Clinical and community delivery systems for preventive care: an integration framework

Area of Science:

• Public Health
• Health Services Research
• Preventive Medicine

Background:

• Clinical preventive services (CPS) are crucial for reducing morbidity and mortality but are underutilized in the US, creating a significant
• prevention gap.
• Current delivery of CPS is often uncoordinated between clinical and community settings, leading to inefficiencies and reduced benefits.

Purpose of the Study:

• To develop a framework for fully integrating CPS delivery across clinical and community care systems.
• To identify essential stakeholders, infrastructure, and policies needed for successful integration.

Main Methods:

• A comprehensive literature review.
• Semi-structured interviews with 50 national experts.
• Field observations of 53 successful programs.
• A national stakeholder meeting.

Main Results:

• A framework for clinical-community integration of CPS was developed.
• Key stakeholders include clinicians, community organizations, spanning personnel, leadership, and funders.
• Successful integration requires spanning personnel and infrastructure to connect clinical and community settings and aid patient navigation.

Conclusions:

• Integrating clinical and community preventive services is essential to close the prevention gap.
• Successful integration requires collaboration among diverse stakeholders and supportive policies.
• While challenging, establishing effective clinical-community integrations is feasible, leveraging existing models and addressing financing and sustainability.