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Collaborative care: The importance of community partnerships in hospital medicine

Santiago C, Schulman K, Ahuja N, Hom J, Shaw JG, Blacker A
J Gen Intern Med

In the evolving landscape of healthcare, hospital medicine is expanding beyond traditional boundaries to address social drivers of health (SDOHs), which necessitates increased community partnership and engagement. At Stanford Medicine, the Division of Hospital Medicine has pioneered initiatives to enhance patient outcomes by addressing critical SDOH such as housing and food insecurity. Within our academic hospitalist division, the establishment of a Director of Community Partnership role in 2024 marked a significant step in recognizing and addressing the SDOH needs of hospitalized patients. Collaborative efforts with local Medicaid plans, county systems, and private non-profit organizations have facilitated improved care transitions, specialty care access, and support services. For instance, partnerships with Santa Clara County and Mom's Meals have, respectively, enabled the provision of permanent supportive housing and medically tailored meals to vulnerable patients. These initiatives underscore the importance of community-academic partnerships in fostering health equity, studying the impacts of various interventions, and improving patient care. Despite challenges posed by evolving Centers for Medicare & Medicaid Services policies (e.g., proposed rule changes include removing SDOH screening metrics), the commitment to building sustainable, bidirectional relationships with community organizations remains crucial. Hospitalists, despite being focused on inpatient care, should engage in these partnerships, as they can significantly impact health outcomes. This perspective highlights the transformative potential of community-academic partnerships in hospital medicine and calls for continued efforts to integrate SDOH considerations into patient care.

Santiago C, Schulman K, Ahuja N, Hom J, Shaw JG, Blacker A. Collaborative care: the importance of community partnerships in hospital medicine. J Gen Intern Med. 2025. Epub ahead of print. DOI:10.1007/s11606-025-09768-0. PMID: 40721704

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Social Determinant of Health
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