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Objectives: Interest is increasing in collaborations between public health and primary care to address the health of a community. Although the understanding of how these collaborations work is growing, little is known about the barriers facing these partners at the local level. The objective of this study was to identify barriers to collaboration between primary care and public health at the local level in 4 states. Methods: The study team, which comprised 12 representatives of Practice-Based Research Networks (networks of practitioners interested in conducting research in practice-based settings), identified 40 key informants from the public health and primary care fields in Colorado, Minnesota, Washington State, and Wisconsin. The key informants participated in standardized, semistructured telephone interviews with 8 study team members in 2014 and 2015. Interviews were audio recorded and transcribed verbatim. We analyzed key themes and subthemes by drawing on grounded theory. Results: Primary care and public health participants identified similar barriers to collaboration. Barriers at the institutional level included the challenges of the primary care environment, in which providers feel overwhelmed and resources are tight; the need for systems change; a lack of partnership; and geographic challenges. Barriers to collaboration included mutual awareness, communication, data sharing, capacity, lack of resources, and prioritization of resources. Conclusions: Some barriers to collaboration (eg, changes to health care billing, demands on provider time) require systems change to overcome, whereas others (eg, a lack of shared priorities and mutual awareness) could be addressed through educational approaches, without adding resources or making a systemic change. Overcoming these common barriers may lead to more effective collaboration. [ABSTRACT FROM AUTHOR]

Introduction: This practice-based research study capitalized on the statewide implementation of a comprehensive, locally-driven initiative to implement evidence-based policy, system and environmental changes related to obesity and tobacco use. The study examined local health department (LHD) performance and factors such as organizational quality improvement (QI) maturity, structure and governance. Methods: State health department staff reviewed grant reports and documentation pertaining to all LHD grantees, which collectively represented all 87 counties and 4 cities in Minnesota (MN), in order to designate grantees as either: "Exceeds Expectations," "Meets Expectations" or "Approaching Expectations." A study team of state, local and academic partners then used select measures from the QI Maturity Tool to calculate a QI Maturity Score, and subsequently place grantees into three levels of QI maturity: low, medium and high. Multivariate regression was performed to examine the potential relationship between grantee performance and QI maturity, as well as other covariates. Results: Of the final sample of 91 counties/cities, 87 had complete data for multivariate analysis. The distribution of grantee performance was: exceeds expectations (29.7%), meets expectations (55.0%) and approaching expectations (15.3%). Organizational QI maturity was strongly, positively associated with grantee performance comparing the "exceeds expectations" to those who "met or approached expectations" (OR=4.29, 95 % CI: 1.90-9.73, p=0.0005). Implications: Organizational QI maturity was strongly associated with LHD performance. More research is needed to determine whether a more mature approach to quality improvement is merely a marker for overall LHD capacity or has its own unique contribution to performance. Findings have been used to inform the next funding cycle of this initiative and provide support to implementing annual assessment of QI maturity in MN. [ABSTRACT FROM AUTHOR]