The PHHS Division mission is to proactively intervene at the earliest possible opportunity in community, emergency department, and other healthcare settings to improve health for the most at-risk populations through screening, surveillance, behavioral intervention, and linkage to needed care and services.

The UC Department of Emergency Medicine was an early pioneer in operationalizing the potential role emergency medicine can play in proactively improving the health of populations rather than simply reacting to the acute disease states of individual patients. Much of this work was honored with the recent receipt of the SAEM Public Health Leadership Award by Associate Professor of Emergency Medicine, Dr. Michael Lyons.

The first initiative in what has now become the Division of Population Health and Health Services (PHHS) began in 1998 with the launch of the Early Intervention Program (EIP). In the more than two decades since, the PHHS division has grown substantially with funding from a variety of public health, foundation, community, healthcare, and research organizations.

Those most at-risk for preventable adverse outcomes are most likely to interact with the emergency department compared to other points of access in least likely to interact with the traditional health system. Unlike expensive and labor intensive outreach to intervene in the community, EDs passively receive target populations in a medical setting where there is a ready opportunity for interaction and attempted intervention. EDs are a key component of the health care safety net, routinely encountering millions of people from every background, socioeconomic group, and health status. Patients often accept preventive services and value counseling during emergency visits, even when different from their immediate motivation for seeking emergency care.

• EDs already perform some prevention services such as tetanus immunizations.

• EDs are often the only source of prevention services for a highly vulnerable population without other health care access. Simply using the ED correlates with lack of some preventive services.

• Unexpected circumstances leading to ED encounters often constitute a teachable moment, potentially making prevention interventions even more effective than they would be in other settings. Several ED interventions targeted at high-risk populations have been shown to be effective.

• Unmet prevention needs will result in more ED visits of even higher acuity.

Several other factors are important to consider in addition to the many conditions amenable to primary and secondary prevention intervention in the ED:

1. In the expansive view of the PHHS division, emergency medicine can integrate with community and other healthcare settings to prevent the need for a future ED visit just as public health agencies and other healthcare providers can work to prevent the need for a future ED visit.

2. The increasingly recognized role of EDs in contributing to epidemiology and surveillance

3. The importance of social determinants of health before and after the ED encounter that impact outcomes even more so than ED intervention

4. The need for rigorous and comprehensive outcomes evaluation to prioritize, optimize, implement, scale, and advocate potential interventions