinical encounter. As health systems explore ways to identify and address social drivers of health, medical schools are rapidly expanding curricula beyond biomedical conditions, as reflected in the multifaceted health systems science curriculum. Many of today’s medical students struggle to find connections among the core tasks of mastering biomedical clinical medicine, their evolving professional identity and career trajectory, and addressing systemic and societal barriers to population health. The authors argue that the 7-domain framework can serve as a conceptual bridge that links the care of individual patients with topics in the health systems science curriculum to promote health equity. The authors provide illustrative examples of the 7 domains as an organizing lens that can promote curiosity and understanding of seemingly disparate topics, such as interpersonal violence, social drivers of health, and structural racism, as well as help students expand and define their professional identities as physicians beyond diagnosis and treatment of biomedical conditions. The authors invite discussion and experimentation around the use of the 7-domain framework in teaching, assessment, and curriculum development and point to resources for clinical educators for teaching and measuring the effects of the H&P 360 on learners, preceptors, and patients.