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Measuring Local Public Health and Primary Care Collaboration

A Practice-Based Research Approach

Gyllstrom, Elizabeth, PhD, MPH; Gearin, Kimberly, PhD; Nease, Donald Jr, MD; Bekemeier, Betty, PhD, MPH, FAAN; Pratt, Rebekah, PhD

Journal of Public Health Management and Practice: July/August 2019 - Volume 25 - Issue 4 - p 382–389
doi: 10.1097/PHH.0000000000000809
Research Reports: Research Full Report

Objective: To describe the degree of public health and primary care collaboration at the local level and develop a model framework of collaboration, the Community Collaboration Health Model (CCHM).

Design: Mixed-methods, cross-sectional surveys, and semistructured, key informant interviews.

Setting: All local health jurisdictions in Colorado, Minnesota, Washington, and Wisconsin.

Participants: Leaders from each jurisdiction were identified to describe local collaboration. Eighty percent of local health directors completed our survey (n = 193), representing 80% of jurisdictions. The parallel primary care survey had a 31% response rate (n = 128), representing 50% of jurisdictions. Twenty pairs of local health directors and primary care leaders participated in key informant interviews.

Main Outcome Measure(s): Thirty-seven percent of jurisdictions were classified as having strong foundational and energizing characteristics in the model. Ten percent displayed high energizing/low foundational characteristics, 11% had high foundational/low energizing characteristics, and 42% of jurisdictions were low on both.

Results: Respondents reported wide variation in relationship factors. They generally agreed that foundational characteristics were present in current working relationships but were less likely to agree that relationships had factors promoting sustainability or innovation.

Conclusions: Both sectors valued working together in principle, yet few did. Identifying shared priorities and achieving tangible benefits may be critical to realizing sustained relationships resulting in population health improvement. Our study reveals broad variation in experiences among local jurisdictions in our sample. Tools, such as the CCHM, and technical assistance may be helpful to support advancing collaboration. Dedicated funding, reimbursement redesign, improved data systems, and data sharing capability are key components of promoting collaboration. Yet, even in the absence of new reimbursement models or funding mechanisms, there are steps leaders can take to build and sustain their relationships. The self-assessment tool and the CCHM can identify opportunities for improving collaboration and link practitioners to strategies.

Center for Public Health Practice, Minnesota Department of Health, St Paul, Minnesota (Drs Gyllstrom and Gearin); Department of Family Medicine, University of Colorado, Aurora, Colorado (Dr Nease); Department of Psychosocial and Community Health, School of Nursing, University of Washington, Seattle, Washington (Dr Bekemeier); and Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota (Dr Pratt).

Correspondence: Elizabeth Gyllstrom, PhD, MPH, Minnesota Department of Health, 625 Robert St N, PO Box 64975, St Paul, MN 55164 (

On behalf of the Local Primary Care-Public Health Study Group; the following of whom are members: Beth Gyllstrom, Principal Investigator (Minnesota); Rebekah Pratt, Co-Principal Investigator (Minnesota); Laura-Mae Baldwin (Washington); Betty Bekemeier (Washington); Kim Gearin (Minnesota); David Hahn (Wisconsin); Tracy Mrochek (Wisconsin); Kevin Peterson (Minnesota); Don Nease (Colorado); Lisa Van Raemdonck (Colorado); and Susan Zahner (Wisconsin).

Funding for this study was provided by the Robert Wood Johnson Foundation (RWJF), Award #71270. The authors gratefully acknowledge the Public Health Practice-Based Research Networks (PBRN) program and National Coordinating Center for PHSSR and PBRNs. This research would not be possible without the local public health directors and local clinic leadership who participated in the study, as well as all those who participate on their PBRNs and have provided guidance on the implementation of the study.

RWJF was not involved in the study design, collection, analysis and interpretation of the data, writing of the report, or the decision to submit this report for publication. The views expressed here do not necessarily reflect the views of the Foundation.

There are no other potential conflicts of interest for the authors.

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