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Abstract and Introduction
Abstract
Introduction Until recently, health care systems in the United States often lacked a unified approach to prevent and manage chronic disease. Recent efforts have been made to close this gap through various calls for increased collaboration between public health and health care systems to better coordinate provision of services and programs. Currently, the extent to which the public health workforce has responded is relatively unknown. The objective of this study is to explore health care system collaboration efforts and activities among a population-based sample of state public health practitioners.
Methods During spring 2013, a national survey was administered to state-level chronic disease public health practitioners. Respondents were asked to indicate whether or not they collaborate with health care systems. Those who reported "yes" were asked to indicate all topic areas in which they collaborate and provide qualitative examples of their collaborative work.
Results A total of 759 respondents (84%) reported collaboration. Common topics of collaboration activities were tobacco, cardiovascular health, and cancer screening. More client-oriented interventions than system-wide interventions were found in the qualitative examples provided. Respondents who collaborated were also more likely to use the Community Guide, use evidence-based decision making, and work in program areas that involved secondary, rather than primary, prevention.
Conclusion The study findings indicate a need for greater guidance on collaboration efforts that involve system-wide and cross-system interventions. Tools such as the Community Guide and evidence-based training courses may be useful in providing such guidance.
Introduction
Effective prevention and management of chronic conditions is a high priority — chronic disease affects nearly 1 in 2 adults in the United States and accounts for 75% of our nation's health care costs. Efforts to reduce the burden of chronic disease have been fragmented, with different health care systems working independently to achieve outcomes.
Increased collaboration among different health care systems to prevent and manage chronic diseases has been recently prioritized. In 2012, for example, the Institute of Medicine (IOM) published a national report, Primary Care and Public Health: Exploring Integration to Improve Population Health, which recognized need and identified opportunities for health care to improve population health. The Patient Protection and Affordable Care Act (ACA) emerged in the IOM's report as a key vehicle for health systems to achieve increased collaboration.
The Centers for Disease Control and Prevention (CDC) and the Public Health Accreditation Board (PHAB) have reinforced the vision for more unified chronic disease approaches across health care systems. Two of CDC's 4 key chronic disease practice domains call on public health to improve the services provided by health care systems. Health care system collaboration is now required by PHAB for health departments' accreditation, and the movement toward collaborative chronic care continues to grow.
However, despite the growing emphasis on these issues, few data are available on how the public health workforce has responded to the call for greater collaboration. The objective of our study is to bridge this gap by using a mixed methods study with 2 goals: 1) to explore the patterns and correlates of public health's collaboration with health care systems from the perspective of state public health practitioners, and 2) to compare practitioners' collaborations with those recommended by CDC.
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