Public Health-Primary Care Collaboration Study

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1 Public Health-Primary Care Collaboration Study Minnesota Local Public Health Association April 21, 2016 HEALTH PARTNERSHIPS DIVISION

2 Practice-Based Research PH practice leaders Academic researchers Practice-based research networks (PBRNs) study the effectiveness, efficiency & equity of public health and other sector (e.g., health care) strategies in real-world practice settings. 2

3 MN Research to Action Network Minnesota Local Public Health Association Renee Frauendienst Karen Jorgensen-Royce Katherine Mackedanz SCHSAC Lowell Johnson Rosemary Schultz 3

4 MN Research to Action Network University of Minnesota Rebecca Wurtz, School of Public Health Rebekah Pratt, Family Medicine & Community Health Minnesota Department of Health Kim Gearin Beth Gyllstrom Chelsie Huntley Kerri Sawyer 4

5 Public Health-Primary Care Collaboration Study Partnership between public health and primary care practice-based research networks across four states: MN, CO, WA, and WI Conducted interviews with 20 pairs of public health and primary care respondents at local jurisdiction level Online survey across all local jurisdictions All results show represent % strongly agree/agree unless otherwise noted 5

6 Survey Results Public Health: 80% (n=193 jurisdictions) Primary Care: Overall: 31% (n=128) Jurisdiction-Specific*: 50% *Primary care survey oversampled jurisdictions to increase overall jurisdiction-specific response rate. 6

7 Ways of Working Together Response Options PH PC Respond to immediate events (e.g., outbreak, crisis) 95% 57% Work together on specific clients 77% 50% Come together for meetings/conferences/committees Project-specific work, such as CHNA or strategic planning 80% 45% 80% 37% Quality improvement initiatives 17% 23% Ongoing, long-term working relationship 69% 41% 7

8 Reasons for Working Together Response Options PH PC Improve population health in community 95% 79% Good PH practice (PH Only) 91% n/a Engage more stakeholders in work 81% 31% Improve individual patient care 79% 59% Meet specific program requirements or mandates 60% 38% Extend population/demographic reach 53% 36% Build more credibility in community 50% 18% Share costs & maximize resources 44% 29% 8

9 Foundational Characteristics Key factors establish a solid foundation for the relationship. Examples include: aligned leadership; shared vision; mutual knowledge, trust and respect; and basic communication. General agreement between PC and PH that foundational characteristics present. 9

10 Mutual Trust and Respect 82% 73% 95% 79% Public Health Primary Care Relationship of mutual trust exists Opinions and recommendations respected 10

11 Leadership Support 64% 63% 49% 38% Public Health Primary Care Decision-makers committed to and supportive of working together Decision-makers take a lead role to direct how to work together 11

12 Energizing Characteristics These factors are more dynamic and actionoriented. Examples include: joint strategic planning; data sharing; dedicated funding and FTE; formal structures in place (e.g. MOU, grant contracts); and confidence in sustainability. Both PC and PH respondents less likely to agree that current relationships feature these energizing factors. 12

13 Relationship-Building Public health more likely to report that staff are knowledgeable about how to build and support the working relationship higher capacity in this area 81% 41% Public Health Primary Care 13

14 Relationship-Building 41% Public Health Primary Care 28% 24% 18% Collaboration roles/responsibilities well-defined Adequate FTE dedicated to support work together 14

15 Sustainability 69% 45% Public Health Primary Care 10% 9% Adequate financial resources secured to support joint work Believe relationship will carry on even with staff or funding changes 15

16 Current Working Relationship Consistently/Frequently Work Together Satisfaction With Working Relationship 59% 54% 41% 26% PH PC PH PC 16

17 Discussion Breakout #1 How do these findings fit with your experiences? Are we satisfied with these findings? What could encourage/support more mutuallybeneficial outcomes? 17

18 Collaboration Framework Low Foundation/High Action High Foundation/High Action Energizing Characteristics Low Foundation/Low Action Lack partnership basics Lack project- or program-specific interactions No dedicated staffing or financial commitment Land of Opportunity High Foundation/Low Action Foundational Characteristics 18

19 Collaboration Framework Energizing Characteristics Low Foundation/High Action Come together on specific project or to address crisis Formal structures to support work Leadership strongly directs work Lack partnership elements that contribute to ongoing work together Jurisdictions have higher levels of acting together, but weak partnership foundation Low Foundation/Low Action Lack partnership basics Lack project- or program-specific interactions No dedicated staffing or financial commitment Land of Opportunity High Foundation/High Action High Foundation/Low Action Foundational Characteristics 19

20 Collaboration Framework Energizing Characteristics Low Foundation/High Action Come together on specific project or to address crisis Formal structures to support work Leadership strongly directs work Lack partnership elements that contribute to ongoing work together Jurisdictions have higher levels of acting together, but weak partnership foundation Low Foundation/Low Action Lack partnership basics Lack project- or program-specific interactions No dedicated staffing or financial commitment Land of Opportunity High Foundation/High Action High Foundation/Low Action Partnership elements: shared vision, mutual trust & respect, value Committed leadership Lack tangible ways to work together (e.g., projects or program-specific interactions) Strong partnership foundation, though limited action actually working together Foundational Characteristics 20

21 Collaboration Framework Energizing Characteristics Low Foundation/High Action Come together on specific project or to address crisis Formal structures to support work Leadership strongly directs work Lack partnership elements that contribute to ongoing work together Jurisdictions have higher levels of acting together, but weak partnership foundation Low Foundation/Low Action Lack partnership basics Lack project- or program-specific interactions No dedicated staffing or financial commitment Land of Opportunity High Foundation/High Action Partnership elements: shared vision, mutual trust & respect, value Committed leadership that takes strong role directing work Formal structures to support work Ongoing working relationship The Promised Land High Foundation/Low Action Partnership elements: shared vision, mutual trust & respect, value Committed leadership Lack tangible ways to work together (e.g., projects or program-specific interactions) Strong partnership foundation, though limited action actually working together Foundational Characteristics 21

22 PH/PC Jurisdiction Distribution Low Foundation/High Action High Foundation/High Action Energizing Characteristics 10% (n=20) Jurisdictions have higher levels of acting together, but weak partnership foundation Low Foundation/Low Action 42% (n=80) Land of Opportunity 37% (n=71) The Promised Land High Foundation/Low Action Foundational Characteristics 11% (n=22) Strong partnership foundation, though limited action actually working together 22

23 Discussion Breakout #2 Overall reaction to the framework how does this fit or resonate with your experience? How might these results and the framework help inform your future work with primary care? What is needed to achieve the highest quadrant and maintain that position? 23

24 Acknowledgements The Minnesota Department of Health is a grantee of Public Health Services and Systems Research (PHSSR), a national program of the Robert Wood Johnson Foundation. This research would not be possible without the local PH directors and local clinic medical directors & staff who participated in the interviews & surveys, as well as all who participate on their practice-based research networks and have provided guidance on the implementation of this study. HEALTH PARTNERSHIPS DIVISION 24

25 Study Team Members The following are members of the study team: Beth Gyllstrom, Principal Investigator (MN), Rebekah Pratt, Co-PI (MN), Laura-Mae Baldwin (WA), Betty Bekemeier (WA), Kim Gearin (MN), David Hahn (WI), Tracy Mrachek (WI), Don Nease (CO), Kevin Peterson (MN) Lisa Van Raemdonck (CO), and Susan Zahner (WI). HEALTH PARTNERSHIPS DIVISION 25

26 For More Information Minnesota Research to Action Network: Research Findings: Search for: Measuring Variation in the Integration of Primary Care and Public Health: A Multi-State PBRN Study of Local Integration and Health Outcomes Renee Frauendienst Beth Gyllstrom Kim Gearin

Local Public Health and Primary Care Collaboration: A Practice-Based Approach

Bridging Health and Health Care Local Public Health and Primary Care Collaboration: A Practice-Based Approach Research In Progress Webinar Wednesday, July 13, 2016 12:00-1:00pm ET/ 9:00-10:00am PT 1 Title