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Clinic and Community: The Road to Integration.

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  • 1University of Michigan School of Public Health, Ann Arbor, Michigan.

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Integrating clinical and community systems is crucial for addressing health inequities. Demonstration projects showed that changes in clinic and community policies, alongside new linking mechanisms, were key to successful integration.

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Area of Science:

  • Public Health
  • Health Systems Research
  • Community Health

Background:

  • Growing recognition of social and environmental determinants of health.
  • Need for interaction between clinical providers and community systems.
  • Kresge Foundation's Safety Net Enhancement Initiative funded projects in vulnerable communities.

Purpose of the Study:

  • To analyze integration efforts between clinical and community systems.
  • To identify common features and steps for successful integration.
  • To address health inequities through system linkage.

Main Methods:

  • Qualitative analysis of integration efforts from 2011-2013.
  • Analysis of steps taken by demonstration sites over a 3-year period.
  • Focus on within-site and between-site integration.

Main Results:

  • Increased clinical capacity through policy/practice changes and onsite services.
  • Expanded definition of health by clinical providers.
  • Successful changes in clinic and community policies and practices.
  • Creation of mechanisms linking community resources to clinical systems.

Conclusions:

  • Clinical systems require shifts in perspective, behavior, and administration for integration.
  • Community systems need internal and inter-organizational changes for integration.
  • Effective coordination between clinical and community environments is essential.