title: Health care system collaboration to address chronic diseases: a nationwide snapshot from state public health practitioners.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Prevention Research Center in St Louis, Brown School, Washington University in St Louis, 621 Skinker Blvd, St Louis, MO 63130-4838. E-mail: lindsayelliott@brownschool.wustl.edu.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Elliott
authors.affiliation: Brown School, Washington University in St Louis, St Louis, Missouri.
authors.forename: Timothy D
authors.initials: TD
authors.lastname: McBride
authors.affiliation: Brown School, Washington University in St Louis, St Louis, Missouri.
authors.forename: Peg
authors.initials: P
authors.lastname: Allen
authors.affiliation: Brown School, Washington University in St Louis, St Louis, Missouri.
authors.forename: Rebekah R
authors.initials: RR
authors.lastname: Jacob
authors.affiliation: University of Mississippi Medical Center, Jackson, Mississippi.
authors.forename: Ellen
authors.initials: E
authors.lastname: Jones
authors.affiliation: Canadian Partnership Against Cancer, Toronto, Ontario.
authors.forename: Jon
authors.initials: J
authors.lastname: Kerner
authors.affiliation: Brown School, Washington University in St Louis, St Louis, Missouri.
authors.forename: Ross C
authors.initials: RC
authors.lastname: Brownson
mesh_terms: D000328:Adult; D002908:Chronic Disease / Q000628:therapy*; D018672:Community Health Planning; D003299:Cooperative Behavior; D003657:Decision Making; D055317:Evidence-Based Practice / Q000193:education; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011322:Primary Prevention; D015980:Public Health Practice; D036301:Qualitative Research; D057566:Self Report; D012959:Socioeconomic Factors; D013219:State Government; D011795:Surveys and Questionnaires; D020340:Tobacco Use Cessation; D014481:United States; D055815:Young Adult