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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.

In mid-2012, the Polk County Health Department initiated a community health needs assessment process with the 3 medical centers serving this rural Wisconsin county of 45 000 residents. The collaborative process drew on primary and secondary data, including clinical data pooled from health care organizations, to assess population health. Community health assessment ultimately engaged more than 1800 county residents through coordinated surveys and community forums. Although the Polk County Health Department has a long history of collaboration with the local health care community, the Patient Protection and Affordable Care Act, coupled with meaningful use requirements for health care providers, sharply increased engagement, contributed to shared priorities, and brought this relationship to a new level. Partners have now convened community-based workgroups around the top 3 health focus areas selected from the assessment process. Community health assessment emphasized the social determinants of health as a step toward a more "upstream" orientation to population health goals.