Clinical Practice & Population Health

Clinical Practice & Population Health

Domain 1: Population Health Management Domain 2: Partnering with Communities to Improve Health Domain 3: Environmental Health Domain 4: Occupational Health Domain 5: Global Health Domain 6: Cultural Dimensions of Practice Domain 7: Emergency Preparedness and Response Systems

Domain 1: Population Health Management

A. Principles of patient and community engagement for population health improvement
1. Role of communities and patients in population health improvement
2. Community context, history, assets, and strengths
3. Community-oriented primary care (COPC)
4. Patient and community perspectives on their needs and concerns
5. Patient engagement in the critical evaluation of health-related news and information
6. Population-specific materials informed by community engagement
7. Educational and clinical activities with communities as partners
B. Social and structural influences on clinical interventions
1. Social Determinants of Health Framework and use in clinical decision making
2. Education quality, job training, language, and literacy comprehension
3. Access to language services, digital accessibility, and technology literacy
4. Social norms, discrimination, and trust in government and the health care system
5. Institutional histories of policies and actions contributing to health inequities
6. Impact of local, state, and national policies and actions contributing to health inequities
7. Community attitudes toward health care and other institutions
C. Patient population health assessment and improvement
1. Community health needs and assets assessment
2. Coordinated care for groups of patients with multiple conditions or high care needs
3. Unique needs of diverse patient populations within health systems
D. Coordination of health services
1. Connection to community resources
2. Alignment of resources with patient and population needs
3. Communication and knowledge sharing among health professionals, patients, and health care partners
4. Integration of clinical and wellness services
a. Integrated primary care and behavioral health services
b. Patient-centered medical homes
c. Home care and telemedicine services
d. Care coordination models, case management models
E. Interprofessional team-based care
1. Core principles of interprofessional practice
2. Roles and responsibilities of the interprofessional team
3. Composition of interprofessional care teams
F. Systems thinking in population health
1. Impact of system structures, dynamics, and interconnections on health outcomes
2. System analysis to inform design, processes, and policies to improve health outcomes and lower costs
3. Interactions among organizational components and partners that improve outcomes
4. Coordination and alignment across sectors to build and sustain integrated system of care within communities

Domain 2: Partnering with Communities to Improve Health

A. Population health assessments
1. Approaches to developing and maintaining partnerships among key stakeholders
2. Methods of assessment, planning models, frameworks, and tools
3. National, state and local requirements that guide community health assessments and improvement planning
B. Principles of successful partnering
1. Application of community engagement principles to identify and prioritize interventions
2. Strategies for decision-making and power-sharing
3. Strategies for building community capacity
C. Community-engaged research
1. Principles of community-engaged research (CER) and community-based participatory research (CBPR)
2. Differences between CER, CBPR and traditional research
3. Benefits, challenges and ethical considerations of CER and CBPR
4. Appropriate circumstances for applying a CER or CBPR approach
D. Communications
1. Communication channels and strategies
a. Grass roots, mass media, social media, risk and crisis communication, policy, advocacy
2. Impact statements supporting evidence-based practices
3. Strategic communication planning based on audience characteristics, health literacy, timing, and delivery channels
4. Translation of research findings into clear and actionable formats for intended audiences
5. Tailored messaging reflecting literacy levels, cultural contexts, community perspectives, and trust considerations
6. Accessible communication of data and population health information for diverse audiences
E. Key evidence‐based resources for community preventive services
1. Community Preventive Services Task Force: The Community Guide to Preventive Services
2. Agency for Healthcare Research and Quality (AHRQ)
3. U.S. Preventive Services Task Force (USPSTF)
4. Healthy People 2030
5. County Health Rankings & Roadmaps (CHR&R)
6. Community Toolbox

Domain 3: Environmental Health

A. Scope of environmental health
1. Interrelationships between people, animals (One Health), and their environment
2. Unaltered (natural) and altered (human-impacted and built) environments
3. Environmental health in local, state, federal, and global policies and agencies
4. Hazardous substances and their impact on health
5. Climate change and extreme weather events
6. Environmental justice
a. Differential exposures and outcomes by geography, income, race
B. Environmental contaminants, vectors, and routes of entry
1. Chemical, biological, and physical agents
a. Tobacco, solvents, heavy metals, asbestos, pesticides
b. Mold, Legionella, zoonotic pathogens, disease vectors
c. Solar and nuclear radiation, temperature extremes, noise, geologic or weather-related hazards
2. Routes of entry
a. Inhalation, ingestion, dermal absorption
3. Indoor and outdoor environments
a. Ventilation, radon, indoor air quality
b. Air and water quality, noise, pollution
C. Environmental health risk assessment and risk management
1. Foundational steps in environmental health risk assessment:
a. Hazard identification
b. Dose-response assessment
c. Exposure assessment
d. Risk characterization
2. Risk management strategies
a. Recognition and mitigation of environmental hazards, particularly for children, older adults, marginalized, or at-risk populations
b. Use of regulatory standards and public health interventions to guide safe exposure levels and remediation efforts
c. Community engagement and education to support informed decision-making and local advocacy
3. Social, political, economic, and behavioral drivers of environmental vulnerability
a. Access to affordable health insurance, environmental health services, and clinical care
b. Health literacy and communication barriers
c. Access and adherence to balanced nutrition
d. Access to safe and affordable health-promoting housing, school, and recreational environments
e. Substance use and behavioral health challenges
f. Oral health and gaps in preventive care

Domain 4: Occupational Health

A. Employment‐based risks and injuries
1. Biological, chemical, radiological, and physical agents
2. Infectious and chronic diseases due to occupational exposures
3. Common occupational diseases and injuries
4. Psychosocial risk factors
5. Risks specific to health care workers including understaffing, fatigue, and environmental exposures
6. Emerging issues such as remote work models, automation, and workforce aging
B. Prevention and control of occupational exposures and injuries
1. Exposure and injury types in health care settings
a. Needlestick injuries, musculoskeletal injuries
b. Latex allergy, workplace violence, psychosocial stressors
2. Prevention strategies in health care settings
a. Training and education, ergonomic design, mental health and well-being supports
3. Control methods for risk reduction
a. Surveillance of injury and illness trends
b. Engineering controls: ventilation systems, sharps disposal containers
c. Administrative controls: shift scheduling, workload management, training protocols
d. Safe work practices: hand hygiene, proper lifting techniques
e. Incident reporting systems
f. Personal protective equipment (PPE)
g. Policy implementation and enforcement
4. Roles and governance of key organizations in occupational health
a. Occupational Safety and Health Administration (OSHA)
b. National Institute for Occupational Safety and Health (NIOSH)
c. State regulatory agencies
d. Occupation-specific organizations

Domain 5: Global Health

A. Global demographics, disease distribution, and population patterns
1. Population health metrics
a. Size, age distribution, morbidity, mortality, and fertility rates
2. Burden of disease and related risk factors
3. Population growth, urbanization, and links to health and development
4. Health needs and challenges related to migration, refugees, and displaced populations
B. Strategies to address key burdens of disease
1. Global disease surveillance and response systems
a. Disease surveillance networks, laboratory capacity, data sharing systems, and outbreak control measures
2. Prevention and control programs
a. Immunization and vaccination programs, clean water and sanitation, hygiene, vector control, nutrition, maternal and child health programs
3. Health systems strengthening
a. Workforce development and training, health financing, supply chains and infrastructure
4. Community-based, culturally relevant, and linguistically appropriate interventions
a. Community engagement and capacity-building, interventions using cultural and social contexts, local partnerships
5. Digital health and technology innovations for surveillance, education, remote care delivery, coordination, and monitoring
6. Roles and governance of key organizations in global health
a. Intergovernmental Organizations: World Health Organization (WHO), UNICEF, Gavi-The Vaccine Alliance, global partnerships
b. U.S. Government Agencies: Centers for Disease Control and Prevention (CDC), National Institutes of Health (NIH), US State Department
c. Non-Governmental Organization (NGOs), Private Voluntary Organizations (PVOs), and private foundations
C. Effects of globalization on health
1. Emerging and re-emerging diseases, antimicrobial resistance, climate change, food and water access and sustainability
2. Needs of immigrant, refugee, and stateless populations
3. Impacts of natural disasters
4. Impacts of political and social disruptions
5. Impact of trade and travel on disease spread and access to care
6. Global supply chains and impact on medication, vaccine, and personal protective equipment (PPE) availability and cost
7. Cultural exchange and health behaviors influenced by global media and norms
D. Effects of pandemics and post-pandemic health
1. Emerging and re-emerging diseases
2. Risk, impacts, and mitigation
3. Effects of pandemic interventions, isolation, and quarantine on physical and mental health
4. Long-term effects on health
5. Government and health system resource allocation for prevention and preparation
6. Role of media, trust, and public health communication
7. Vaccine development and equitable distribution

Domain 6: Cultural Dimensions of Practice

A. Cultural considerations in the delivery of health services
1. Cross-cultural care
2. Culture of communities, institutions, health care professionals, and patients
3. Attitudes, beliefs, and assumptions influencing patient care
4. Personal identity and recognition of strengths and limitations in cross-cultural understanding
5. Patient-health professional racial and ethnic concordance based on patient preference and availability
6. Cultural considerations in interprofessional education and training
7. Effective use of interpreters and translation services
B. Cultural influences on individuals and communities
1. Attitudes toward health care, cultural and health-related beliefs
2. Social identities of the individual
3. Language and communication
C. Interpersonal and community interactions
1. Effects of culture on health professional-community relationships
2. Patient- and community-centered care
3. Factors contributing to unequal treatment, bias, or stereotyping in health care and educational settings

Domain 7: Emergency Preparedness and Response Systems

A. Preparedness and response systems
1. Role of incident command and unified command systems
2. Roles of Epidemic Intelligence Service (EIS) and U.S. Public Health Service
3. Coordination among emergency medical services (EMS), public health, hospital, health care professional, and community partners
B. Health system workforce readiness
1. Defined functions of individuals and organizations within the health care system
2. Functions of state and local health departments and public health laboratories
3. Community and individual resilience in response and recovery
4. Protection of vulnerable populations in emergency planning
5. Methods of timely and effective emergency communications and coordination
6. Safety of public health officials and health care workers